Roth spots
Roth spots: Retinal haemorrhages with white or pale centres, commonly associated with subacute bacterial endocarditis and immune complex mediated vasculitis.
Bupropion toxicity
Bupropion is an antidepressant mainly used now for nicotine suppression. It comes as an extended release preparation 150 mg in Australian and New Zealand. In overdose it can cause seizures and cardiotoxicity however, good supportive care usually prevents any adverse outcome.
MAOI toxicity
Monoamine Oxidase inhibitors (MAOIs) come in different varieties and there is a little more to remember than just the interaction with cheese. The irreversible non-selective (MAO-A+B) are notorious for causing lethal serotonin toxicity in overdose, these include Phenelzine and Tranylcypromine.
Valproic Acid
Valproic acid (sodium valproate) in overdose results in CNS depression and large overdoses can result in multi-system organ failure and death. Chronic toxicity can cause life threatening hyperammonia and hepatotoxicity.
Phenytoin toxicity
Phenytoin intoxication can occur either with repeated supra therapeutic dosing or an acute overdose. Dose-dependent CNS depression occurs. Most presentations are benign and have good outcomes with supportive care. The main risk to patients is falling which can last days.
Newer Anticonvulsants
Overdose with newer anticonvulsant agents include: Gabapentin, Lamotrigine, Levetiracetam, Oxcarbazepine, Pregabalin, Tiagabine, Topiramate and Vigabatrin.
Carbamazepine toxicity
Carbamazepine overdose has a predictable dose-dependent CNS depression and anticholinergic effects. Carbamazepine if unique in the anticonvulsants that is also has sodium channel blocking effects and can act similarly in overdose to a tricyclic antidepressant and the role of sodium bicarbonate should be remembered.
Benzodiazepine toxicity
We discuss the management of benzodiazepine overdose including zopiclone and zolpidem as which carefully selected cases to use flumazenil. Benzodiazepines are a frequent presentation either as a single ingesting or in combination. With good supportive care prognosis is excellent.
Warfarin toxicity
Over anticoagulation is a common problem with warfarin and acute intoxication maybe in those with or without an anticoagulation requirement. This can make the approach to treatment difficult when considering the need for therapeutic anticoagulation and expert advice maybe required.
NOACs
The NOACs, new oral anticoagulants (although not so new now) have been promoted as equivocal or if not better than warfarin for anticoagulation. Certainly from a consumer point of view it is far easier to manage than clean loading and INR checks.
Anticoagulant Rodenticides
Commonly called "superwarfarins" they cause massive anticoagulation in patients that last from weeks to months. In contrast single ingestions can be benign, particularly in children when it would be extremely rare for them to ingest enough unintentionally as these agents contain a bittering agent.
ECG Case 081
A 74 yr old patient presents to the ER having suffered several episodes of chest pain over the preceding 24 hours. Describe and interpret his ECGs. LITFL Top 100 ECG