Description
Pill Poisoning in Urban Areas – A Case-Based Approach focuses on the rising incidence of intentional and accidental drug overdoses in city settings due to easy access to pharmaceuticals. This approach uses real-life scenarios to explore common agents involved—such as analgesics, antidepressants, and sedatives—and their clinical manifestations. It emphasizes early recognition, risk assessment, and evidence-based management including gastric decontamination, antidotes, and supportive care. The session also highlights the nurse's and physician's roles in patient monitoring, mental health evaluation, and preventive education. Case-based learning enhances practical decision-making in time-sensitive toxicological emergencies.
Summary Listen
- Paracetamol poisoning is a common toxicity that can lead to acute liver failure if a toxic dose is ingested. The therapeutic daily dose of paracetamol is up to 4 grams in adults, and exceeding this can cause toxic effects. A single ingestion of more than 10 grams in 24 hours is considered a toxic dose.
- Paracetamol is metabolized primarily through glucuronidation and sulfation, but a small percentage is converted to NAPQI, a toxic metabolite. Overdoses can deplete glutathione reserves, leading to NAPQI binding to liver cells and causing toxicity. This process damages the peri-central zone (Zone 3) of the liver the most.
- The Rumack-Matthew nomogram is used to assess hepatotoxicity risk based on serum paracetamol levels 4 hours post-ingestion. Levels above the treatment line necessitate acetylcysteine administration. However, it is ineffective for staggered dosing or IV paracetamol ingestion.
- Acetylcysteine is the antidote for paracetamol poisoning, administered intravenously over 21 hours. The treatment aims to maintain acetaminophen levels below 10, INR below 2, and normalization of ALT/AST levels. Liver transplantation is considered if the patient develops severe acidosis, coagulopathy, or encephalopathy.
- Benzodiazepines are commonly used for anxiety, insomnia, and seizure control. Overdoses cause sedation, ataxia, and respiratory depression. Flumazenil is a selective antagonist that can reverse the sedative effects of benzodiazepines but is contraindicated in patients with a history of seizures or co-ingestion of pro-convulsant drugs.
- Tricyclic antidepressants (TCAs) can cause life-threatening toxicity if ingested in large doses (more than 1 gram). TCA overdose leads to a combination of antihistaminic, anticholinergic, alpha-adrenergic blockade, serotonin reuptake inhibition, and sodium channel blockade.
- The diagnosis of TCA overdose relies on a history of exposure, clinical symptoms, and ECG findings, including QRS prolongation and abnormal QRS morphology. Treatment involves airway management, decontamination, and sodium bicarbonate to counteract sodium channel blockade.
- Toxic-drome recognition and bedside clinical assessments are crucial in guiding treatment before toxicology results are available. Recognizing common toxidromes can help narrow down the list of likely ingested substances and inform initial management strategies.
Sample Certificate
About the Speakers
Dr. Mohnish Tripathi
Consultant & Head Emergency and Trauma, Sarvodaya Healthcare, Greater Noida West
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