Acetaminophen Overdose |
- Initial phase: Nausea, vomiting, anorexia
- Right upper quadrant pain (liver toxicity due to hepatocellular damage)
- Jaundice, confusion, and altered mental status in severe cases (hepatic failure)
- Prolonged bleeding time (due to liver dysfunction)
- Can progress to multi-organ failure if untreated
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- Serum acetaminophen levels (peak levels 4 hours post-ingestion)
- Liver function tests (LFTs) showing elevated ALT, AST, and bilirubin
- Coagulation profile: prolonged PT/INR indicating liver dysfunction
- ABG for metabolic acidosis (in severe cases)
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- Administer N-acetylcysteine (NAC), ideally within 8-10 hours of ingestion
- Monitor liver and renal function throughout treatment
- Symptomatic treatment for nausea and pain
- In severe cases, consider liver transplantation if hepatic failure occurs
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Tricyclic Antidepressant (TCA) Overdose |
- Anticholinergic effects: Dry mouth, blurred vision, urinary retention, constipation
- Cardiovascular toxicity: Tachycardia, prolonged QT interval, and arrhythmias (e.g., torsades de pointes)
- CNS depression: Coma, confusion, agitation, seizures
- Hypotension and respiratory depression in severe overdose
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- Clinical diagnosis based on symptoms and known TCA ingestion
- ECG: Prolonged QT interval and possible rightward axis deviation
- Serum TCA levels (if available) to assess severity
- Electrolyte panel, ABG, and renal function tests
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- Supportive care: IV fluids, monitoring of vital signs, and ECG monitoring
- Sodium bicarbonate to treat arrhythmias and correct acidosis
- Benzodiazepines for seizures and agitation
- Consider activated charcoal if ingestion was within 1-2 hours
- Intensive care monitoring for severe toxicity
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Paraquat Poisoning |
- Initial symptoms: Nausea, vomiting, and abdominal pain
- Respiratory distress: Dyspnea, hypoxia, and pulmonary edema
- Progressive multi-organ failure: Kidney, liver, and heart dysfunction
- Severe cases: Sepsis, shock, and death
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- Clinical diagnosis based on history of exposure (e.g., agricultural use)
- Chest X-ray: Pulmonary edema or fibrosis
- Serum paraquat levels, though not routinely available in all settings
- ABG to monitor respiratory function and acidosis
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- Activated charcoal if ingestion occurred within 1-2 hours
- Supportive care: Mechanical ventilation for respiratory failure
- IV fluids and renal support for kidney failure
- Consider plasma exchange or hemodialysis in severe cases
- Antioxidants (e.g., N-acetylcysteine) may be used in some cases
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Organophosphate Poisoning |
- Excessive salivation, lacrimation, urination, diarrhea, gastrointestinal cramps (SLUDGE)
- Muscle weakness, fasciculations, and respiratory failure
- Central nervous system symptoms: Headache, confusion, seizures
- Bradycardia, hypotension, and miosis (pinpoint pupils)
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- Clinical diagnosis based on symptoms and history of exposure (e.g., pesticide exposure)
- Serum cholinesterase levels (reduced in poisoning)
- Urinary toxicology screen for metabolites (if available)
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- Atropine to reverse muscarinic effects
- Pralidoxime (2-PAM) to reactivate acetylcholinesterase
- Supportive care: Oxygen, mechanical ventilation, and IV fluids
- Benzodiazepines for seizures
- Close monitoring in an ICU setting for severe toxicity
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Opioid Overdose |
- Respiratory depression, hypoventilation, or apnea
- Pinpoint pupils (miosis)
- Coma, altered mental status
- Bradycardia and hypotension
- Cold, clammy skin
- Possible cyanosis (due to hypoxia)
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- Clinical diagnosis based on symptoms and history of opioid use
- Serum opioid levels (if available)
- Arterial blood gas (ABG) for assessing respiratory acidosis
- Pulse oximetry to assess oxygen saturation
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- Immediate administration of naloxone (opioid antagonist) via IV, IM, or intranasal
- Provide respiratory support: oxygen and mechanical ventilation if needed
- Continuous monitoring, as naloxone may wear off before opioids
- Consider repeat doses of naloxone, especially with long-acting opioids
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Carbon Monoxide Poisoning |
- Headache, dizziness, and lightheadedness
- Confusion, lethargy, and difficulty concentrating
- Cherry-red skin color (in severe cases)
- Shortness of breath, chest pain
- Severe poisoning: arrhythmias, hypotension, and coma
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- Carboxyhemoglobin levels (confirm diagnosis)
- ABG: Decreased oxygen saturation and metabolic acidosis
- CT brain scan if neurological symptoms present (rule out stroke)
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- Administer 100% oxygen via non-rebreather mask to remove CO from hemoglobin
- Consider hyperbaric oxygen therapy (HBOT) for severe poisoning or high-risk patients (e.g., pregnant women, neurological symptoms)
- Supportive care: fluids, monitoring of oxygen saturation, and cardiovascular support
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Alcohol Poisoning |
- Respiratory depression and altered mental status
- Hypotension, hypothermia
- Gastric irritation, nausea, vomiting
- Hypoglycemia in severe cases
- Ataxia and slurred speech
- In severe cases: coma, seizures, and aspiration pneumonia
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- Clinical diagnosis, based on history of heavy alcohol consumption
- Blood alcohol concentration (BAC) to determine severity
- Electrolyte panel and blood glucose levels to identify abnormalities
- ABG for assessing acid-base status (metabolic acidosis or alkalosis)
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- Administer IV fluids to prevent dehydration and correct electrolyte imbalances
- Glucose administration if hypoglycemia is present
- Thiamine (B1) supplementation to prevent Wernicke's encephalopathy
- Supportive care for respiratory and cardiovascular function; consider intubation if necessary
- Monitor and treat for complications like hypothermia, hypotension, and arrhythmias
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Iron Overdose |
- Initial phase: Vomiting, diarrhea, abdominal pain, and lethargy
- Potential shock and metabolic acidosis after a few hours
- Liver failure and coagulopathy in severe cases
- Hypotension and tachycardia
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- Serum iron levels: elevated iron concentration
- ABG to assess metabolic acidosis
- Iron studies (TIBC, ferritin) to confirm overload
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- Administer activated charcoal if within 1 hour of ingestion
- IV deferoxamine (iron chelation) to bind excess iron
- Supportive care: fluids, vasopressors, and correction of acidosis
- Monitor and treat for shock, liver failure, and coagulopathy
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Snake Bites (Venomous) |
- Localized swelling, pain, and erythema at bite site
- Systemic symptoms: nausea, vomiting, weakness, sweating, and confusion
- Signs of coagulopathy (e.g., bleeding gums, bruising) in severe cases
- Possible hemolysis, hypotension, and shock
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- Clinical diagnosis based on the type of snake and bite site
- Serum venom levels or identification of venom by enzyme-linked immunosorbent assay (ELISA)
- Coagulation profile to assess bleeding risk
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- Administer antivenom specific to the snake species
- Supportive care: IV fluids, oxygen, and blood transfusion if required
- Monitor for signs of coagulopathy, renal failure, and respiratory distress
- Wound care and tetanus prophylaxis as necessary
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Beta-Blocker Overdose |
- Bradycardia, hypotension
- Fatigue, dizziness, confusion
- Cold extremities, wheezing (bronchospasm in asthmatic patients)
- Severe cases: Hypoglycemia, shock, and cardiac arrest
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- Clinical diagnosis based on history of beta-blocker use
- Serum beta-blocker levels (if available)
- ECG showing bradycardia and AV block
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- IV fluids and atropine for bradycardia
- Glucagon for severe bradycardia and hypotension
- Calcium salts (e.g., calcium gluconate) for severe toxicity
- Consider pacing for symptomatic bradycardia
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Calcium Channel Blocker (CCB) Overdose |
- Bradycardia, hypotension
- Fatigue, dizziness, confusion
- Syncope, heart block, and severe cases of cardiac arrest
- Hyperglycemia, pulmonary edema
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- Clinical diagnosis based on history of CCB use
- Serum calcium channel blocker levels (if available)
- ECG: Heart block, bradycardia, and prolonged PR interval
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- IV calcium gluconate to reverse toxicity
- Vasopressors for hypotension (e.g., norepinephrine)
- Glucagon for severe bradycardia
- Consider high-dose insulin therapy for inotropic support
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Digoxin Toxicity |
- Gastrointestinal symptoms: Nausea, vomiting, diarrhea
- Bradycardia, arrhythmias (e.g., AV block, ventricular arrhythmias)
- Visual disturbances (e.g., yellow-green halos, blurred vision)
- Confusion and lethargy in severe toxicity
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- Clinical diagnosis based on history of digoxin use
- Serum digoxin levels (therapeutic range: 0.5-2 ng/mL)
- ECG: Characteristic "scooped" ST segment and arrhythmias
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- Digoxin-specific antibody (ovine digoxin immune fab) for severe toxicity
- IV potassium for hypokalemia
- Activated charcoal if ingestion was recent
- Atropine for bradycardia
- Temporary pacing if heart block or severe arrhythmias
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