CICM SAQ 2010.2 Q29

Questions

A 16 year old female is admitted to the ICU following a multiple drug overdose.

a) Outline the role of activated charcoal in the management of drug overdose.
b) What are the complications of activated charcoal therapy?
c) When is dialysis utilised in toxic syndromes?
d) In the context of an overdose, list 3 drugs for which charcoal haemoperfusion may be useful.


Answers

Answer and interpretation

a) Outline the role of activated charcoal in the management of drug overdose.

  • Single dose activated charcoal is generally preferred method of decontamination but does not improve outcome when applied to unselected patients and should not be regarded as routine.
  • Indicated when likely that toxic agent is still within the GI tract (1st hour for most agents) and potential benefits outweigh risks.

b) What are the complications of activated charcoal therapy?

  • Vomiting
  • Pulmonary aspiration
  • Direct administration to lung via misplaced NG tube (potentially fatal)
  • Impaired absorption of oral medications / antidotes
  • Corneal abrasions
  • Constipation / bowel obstruction (MDAC)

c) When is dialysis utilised in toxic syndromes?

Best if drug is:

  • Water soluble
  • MW <500
  • Not highly protein bound Eg Lithium, Ethylene glycol, Salicylates, Na Valproate
  • Also good for correcting fluid and electrolyte abnormalities

d) In the context of an overdose, list 3 drugs for which charcoal haemoperfusion may be useful.

Common drugs

  • carbamazepine
  • theophylline
  • paraquat

Exams LITFL ACEM 700

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Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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