Reviewed and revised 24 May 2014 OVERVIEW MECHANISM OF ACTION TOXICOKINETICS RISK ASSESSMENT CLINICAL FEATURES Effects include: Complications INVESTIGATIONS (Guided by clinical assessment) Laboratory tests MANAGEMENT Resuscitation Supportive care and monitoring Decontamination Disposition References and Links Journal articles
Renal replacement therapy: Fluid Management
Ethanol (ethyl alcohol) is an aliphatic alcohol, C2H5OH. The primary effect of ethanol is CNS depression, which is additive with other CNS depressants
High-dose Insulin Euglycaemic Therapy (HIET) is primarily used in the therapy of severe calcium channel blocker toxicity. HIET can also be used for severe beta blocker toxicity and potentially other toxicities/ presentations requiring inotropic support
Sympathomimetic syndrome with potential for life-threatening vascular complications (ischemia, dissection and haemorrhage). Note: ecstasy is also associated with hyponatraemia
End-stage renal failure has multiple implications for ICU management
Fluid responsiveness is an increase of stroke volume of 10-15% after the patient receives 500 ml of crystalloid over 10-15 minutes (as defined by Paul Marik). The definitive test for fluid responsiveness is a Fluid challenge
Drug withdrawal in ICU is more common than generally appreciated.
Haemoperfusion: Renal replacement therapy (RRT) using an adsorbent cartridge to remove circulating toxins
Extracorporeal Elimination recommended for the following intoxications: methotrexate, procanamide, lithium, metformin, ethanol, methanol, ethylene glycol, salicylates, theophylline, sodium valproate.
The role for digestive tract decontamination depends on: severity of poisoning; time from ingestion; risk of intervention
A 26 year old woman describes sudden severe left iliac fossa pain late in the evening prior to presentation. On the morning of presentation she complained of bilateral shoulder tip pain and had a presyncopal episode on standing up. She is not pregnant.