GENERAL APPROACH TO THE POISONED PATIENT - rEMERGs

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‣‣‣‣‣IronLithiumBody packersBody stuffersSlow release preparations ASA CCBs Valproic acidO<strong>THE</strong>R GI DECONTAMINATION Endoscopic removal: difficult to remove concretions and body packs; complications ofprocedure usually outweigh potential benefit; rarely indicated (very durable packs withbody packers) Surgical removal: rarely body packs causing bowel obstruction or intestinal ischemia Surgery post GI perforation after caustic ingestionsELIMINATION<strong>GENERAL</strong> Elimination = removal of toxin after it has been absorbed Indications‣ Patients who fail supportive care‣ Patients in whom the normal route of elimination is impaired (renal failure)‣ Patients in whom the toxin is expected to be very significant‣ Patients that are not expected to tolerate the physiologic effects Methods of Elimination‣ MDAC‣ Hemodialysis‣ Urine alkalinization‣ Peritoneal dialysis‣ Charcoal hemoperfusion‣ Hemofiltration‣ Plasmapheresis‣ Exchange transfusion‣ Diuresis‣ Chelation Ion Trapping = Urine Alkalinization‣ ASA‣ Barbituates‣ Formic acid (methanol): minor role‣ Methotrexate‣ Chlorpropamide (Diabenese - oral hypoglycemic)HEMODIALYSIS What are features of dialyzable drugs?‣ Low Vd‣ Low protein binding‣ Small molecular weights‣ Water soluble
‣ Single compartment kinetics‣ Low endogenous clearanceAdv of hemodialysis over other extracorporeal techniques‣ Corrects acid - base abnormalities‣ Corrects electrolyte abnormalities‣ Removes MORE drug than CRRT (continous hemofiltration)Toxins well removed by HEMODIALYSIS‣ Methanol‣ Ethylene Glycol‣ Isopropranol‣ ASA‣ Lithium‣ Valproic acid‣ TheophyllinDIALYZABLE OVERDOSESM MethanolE Ethylene GlycolT TheophyllineI IsopropranolV Valproic AcidA ASAL LithiumPossibly effective dialysis‣ Amanita mushroom toxin‣ Tegretol‣ BB: atenolol, sotalol‣ Paraquat‣ Phenytoin‣ Phenobarbital‣ Procainamide‣ Methotrexate
Page 1 and 2: GENERAL APPROACH TO THE POISONEDPAT
Page 3 and 4: TOXINS CAUSING SEIZURESCAPITCyclic
Page 5: -acrylic paints, glues, adhesives,
Page 8 and 9: TOXICOLOGICAL TESTS Immunoassays‣
Page 10 and 11: Include multiple different overd
Page 14 and 15: DIAGNOSTIC IMAGING AND TOXICOLOGYRA

GENERAL APPROACH TO THE POISONED PATIENT - rEMERGs

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