2. 1) A patient is admitted in a hospital with the symptoms of delirium, dryness of
mouth, dilatation of the pupil, difficulty in swallowing, hyper pyrexia,
tachycardia and blurred vision. Urine sample shows the presence of alkaloid.
• Write the probable diagnosis and outline the management.
3. • It is a case of Belladona (Datura) Poisoning
Management : General & Specific
General
a) Gastric lavage with tannic acid
b) Patient kept in a dark quiet room
c) Airway breathing maintained
d) Volume replacement with fluids
e) Cold sponging to reduce body temperature
f) Artificial respiration if needed
g) Diazepam to control convulsions
Specific
Physostigmine 1-3mg
s.c (or) I.V
Antagonises both
central and peripheral
effects.
4. 2) A farmer is admitted in a hospital with the following clinical signs -
Excessive salivation, constricted pupil, spasm of accommodation , bradycardia,
vomiting, abdominal cramps, tenesmus, bronchospasm, pulmonary oedema
and involuntary twitchings.
• Write the probable diagnosis and outline the management.
5. • It is a case of Organophosphorus Poisoning (OPC)
General Management :
i) Termination of exposure to the poison: fresh air,
wash skin and mucous membrane with
soap and water, gastric lavage according to need
ii) Maintain patent airway, Positive pressure ventilation if it is failing
iii) Supportive measures – maintain BP, hydration, control of
convulsions with diazepam
6. OPC contd…
Specific antidotes:
a. Atropine → 2mg I.V repeated every 10min till
pupil dilates or till signs of atropinization appear.
It counteracts the muscarinic symptoms
b. Cholinesterase reactivators
→ Used to restore neuro muscular
transmission
→ Eg: Pralidoxime 1-2g I.V
→ Not useful in carbamate poisoning
7. 3) A Patient was brought to the hospital by a policeman with
1. Nausea, vomiting and abdominal pain with cramps 2. Head ache, dizziness and
vertigo 3. Muscular weakness 4. Depressed cardiac action (Bradycardia) 5.
Hypothermia 6. Dyspnoea and cyanosis 7. Pupils dilated 8. Photophobia, blurred
vision and sudden complete loss of vision. Later the patient went in to coma. His
breath smells illicit liquor. His urine is strongly acidic and contains traces of albumin.
• Write the probable diagnosis and outline the management.
8. • It is a case of Methanol Poisoning
• Management :
1. Keep the patient in a quiet dark room, protect the eyes from light
2. supportive measures to maintain ventilation and BP
3. Gastric lavage with sodium bicarbonate,
4. Sod. Bicarbonate I.V is used for acidosis, it also prevents retinal
damage
5. Potassium chloride given in case of hypokalemia
6. Ethanol 100mg / dl in blood saturates alcohol dehydrogenase and
retards methanol metabolism.
• Ethanol administered through NG tube loading dose– 0.7 ml/ kg
followed by 0.15ml / kg 1hour drip. Ethanol is not given I.V directly
9. 7. Haemodialysis – to clear toxic metabolites
8. Fomepizole → inhibits enzyme alcohol dehydrogenase and
retards methanol metabolism
Loading dose 15mg / kg I.V directly over 30 mins
Followed by 10mg /kg every 12 hours
Till serum methanol falls below 20mg / dl
9. Folate therapy: Calcium leucovorin 50 mg injected 6th hourly
reduces blood formate level
10. 4) A Patient was brought to the hospital with following symptoms. 1. Pin –
Point pupils 2. Respiratory depression 3. Cyanosis 4. Reduced urinary output
5. Hypotension 6. Shock & coma. Injection marks were seen over the forearm.
• Write the probable diagnosis and outline the management.
11. It is a case of opioid poisoning.
Eg: Heroin, Morphine, Methadone & Pethidine
Management –
a) Maintain Airway and provide respiratory support
b) Supplementary high flow oxygen is given
c) Positive pressure ventilation reduces pulmonary edema.
d) Maintenance of BP with i/v fluids and vasoconstrictors
12. e) Gastric lavage should be done with potassium permanganate to
remove unabsorbed drug.
Lavage is indicated even if the drug is injected because, Morpine being
a basic drug it is partitioned to the acid gastric juice, ionizes there and
does not diffuse back in to blood.
f) Specific antidote: Naloxone, an opiod antagonist bolus dose (0.4 -0.8
mg iv)repeated every 2min until the level of consciousness and
respiratory rate increase and pupils dilate. Bolus dose is followed by
infusion of naloxone.
g) Coma, convulsions and hypotension should be treated accordingly
13. 5) An adult female was brought to the casualty with h/o intake of 20 sleeping
tablets for suicidal attempt. The signs and symptoms were 1. Weakness
2.Prolongation of reaction time 3.Ataxia 4.Drowsiness 5.Hypotension
6.Unconsciousness 7. Respiratory depression
• Write the probable diagnosis and outline the management.
14. It is a case of Benzodiazepine Poisoning
Management
General measures:
• Patent Airway
• Maintain BP, cardiac and renal function with fluids/transfusion
• Gastric lavage with activated charcoal
Specific measures:
• Flumazenil 0.2mg/min. i/v till the patient regains consciousness.
(BZD poisoning patient alone responds within 5 min).
• Maintenance does of 0.1mg/min. until the patient is awake and
responsive
16. 6) A child was brought to the hospital with h/o excessive intake of tablets ( > 20
tablets), which was used by his mother for anaemia. The child presents with the
following signs and symptoms :Vomiting, abdominal pain, hemetemesis,
diarrhea, lethargy, cyanosis, dehydration, acidosis, convulsions, shock, CVS
collapse.
• Write the probable diagnosis and outline the management.
17. It is a case of iron Poisoning
To prevent further absorption of iron from gut
(a) Induce vomiting or perform gastric lavage with sodium bicarbonate
solution.
(b) Egg yolk and milk orally: to complex iron.
Activated charcoal does not adsorb iron.
To bind and remove iron already absorbed
Desferrioxamine is the drug of choice - Injected i.m. 0.5–1 g (50
mg/kg) repeated 4–12 hourly as required, or i.v. (if shock is present)
10–15 mg/kg/hour; max 75 mg/kg in a day till serum iron falls below
300 μg/dl.
Alternatively DTPA or calcium edetate may be used if desferrioxamine
is not available.
18. SUPPORTIVE MEASURES
• Fluid and electrolyte balance
• Acidosis corrected by appropriate i.v. infusion.
• Respiration and BP may need support.
• Diazepam i.v. used to control convulsions
19. 7) A patient was admitted to the emergency ward with history of abdominal
pain, nausea, vomiting, and anorexia. Patient then revealed h/o intake of
about 25 – 30 tablets which he used to take for fever. Investigation revealed
altered liver function tests
• Write the probable diagnosis and outline the management.
20. It is a case of PARACETAMOL POISONING
• SUPPORTIVE MEASURES
• Gastric lavage done
• Activated charcoal give orally or through NG tube to prevent further
absorption
• SPECIFIC ANTIDOTE
• N-acetylcysteine 150 mg / kg IV infused in 200ml 5% glucose solution
slowly over 15 minutes followed by the same dose over next 20 hours
• It replenishes the glutathione stores of liver and prevents binding of
toxic metabolite to other cellular constituents
21. 8) A 50 year old male patient who is a known case of Depression is admitted in
a hospital after drug overdose with the symptoms of Dryness of mouth,
tachycardia, flushed skin, muscle twitching and seizure. ECG showed - Wide
QRS interval, ↑ QT interval
• Write the probable diagnosis and outline the management.
22. • It is a case of TRICYCLIC ANTIDEPRESSENT POISONING:
• Symptomatic treatment only. No specific antidote.
• Gastric lavage with activated charcoal, adequate oxygenation, IV
fluids-To maintain BP,
• Sodium bicarbonate 50-80 ml IV –to correct acidosis
• Diazepam (5-10mg IV)-To treat convulsion
• Propranolol/lidocaine-To treat cardiac arrhythmia
• Physostigmine 2mg IV/30 minutes-To reverse anticholinergic side
effects.
• Dobutamine 0.5-1.5µg/kg/mt –treat hypotension
23. 9.A case of mitral stenosis with atrial fibrillation who is on treatment developed
the following symptoms. Hemoptysis, Epistaxis, Hematuria, Widespread
bruising and Joint swelling. Laboratory investigations showed ↑ Prothrombin
time
• Write the probable diagnosis and outline the management
24. It is a case of Warfarin toxicity
• Withhold the anticoagulant.
• Give fresh blood transfusion; this supplies clotting factors and
replenishes lost blood.
• Alternatively fresh frozen plasma may be used as a source of clotting
factors
Specific antidote:
Vitamin K1; but it takes 6–24 hours for the clotting factors to be
resynthesized and released in blood after Vit K administration
25. 10. A patient was admitted to the hospital with the following signs & symptoms
vomiting, delirium, acidotic breathing, hyperpyrexia, convulsion, coma after
consuming 20 tablets of a NSAID with antiplatelet action.
• Write the probable diagnosis and outline the management
26. It is a case of Salicylate (Aspirin) poisoning.
Management:
a. Symptomatic & supportive management only
b. Gastric lavage to remove unabsorbed drug
c. External cooling
d. I.v fluid with Na+, K+, HCO3
- & glucose
e. Alkaline diuresis or
f. Haemodialysis to remove absorbed drug.
g. Blood transfusion & Vit K ( if bleeding present).
