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.
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.
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.
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
Strychnine has had a colorful history from Wes Anderson's "The Grand Budapest Hotel" to Tovery swallowing some down with a charcoal chaser to prove how effective charcoal can be at the French Academy of Medicine in 1831
Paraquat is a widely used herbicide and is unique in toxicology for a couple of reasons. Firstly supplemental oxygen should be avoided due to the risk of developing oxygen free radicals. Secondly treatment does not follow the usual RRSIDEAD approach, patients require immediate decontamination to prevent a lethal outcome.
Organophosphate and carbamate insecticides are responsible for 100,000+ deaths worldwide, particularly in developing countries due to its availability. Organophosphorus agents can be broken down into three groups:
Chlorinated pesticides are widely used in agriculture but the most common source or organochlorines is Lindane, used for the treatment of head lice. Acute ingestion or repeated large dermal expose causes neurological toxicity which can lead to seizures and a coma.
Hydrogen Peroxide is an oxidising agent used widely in domestic and industrial products. It causes damage by three main mechanisms: direct corrosive injury, oxygen gas formation and lipid peroxidation.
Hydrofluoric acid is found in car wheel cleaners, rust removal and glass etching solutions. Classically the person will present with pain out of proportion hours after dermal exposure.
Glyphosate is a widely used herbicide. It can cause gastrointestinal corrosive symptoms and due to the surfactant that is present a severe metabolic acidosis, hyperkalaemia and cardiovascular collapse can occur.
Corrosive ingestion: Patients who are asymptomatic at 4 hours and tolerating oral fluids can be medically cleared. Symptomatic patients need to remain nil by mouth and are admitted for observation and further investigation within 24 hours. Management is then directed dependent on these findings.