Sunday, April 12, 2009

Magic Medicine Formula (4)

Dear friends, time for some medical formulas again;) This time the topic is about poisoning. A fairly common problem to encounter in ER, as well as popular in exam questions, and more importantly, you usually can't obtain any history from the patients! So the "clues" are crucial in helping to reach the diagnosis. Below are some tips that I found useful:

Check if the patient's having:
- Respiratory depression? Think of opiates, benzodiazepine toxicity;
- Coma? Think of benzodiazepines, alcohol, opiates, barbiturates;
- Constricted pupils? Think of opiates or organophosphates;
- Dilated pupils? Think of tricyclics, amphetamines;
- Hyperthermia? Think of amphetamines, ecstacy, aspirin, cocaine;
- Tachycardia? Think of salbutamol, antimuscarinics, tricyclics;
- Metabolic acidosis? Think of alcohol, paracetamol, theophylline, methanol;
- Seizures? Think of tricyclics, phenothiazines, theophyllines.

Quick mnemonics to help in diagnosis/ management:

Think that patient with cholinergic toxicity (eg organophosphate) is "wet" and look for DUMBELS:

D - Diarrhea/ diaphoresis
U - Urination
M - Miosis
B - Bradycardia
E - Emesis
L - Lacrimation
S - Salivation

*Presentation of Glyphosate poisoning can mimic organophosphote poisoning but the management is VASTLY different - must be aware of that!

Anticholinergic toxicity, in contrast, is very "dry" and look for:
"Hot as hades, blind as a bat, dry as a bone, red as a beet, mad as a hatter"!

For tricyclic antidepressants, main presentation can be remembered as:
TCA = Three C's = Convulsion, Coma, Cardiotoxic (remember to do a stat ECG!)

For paracetamol overdose, the important King's college criteria for liver transplantation can be remembered as:
pH less than 7.3 OR all three of PCM:
P - PT>100 sec
C - Creatinine > 300 mmol/L
M - Major encephalopathy (Grade III/ IV)

Severe poisoning of certain drugs might require hemodialysis and they are BLAST:
B - Barbiturates
L - Lithium
A - Alcohol
S - Salicylates
T - Theophylline

And just to remember that the first & last alphabet i.e. Barbiturates & theophylline - hemoperfusion can be done too.

And lastly, must know the antidote for specific overdose/ poisoning and certainly not searching for books when you see a poisoning case! ;)

Related posts:
Magic Medicine Formula (1)
Magic Medicine Formula (2)
Magic Medicine Formula (3)


Joechooi said...

Finally ur blog is available for access again =)
Haha, your mnemonics are fun, thanks a lot though, hope so it will helps in my coming exams :)

Zzzyun said...

wow seems complicated... hope i can rmb at least most of them!

peanut said...

thanx.. this is seriously useful.. but still need to memorize hmm..

Anonymous said...

lol cool stuff..
i dont even understand a thing! =P

WinnieH said...

your mnemonics are really helpful =) keep on posting more of your formulas! thanks!!

Anonymous said...

Hey are you a professional journalist? This article is very well written, as compared to most other blogs i saw today….
anyhow thanks for the good read!

Darren Lee said...

Anonymous: Thanks for the comment. The "Formula" is something that I've collected along my studies and just to share. Glad that it's helpful to you. ;)

Anonymous said...

Your blog keeps getting better and better! Your older articles are not as good as newer ones you have a lot more creativity and originality now keep it up!

Darren Lee said...

Dear anonymous, thanks for the encouragement!;)

Anonymous said...; You saved my day again.

Syims said...

These mneumonics really help! My A&E speacialist asked us on this during my A&E posting back in med sch.

Darren Lee said...

Thanks Syims!

Anonymous said...

hi, helpful mnemonics!

Anonymous said...

i truly adore all your posting way, very exciting.
don't give up and also keep penning seeing that it just simply nicely to read it.
looking forward to look into far more of your well written articles, goodbye ;)

Darren Lee said...

Thanks anonymous, but i'll really appreciate if you could leave ur name! ;)

icy-lim said...

Dear Dr Lee,

Glad to get access to your blog again!

I have been following your blog for four years and I'm now a second-year medical student.

Those mnemonics are very useful. Do you mind sharing more?

I think you are a doctor who is very different from others. A doctor with magics is definitely an interesting one. You make me realize that even a doctor can get a life out of medical field. I'm totally impressed and inspired.

Hope to see more posts from you. All the best.


Darrenmagic said...

icy-lim: Thanks for the kind words. Yes more will come and stay tuned ;D

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