Vomiting should be controlled ASAP with medium to high doses of metoclopramide (10–50 mg IV) or a 5HT3 antagonist (ondansetron, tropisetron, dolasetron etc.). Vomiting leads to electrolyte imbalances and increased vagal tone which may increase cardiac toxicity.
(Mg) abnormalities. With chronic poisoning,
digoxin poisoning. Patients often die with elevated digoxin concentration rather than from digoxin toxicities.
Extracorporeal methods of elimination do not significantly increase digoxin clearance. Repeat dose charcoal may be useful. They have been shown to increase clearance and perhaps improve outcomes after yellow oleander poisoning and should be used if tolerated in all such ingestions. There is a small increase in clearance of digoxin with repeat doses of activated charcoal as there is some enterohepatic circulation (more significant in those with renal impairment). Repeat dose charcoal also increases clearance of digitoxin in animal models.
These digoxin specific antibodies bind rapidly to digoxin removing it from the Na+-K+-ATPase pump. The Fab-digoxin complex is then renally excreted. Total digoxin concentrations may increase many fold, however free serum digoxin concentrations fall. The Fab-digoxin complex is excreted with a half-life of 12 to 24 hours; however this may be greatly prolonged in the presence of renal failure.
... Mild acidosis is common in significant poisonings, the correction of the serum bicarbonate to …
Mild acidosis is common in significant poisonings, the correction of the serum bicarbonate to normal concentrations with sodium bicarbonate has been suggested to be clinically useful.
Staff health issues
do not aprraciably off gas
Staff should also
Gown and glove
Pralidoxime binds to organophosphates and removes them from acetylcholinesterase if ageing has not occurred. The pralidoxime-organophosphate complex is water soluble and rapidly excreted by the kidneys.
is controversial, I many institutions
Reactivation is much more likely in diethyl organophosphates which age slowly than dimethyl organophosphates which age rapidly.
Treatment should be tailored to the individual patient by ideally assessing for objective evidence of response following the initial dose. The best intermediat outcome would be improvement in power or in NMJ function, improvement in red cell cholinestersase is another intermetidate outcome often used.