| * Sodium bicarbonate (NaHCO3) |
| Drug group | Features associated with poisoning | Treatment |
|---|
| Paracetamol | - One of the most common causes of severe drug poisoning either alone or as one causative agent in mixed poisoning. N.B.! Combination products (with codeine, for instance) - risk of paracetamol poisoning even if its dose in the combination is low.
- Toxic dose 150 mg/kg. In a person weighing 70 kg, for example, > 10 g/24 h or > 6 g for at least 2 days.
- Poisoning may occur at lower doses if there is abundant alcohol consumption, use of drugs affecting liver metabolism, hepatic or renal failure, fatty liver
- Toxicity is associated with NAPQI, a hepatotoxic metabolite eliminated by glutathione.
- The patient may remain asymptomatic for a long time. Life-threatening liver damage will develop in 3-5 days.
| - Initial treatment: medicinal charcoal, symptomatic treatment
- Antidote (given in hospital): For severe poisoning, N-acetylcysteine should be started as soon as possible.
|
Aspirin
Other NSAIDs | - Untreated aspirin poisoning may be fatal; should be kept in mind as a differential diagnostic alternative in case of mixed poisoning or disturbed consciousness of unknown cause.
- Toxic dose of aspirin: for children, 150 mg/kg, for adults, > 6.5 g. Advanced age and renal failure are predisposing factors.
- Metabolic acidosis, impaired consciousness, convulsions and haemodynamic failure are signs of poor prognosis.
- Poisoning with other NSAIDs is less dangerous.
| - Initial treatment: medicinal charcoal; avoid hyperventilation, maintain pH at > 7.3, sodium bicarbonate (Nabic*), as necessary
- In hospital, measurement of blood concentration; in case of severe poisoning, dialysis and intensive care
|
Antiepileptic drugs
Phenytoin, carbamazepine, valproic acid, lamotrigine, lacosamide, topiramate, levetiracetam, pregabalin, gabapentin | - The toxic dose and clinical symptoms depend on the substance; furthermore, there is very little information available about the toxicity of new drugs. Do not hesitate to contact a specialized poison information center.
- Many of the products are depot products with slow absorption and delayed onset of symptoms.
- CNS symptoms: sedation, coordination and balance problems, muscle jerks (myoclonia), convulsions
- Respiratory depression, arrhythmia, conduction defects
- Bone marrow and liver damage possible as late symptoms in many patients
| - Initial treatment: medicinal charcoal, symptomatic treatment
- In hospital, treatment guided by blood concentrations. Rarely dialysis.
|
| Methotrexate | - Single doses below 200 mg rarely cause severe poisoning but recurrent taking of even low doses (such as 25 mg/day) may do so.
- The patient may be completely asymptomatic at first.
- GI symptoms, fever, rash. Development of liver and kidney damage and bone marrow depression (neutropenic sepsis), CNS symptoms: headache, visual disturbances, confusion
- Fatal poisoning is possible if, for instance, a dose meant to be taken once a week has accidentally been taken every day.
| - Initial treatment: medicinal charcoal, symptomatic treatment
- In hospital, measurement of blood concentrations, folic acid, as necessary, calcium folinate as an antidote, alkalization of urine to speed up elimination, granulocyte growth factor, as necessary
|
| Iron | - Prescription and over-the-counter products. In addition to actual iron products, many vitamin products and herbal medicinal products contain iron.
- In overdose, iron may have local, even caustic, effects on the gastrointestinal tract.
- As systemic symptoms, metabolic acidosis and damage to several organs will follow.
- Toxic dose: more than 60 mg/kg, moderately severe to severe poisoning, less than 40 mg/kg, usually no more than mild poisoning. The dose should be assessed as the amount of elemental iron (Fe) in the product, not of iron salts.
- Initially, there are typically local GI irritation symptoms: severe vomiting, gastric pain, diarrhoea. After absorption, haemodynamic failure, acidosis, GI bleeding, unconsciousness and liver damage may develop.
| - Initial treatment: symptomatic treatment. Medicinal charcoal will not bind iron.
- In hospital, intestinal lavage; consider endoscopic/surgical removal in severe cases; chest X-ray may show iron tablets. Gastric lavage is of no use. Deferoxamine can be used as an antidote.
|
| Oral antidiabetics | - Metformin may cause severe lactic acidosis but not hypoglycaemia in monotherapy.
- Sulphonylureas may cause hypoglycaemia continuing for several days.
- Hypokalaemia, hypomagnesaemia and hypophosphataemia are also common.
| - Initial treatment: medicinal charcoal, sugary food p.o., glucose infusion, as necessary, and Nabic* as first aid for acidosis, as necessary
- In hospital, sufficiently long follow-up, need for glucose infusion for as long as several days
|
| Insulin | - The effect of rapid-acting insulins starts within a few minutes, that of long-acting insulins within 1-2 hours.
- Treatment may be necessary for several days, for ultra-long acting insulins (glargine, detemir, degludec) for up to 3 days.
- Also hypokalaemia, hypomagnesaemia and hypophosphataemia
| - Initial treatment: sugary food orally, glucose infusion, as necessary
- In hospital, sufficiently long follow-up, need for glucose infusion for as long as several days
|