1 / 20

A Patient taking overdose of sleeping pills

A Patient taking overdose of sleeping pills. By Dr WL Yip, AED, QMH. Case report. F / 28, good past health Taken 30tabs of ‘sleeping pills’ suicidal attempt Drowsy, and brought to private hospital by friends within 1 hour. Clinical findings. GCS E4 V1 M5 10/15 Pupil E&R 2mm

fisseha
Download Presentation

A Patient taking overdose of sleeping pills

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. A Patient taking overdose of sleeping pills By Dr WL Yip, AED, QMH

  2. Case report • F / 28, good past health • Taken 30tabs of ‘sleeping pills’ • suicidal attempt • Drowsy, and brought to private hospital by friends within 1 hour

  3. Clinical findings • GCS E4 V1 M5 10/15 • Pupil E&R 2mm • ECG sinus tachycardia 142/min • PR 145, QRS 81, QTc 339

  4. ECG

  5. Management • Gastric lavage • Activated charcoal 50gm • Witnessed generalized seizure (last ~30sec) 1 hour after ingestion, resolved spontaneously • Transferred to AED after stablized • (within 2 hours after ingestion)

  6. Progress in AED • BP 130/65, P 130 • Temp 36.5 • H’stix 6.6 • GCS E4 V1 M5 10/15 • ECG sinus tachycardia 123/min • PR 144, QRS 82, QTc 389 • Admit medical

  7. Progress in ward • Stable all along • Blood test unremarkable • Toxicology: BDZs, diphenhydramine • Fully conscious next day • Seen by psychiatrist: adjustment disorder • Discharged home

  8. Unisom SleepGel • Contain diphenhydramine 50mg in each tablet

  9. Diphenhydramine overdose • First-generation antihistamines • H1-blockers • Ethanolamine • Dose-dependent toxicity • Ingestion >1gm at risk developing severe symptoms

  10. Anticholinergic syndromes • Peripheral (dry mucous membrane, hot, dry and flushed skin, peripheral vasodilation, dilated pupil, blurred vision, urinary retention, intestinal ileus, sinus tachycardia) • Central (disorientation, agitation)

  11. Seizures • Not common • Generally short-lived • May be prolonged / repeated if large dose taken

  12. Other CNS effects • Sedation • Catatonic stupor (highly specific) • Acute extrapyramidal movement disorders • Anxiety • Toxic psychosis

  13. Cardiac toxicity • Sinus tachycardia • Quinidine-like conduction abnormalities • Slow sodium channels conduction result in decreased conduction and contractility • Associated prolonged QT

  14. Other rare features • Rhabdomyolysis • Hyperthermia • Ventricular tachycardia

  15. Management • ABC • Activated charcoal • Gastric lavage • Consider even after 1 hour since diphenhydramine decreases your gut motility

  16. Treatment of agitation • Due to anti-cholinergic effects • Benzodiazepines • Physostigmine (if no conduction disturbance)

  17. Cardiovascular toxicity • No treatment for sinus tachycardia • Intravenous sodium bicarbonate for conduction abnormalities

  18. Prognosis • Most recovered with supportive treatment and observation

  19. Learning Points • We should consider the potential risk of aspiration if we perform GL in patient with impaired conscious level and at risk of developing convulsion Airway protection should be ensured • Precautions and potential advantages in using physostigmine for the treatment of anti-cholinergic poisoning (Burns et al, Ann Emerg Med. April 2000;35:374-381)

  20. Thank you

More Related