Acute digoxin toxicity classically presents with altered mental status, gastrointestinal symptoms (such as nausea, vomiting, and diarrhea), hyperkalemia, and bradydysrhythmias. Digoxin's primary mechanism is inhibition of the sodium-potassium ATPase pump which promotes sodium-calcium exchange, leading to an increase in intracellular calcium and subsequent increase in myocardial contractility. It is currently FDA approved for the management of mild to moderate heart failure and for control of ventricular response in patients with atrial fibrillation. Patients requiring emergent reversal may present with a variety of bleeding including gastrointestinal, intracranial, or bleeds due to trauma.ĭigoxin: Digoxin is one of the oldest cardiac medications with the use of cardiac glycosides dating back to ancient Egypt. The incidence of major hemorrhage increases by a factor of 1.43 for every 0.5 unit increase in INR. The annual risk of major bleeding in a patient on warfarin is estimated to be approximately 1 and 2%. As with all anticoagulants, major bleeding is a feared complication. Anticoagulation with warfarin requires frequent INR monitoring and often dose adjustments. With more than 30 million prescriptions annually, it is the most commonly prescribed oral anticoagulant in North America. Warfarin: Warfarin, a vitamin K antagonist, is a widely used anticoagulant that remains popular despite the introduction of new anticoagulants. Death is usually due to respiratory failure. The classic presentation of organophosphate poisoning includes vomiting, urination, lacrimation, salivation, defecation, diaphoresis, miosis, bradycardia, bronchorrhea, and bronchospasm. Organophosphates irreversibly inhibit acetylcholinesterase leading to a build-up of acetylcholine and stimulation of muscarinic receptors. However, poison control centers in the United States received only 4150 calls for organophosphate poisoning, only three of which resulted in death. For example, over 25000 people committed suicide with pesticides in India in 2010. Most of these deaths take place in the developing world where highly toxic pesticides are readily available and used to commit suicide. Organophosphates: Acute poisoning from organophosphates, usually in the form of insecticides, is possibly responsible for more drug-related deaths worldwide than any other drug class. Patients may go on to develop fulminant liver failure requiring a transplant or, if they survive Stage III, they enter a recovery stage (Stage IV - four days to two weeks post ingestion). Acute renal failure may also occur during this stage. During Stage III (72 to 96 hours after ingestion) nausea, vomiting, and malaise return and patients may also exhibit jaundice and confusion. There may also be hepatomegaly on physical exam. However, patients generally are asymptomatic during Stage II although they may develop some right upper quadrant pain and tenderness. Laboratory evidence of hepatotoxicity usually becomes evident by Stage II (24 to 72 hours after acute ingestion). There is a broad spectrum of overdose presentation depending on whether the intoxication is acute or chronic, the amount of acetaminophen ingested, and time since ingestion. In Stage 1 (0.5-24 hours after ingestion) patients may complain of nausea, vomiting, lethargy and general malaise. It is also the most common cause of acute liver failure (ALF) in the United States, accounting for 50% of all ALF cases. This activity reviews the evaluation and treatment of common overdoses, and highlights the role of the interprofessional team in evaluating and treating patients that have experienced an overdose.Īcetaminophen: Acetaminophen overdose is the most commonly reported overdose in both the UK and in the United States. This activity will focus on updating the health team on sixteen of the most common overdose presentations and their corresponding antidotes. Identifying the ingestion and prompt administration of the correct antidote can prevent significant morbidity and mortality for many patients. While for many overdoses and intoxications the treatment involves supportive care and treatment of the sequelae there are specific antidotes available for a variety of substances. In the United States in 2015 antidotes for various overdoses were used 184,742 times. With more than 2.4 million toxic exposures each year, poisoning is the second most common cause of injury-related morbidity and mortality in the United States. Overdoses and accidental ingestions or exposures are common throughout the world.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |