Management of the Poisoned
Patient
Over 1 million cases
of acute poisoning occur in the USA each year, although only a small number are
fatal. Most deaths are due to intentional suicidal overdose by an adolescent or
adult. Childhood deaths due to accidental ingestion of a drug or toxic
household product have been markedly reduced in the last 40 years as a result
of safety packaging and effective poisoning prevention education.
Even
with a serious exposure, poisoning is rarely fatal if the victim receives
prompt medical attention and good supportive care. Careful management of
respiratory failure, hypotension, seizures, and thermoregulatory disturbances
has resulted in improved survival of patients who reach the hospital alive.
A 62-year-old woman with a history of depression is found in her apartment in a lethargic state. An empty bottle of bupro-pion is on the bedside table. In the emergency department, she is unresponsive to verbal and painful stimuli. She has a brief generalized seizure, followed by a respiratory arrest. The emergency physician performs endotracheal intubation and administers a drug intravenously, followed by another substance via a nasogastric tube. The patient is admitted to the intensive care unit for continued supportive care and recovers the next morning. What drug might be used intravenously to prevent further seizures? What substance is commonly used to adsorb drugs still present in the gastrointestinal tract?
Overdose of bupropion
can cause seizures that are often recurrent or prolonged. Drug-induced seizures
are treated with an intravenous benzodiazepine such as lorazepam or diazepam.
If this is not effective, phenobarbital or anothermore efficacious central
nervous system depressant may be used. To prevent ingested drugs and poisons
from being absorbed systemically, a slurry of activated charcoal is often given
orally or by nasogastric tube.
Related Topics
Privacy Policy, Terms and Conditions, DMCA Policy and Compliant
Copyright © 2018-2023 BrainKart.com; All Rights Reserved. Developed by Therithal info, Chennai.