Module 14- approach to suspected poisoning

ocular decontamination steps
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iv lipid emulsion is useful for?toxins with short half-life ie: ivermectin, permethrin, LAs, ibuprofen, cannabis should only use for severe toxicosis when other treatments are unsuccessfulparacetamol poisoning pathogenesisliver overwhelmed> accumulation of toxic metabolites and oxidative damage heinz body anemia chocolate blood dry eyeparacetamol poisoning clinical signs <24 hourscyanosis facial and paw oedema vomiting anemia tachycardia, tachypneoa, lethargyparacetamol poisoning clinical signs >24 hoursliver failure icterus seizures/coma renal failure haematuria/haemaglobinuriaparacetamol poisoning treatmentrecommended if over >10mg/kg cats and >100mg/kg dogs emetics is 1-2 hours post ingestion absorbents supportive care antidotesN-acetylcysteine - glutathione precursor S-adenosylmethionine (S-AME) Ascorbic acid (vit C) Cimetidine (dogs) - inhibits conversion to toxic metabolite are all antidotes to what?paracetamol poisoninmetaldehyde (snail pellets) poisoning clin. signs"Shake and bake"- hyper aesthesia, tremors, seizures, hyperthermiamethaldehyde poisoning treatmentemetics if asymptomatic and observe activated charcoal if seizures: diazepam, gastric lavage methocarbamol IVFT and nursing careAnticoagulent rodenticides pathogenesisblocks vitamin k activation 1-5 days before clin. signs appearanticoagulent rodenticides clinical signslethargy body cavity haemorrhage epistaxis gi bleed joint pain anaemiaanticoagulent rodenticides treatment- asymptomaticemesis, activated charcoal check coags 24, 48h, 72h if PT prolonged, treat with vitamin k1 (continue for up to 6 weeks)anticoagulent rodenticides treatment- symptomaticimmediate support- oxygen +/- transfusion vitamin k1anticoagulent rodenticides diagnosisprolonged prothrombin time (PT) occurs first platelets- normal or decreased PIVKA- proteins induced by vitamin k antagonism anemiaethylene glycol poisoning clinical signs<12 hours: neurological signs gi signs acidosis 12-24 hours cardiac/respiratory system affected 24-72 hours renal- azotaemia, anuria, hyperkalaemiaethylene glycol diagnosishistory/clin signs metabolic acidosis hypercalcaemia azotaemia calcium oxalate crystals in urine glycosuria/proteinuria "medullary rim sign"Ethylene glycol treatmentemetics not likely to be useful diazepam for seizures correct acidosis IVFT Antidotes if <12 hours20% Ethanol IV or stomach tube 4-Methylpyrazole (fomepizole) Less side effects Limited availibility are antidotes for what?ethylene glycol poisoningTheobromide (chocolate) poisoningseizures arrhytmias gi symptoms panting shakingtheobromide treatmentemesis activated charcoal IVFT continual ECG and seizure monitoring supraventricular tachycardia- beta blocker ventricular tachycardia- lidocaine symptomatic treatment of seizures and gi signsxylitol poisoning pathogenesisstimulates insulin release- hypoglycaemia, hypokalaemia, and hypophosphataemia can cause liver failurexylitol poisoning treatmentemesis before 30 minutes supportive care liver protectants S-AMERaison/Grape poisoning treatmentemesis & charcoal supportive care IVFT 48-72 hours