Downloaded 27 times
Uploaded byAbino David
Paracetamol and sedative overdosage
1. Paracetamol and barbiturate overdoses are common causes of acute liver failure and can be fatal at high doses. N-acetylcysteine treatment may help if given within 24 hours of ingestion. 2. Tricyclic antidepressant overdoses can cause seizures, cardiac toxicity, and serotonin syndrome due to their anticholinergic and sodium channel blocking effects. Treatment involves monitoring, sodium bicarbonate, and overdrive pacing or magnesium for cardiac issues. 3. Prompt supportive care including airway management and decontamination measures are important for managing overdoses of these common drugs to prevent complications and death.
More Related Content
Similar to Paracetamol and sedative overdosage
Paracetamol and sedative overdosage
- 1. PARACETAMOL & SEDATIVE OVERDOSAGE
- 2. OVERVIEW • Considered tobe a safe and cheap analgesic/anti-pyretic • OTC • One of the most common overdosed drugs worldwide • Most common cause of acute hepatic failure in the UK & US
- 3. OVERVIEW • Leading indicationfor hepatic transplantation in patients with drug induced liver disease • Single dose of 10- 15 G can produce clinical evidence of liver injury • Fatal fulminant liver failure is usually associated with a dosage of > 25 G
- 4. OVERVIEW • Blood levelsof > 30 micg/ml 4 hours after ingestion are predictive of severe hepatic disease • Levels < 15 micg/ ml are predictive of low risk • More risk of damage if liver is already damaged by infection (virus), alcohol or other illness
- 5. OVERVIEW • Available assuppositories- 120,125,325 & 650 mg • Chewtabs- 8 mg • Pedtabs - 16 mg • Regular tabs- 325 mg • Extra strong tabs- 500, 650, 1000 mg • Drops, suspension
- 6. OVERVIEW • Maximum permissibledaily dose : 4 g • Now has been reduced to 3 g
- 7. CLINICAL FEATURES • Nausea,vomiting, diarrhoea, abdo minal pain, shock- first 24 to 48 hours • Once these symptoms abate, features of hepatic injury appears. • Maximum derangement & hepatic failure occurs around day 6 • SGOT/PT maybe raised around 10000
- 8. CLINICAL FEATURES • Coma,convulsions, irritability, seizures • Renal failure • myocarditis
- 9. PROGNOSIS • Depends on •Quantity ingested • Timing of initiation of treatment • Pre-morbid health
- 10. TREATMENT • Supportive measures •Airway • Breathing circulation • Gastric lavage- oral administration of activated charcoal/ cholestyramine to prevent the absorbtion of the residual drug • Not useful if given > 3 min after ingestion
- 11. TREATMENT • Levels> 200micg/ml after 4h • Or 100 micg/ml after 8 hours are indications • Administration of sulfhydril compounds( cystamine, cysteine or NAC) reduces the severity of hepatic necrosis. • They work by acting as a reservoir of – SH groups that bind to the toxic metabolytes or stimulate the synthesis/ repletion of hepatic glutathione
- 12. TREATMENT • Must begiven within 8 hours and maybe effective upto as late as 24 to 36 hours • Dose of NAC- 140 mg/kg stat followed by 70 mg/kg Q4h for 15 to 20 doses • If evidence of hepatic failure occurs while on treatment with NAC, consider LT • Lactate levels > 3.5 mmol/L is a fair indicator of the need for LT
- 13. PREVENTION • Keep allmedications out of reach of children • Know the correct dosage • Never mix medicines containing acetaminophen with other drugs • Remove all medications out of reach of adults if there is a past/ family history of suicide/attempt • Avoid PCM in those who consume > 3 units of alcohol/day
- 14. BARBITURATE OVERDOSAGE • Earliestclass of hypnotic-sedatives to be developed • Marilyn Monroe & Judy Garland famous victims • Lethal dose varies according to individual tolerance (2-10 G is potentially fatal) • With other CNS depressants like alcohol,opiates or BZD, the severity of barbiturate overdosage is amplified. • Depresses CNS & respiration
- 15. BARBITURATE OVERDOSAGE • SIGNS & SYMPTOMS • Sluggishness, incoordination • Difficulty in thinking, slow speech • Faulty judgement, drowsiness • Shallow breathing, staggering • Apnea, hypoxia
- 16. BARBITURATE OVERDOSAGE • ARDS • Paranoia • Combativeness • Tachycardia, bradycardia, hypotension, Shock • Coma, death
- 17. BARBITURATE OVERDOSAGE • SIGNS • Hypothermia • Depressed pupillary reflex • Nystagmus • Squint • Supressed DTR
- 18. BARBITURATE OVERDOSAGE TREATMENT Supportive care/decontamination/Accelerate elimination Secure airway Endotracheal intubation- if depressed sensorium, respiratory failure, hypoxia, raised ICT O2 Venous access
- 19. BARBITURATE OVERDOSAGE • Naloxone2 mg. IV to all with depressed sensorium • Measure rectal temperature- rewarming measures • Pressors- noradrenaline, dopamine, fluids • Decontamination- activated charcoal 1G/kg Q6H • Cathartics, gastric lavage
- 20. BARBITURATE OVERDOSAGE Alkalinise urine Sodabicarb1 meq/kg folowed by continuous infuson Add 100- 150 meq of NaHco3 to 850 ml of D5 % Dialysis- hemofiltration preferred over HD Intravenous lipid emulsion (ILE) is emerging as an antidote
- 21. TRICYCLIC ANTIDEPRESSANTS • Oneof the most dangerous drugs • Anti-cholinergic and cardiac depressant properties(Quinidine like NA+ channel blockade) • Newer anti-depressants like sertraline, fluoxetine, fluvoxamine, citalopram, bupropion, trazodone, venlaflaxine etc. are structurally unrelated to TCAD and produce less cardiotoxicity
- 22. TRICYCLIC ANTIDEPRESSANTS • Theycan produce seizures & serotonin syndrome • S & S may occur abruptly in around 30-60 minutes • Anti-cholinergic effects- dilated pupils, tachycardia, dry mouth, flushed skin, fasciculations & reduced peristalsis
- 23. TRICYCLIC ANTIDEPRESSANTS • Cardiotoxicity-widens QRSc leading to ventricular arrhythmias, AV block, and hypotension • Prolonged QT – Venlaflaxine, Citalopram • Severe intoxication- coma, seizures especially Venlaflaxine & Bupropion • Hyperthermia- due to anticholinergic induced reduced sweating
- 24. TRICYCLIC ANTIDEPRESSANTS • Diagnosedby the combination of anticholinergic side effects & prolonged QRSc with seizures • Degree of widening of the QRSc corelates directly with the severity of intoxication rather than the drug levels • Serotonin syndrome- agitation, delirium, muscular hyperactivity, fever
- 25. TRICYCLIC ANTIDEPRESSANTS • TREATMENT •Observe all cases for atleast 6 hours • Admit all patients with anti-cholinergic effects or cardiotoxicity • Activated charcoal, gastric lavage • Cannot be removed by dialysis as they are highly tissue bound
- 26. TRICYCLIC ANTIDEPRESSANTS • SPECIFICTREATMENT • NAHCO3 50 to 10 meq IV- alleviates the NA – channel depressing effect • Maintain pH between 7.45- 7.50 • IV MG or overdrive pacing for long QT sy ndrome/Torsades de pointes • Serotonin syndrome- Benzodiazepines, cyproheptadine 4 mg P/O 3 to 4 doses
- 27. TRICYCLIC ANTIDEPRESSANTS • Severehyperthermia • neuromuscular paralysis • External cooling • intubation