Bloods: usual bloods (FBC, U&Es, LFTs, INR, CRP, glucose) plus venous blood gas, urine tox screen if available, paracetamol level, and salicylate level if salicylism/βGCS/βanion gap
Osmolar gap (true measured serum osmolality β calculated serum osmolality (Na+x2 + urea + glucose)): if >10, something else is in system causing difference e.g. alcohols/glycols
Anion gap ((Na+ + K+) β (Cl- + HCO3-)): normal is 3-12, increases when a new acid has been added to body (e.g. a toxin which has been converted to an acid; lactate; ketoacids)
Common toxidromes
Management
General management
Activated charcoal (50g drink)
Can be given in overdoses <1 hour of ingestion (<4 hours if tricyclic) to reduce absorption of many orally ingested toxins
Only if patient can swallow properly (must have GCS 15)
NOT FOR: acids&alkalis, alcohols, metals, organic solvents
Supportive ABCDE-style management is the major part of management for most overdoses is continuous, supportive ABCDE-style management
A: recovery position, airway adjuncts
B: oxygen, treat hypoventilation
C: cardiac monitor, IV fluids to maintain BP, treat brady/tachycardias (bicarbonate for acidosis)
D: diazepam for seizures, treat hypo/hyperthermia
Control adverse effects e.g. seizures
Haemofiltration may be required (lithium, salicylate, ethanol, ethylene glycol, methanol)
Specific antidotes
A database (e.g. Toxbase) should be used to guide specific management (but examples for common overdoses are below)
Paracetamol β N-acetylcysteine
Morphine β Naloxone
Beta-blocker β Atropine, glucagon
Benzodiazepam β Flumazenil (NOT given for overdoses β risk of seizures)
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