Pediatric emergency medicine trisk 3066 3066
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (102.13 KB, 1 trang )
the references below) and are summarized as follows: APAP concentration over
1,000 mg/L if NAC is not administered, signs of mitochondrial dysfunction and
an APAP concentration over 700 mg/L (4,630 mmol/L) if NAC is not
administered, or signs of mitochondrial dysfunction and an APAP concentration
over 900 mg/L (5,960 mmol/L) if NAC is administered.
Clinical indications for discharge or admission: Patients who do not meet
criteria for NAC administration and who are felt to be safe either from a
psychiatric (intentional overdose) or social (exploratory ingestion,
supratherapeutic ingestion) standpoint may be discharged.
Cardiac Drugs
CLINICAL PEARLS
β-Blockers, calcium channel blockers, clonidine, and digoxin all have
the potential for significant toxicity even in exploratory, small-volume
ingestions.
A triad of bradycardia, hypotension, and HYPOglycemia should prompt
consideration of β-blocker toxicity.
A triad of bradycardia, hypotension, and HYPERglycemia should
prompt consideration of calcium channel blocker toxicity.
A triad of sedation, bradycardia, and pinpoint pupils, especially in the
absence of respiratory depression, should prompt consideration of
clonidine toxicity.
β-Adrenergic Blockers and Calcium Channel Blockers
Current Evidence. The approaches to overdoses of these two categories of
cardiovascular agents are discussed together because of similarities in clinical
presentation and management approach. They both are commonly prescribed to
adult patients with a variety of cardiovascular disorders, including angina and
past myocardial infarction, hypertension, and arrhythmias. As such, experience
with pediatric overdoses has been increasing in more recent years.
β-Adrenergic blockers (BBs) vary considerably in terms of receptor specificity
and pharmacokinetics, but most overdose experience is with propranolol. The
calcium channel blockers (CCBs) most commonly used in the United States
(verapamil, diltiazem, nifedipine, amlodipine, etc.) are chemically dissimilar and
