NSAIDs toxicity
NSAIDs are generally benign in overdose unless a large amount is ingested which would take some effort. As 66% of NSAID overdoses are with ibuprofen we will use this as an example.
Category Toxicants
Sulfonylurea toxicity
Hypoglycaemia can occur at therapeutic doses especially in those who develop renal impairment. In overdose these drugs cause a profound and prolonged hypoglycaemia, usually apparent within 8 hours post ingestion of a standard preparation.
Metformin toxicity
Metformin rarely causes hypoglycaemia but it can cause a profound lactic acidosis in overdose and in patients with renal failure.
Salicylate toxicity
Salicylates in acute overdose classically cause a respiratory alkalosis by stimulating the respiratory centres in the brain followed by a metabolic acidosis by uncoupling oxidative phosphorylation. The classic triad of mild toxicity is nausea, vomiting and tinnitus,
Tramadol toxicity
Tramadol in overdose would have the opiate toxidrome expected (sedation and respiratory depression) but it also can potentially cause seizures in doses >1.5 grams. Tramadol has also been associated with serotonin toxicity, rarely as a single agent but commonly with other co-ingested serotinergically active agents.
Insulin toxicity
While insulin overdose should be simple to manage this guide will show you some of the nuances to the management and help you prevent longterm neurological impairment.
Chloral Hydrate
Chloral hydrate is used in paediatrics undergoing procedures. It was withdrawn from the adult arena due to the narrow therapeutic index. In overdue it causes rapid CNS depression, cardiac dysrhythmias and these are lethal without prompt intervention.Chloral hydrate comes in 200ml bottles, 1g/10ml
Local Anaesthetic
Local Anaesthetic toxicity is nearly always due to a therapeutic error. Usually an incorrect dose, route or technique.
Methanol
Methanol has a long history of causing toxicity. Famously in prohibition when bootleg alcohol or moonshine was produced, unfortunately this is still a problem today with local brews in countries with poor regulations. It is commonly known to cause blindness but it also can be lethal, particularly if the patient has deliberately ingested methanol with a suicidal intent.
Isopropanol
Isopropanol (isopropyl alcohol) causes the same effects as ethanol but is more potent. Commonly found in hand sanitisers, disinfectants, solvents, window cleaners and perfumes. Classically it causes an elevated osmolar gap without an anion gap and the patient smells of acetone. Fortunately care is largely supportive.
Ethylene Glycol
Ethylene Glycol is lethal when >1 ml/kg is ingested therefore any deliberate ingestion need prompt intervention. Commonly found in radiator coolants, antifreeze (concentrations>20%), de-icing solutions, solvents and brake fluids. Unfortunately these products can taste sweet making them appealing to children.
Ethanol
We are all familiar with Ethanol and maybe some of us wouldn't have been conceived without it. However, in your tox patient it causes synergistic CNS depression and even on its own in large doses can be potentially lethal.