Acetylsalicylic acid
With mild intoxication - dizziness, noise in the ears, deafness, increased sweating, nausea, vomiting, headache and confusion. It occurs at a plasma concentration of 150-300 μg / ml.
Treatment - reduced dose or cancellation of therapy.
At concentrations above 300 μg / ml, severe intoxication occurs, manifested by hyperventilation, fever, anxiety, ketoacidosis, respiratory alkalosis, and metabolic acidosis.Oppression of the central nervous system can lead to coma, cardiovascular collapse and respiratory failure can also occur.
The greatest risk of developing chronic intoxication is noted in children and the elderly with more than 100 mg / kg / day for several days.
Treatment
If suspicion of intake of more than 120 mg / kg of salicylates during the last hour is repeatedly injected Activated carbon inside.
When taking more than 120 mg / kg salicylates should determine their plasma concentration, although it is impossible to predict its severity on the basis of this indicator, it is also necessary to take into account the clinical and biochemical indicators.
If the plasma concentration exceeds 500 μg / ml (350 μg / ml for children under 5 years), intravenous sodium bicarbonate effectively removes salicylates from the plasma.
If the plasma concentration exceeds 700 μg / ml (lower concentrations in children and the elderly) or in severe metabolic acidosis, the therapy of choice is hemodialysis or hemoperfusion.
Paracetamol overdose
When an overdose is possible intoxication, especially in elderly patients,children, patients with liver diseases (caused by chronic alcoholism), in patients with eating disorders, as well as in patients taking inductors of microsomal liver enzymes, at which fulminant hepatitis, hepatic insufficiency, cholestatic hepatitis, cytolytic hepatitis, in the cases indicated above - sometimes fatal.
The clinical picture of acute overdose develops within 24 hours after taking paracetamol.
Symptoms: gastrointestinal disorders (nausea, vomiting, decreased appetite, a feeling of discomfort in the abdominal cavity and (or) abdominal pain), pallor of the skin. With the simultaneous administration of 7.5 g or more to adults or children over 140 mg / kg, cytolysis of hepatocytes occurs with complete and irreversible necrosis of the liver, the development of hepatic insufficiency, metabolic acidosis and encephalopathy, which can lead to coma and fatal outcome. After 12-48 hours after the injection of paracetamol, the activity of microsomal liver enzymes, lactate dehydrogenase, bilirubin concentration and a decrease in prothrombin content are noted.Clinical symptoms of liver damage are manifested after 2 days after drug overdose and reach a maximum of 4-6 days.
Treatment
Immediate hospitalization.
Determination of the quantitative content of paracetamol in blood plasma before the start of treatment at the earliest possible time after an overdose.
Introduction donators SH-groups and precursors of the synthesis of glutathione-methionine and acetylcysteine-is most effective in the first 8 hours.
The need for additional therapeutic measures (further introduction of methionine, intravenous injection of acetylcysteine) is determined depending on the concentration of paracetamol in the blood, as well as on the time elapsed after its administration.
Symptomatic treatment.
Laboratory studies of the activity of microsomal liver enzymes are carried out at the beginning of treatment and then every 24 hours.
In most cases, the activity of microsomal liver enzymes is normalized within 1-2 weeks. In very serious cases, liver transplantation may be required.
Caffeine
Common symptoms are gastralgia, agitation, delirium, anxiety, nervousness, anxiety,insomnia, mental agitation, muscle twitching, confusion, convulsions, dehydration, frequent urination, hyperthermia, headache, increased tactile or painful sensitivity, nausea and vomiting (sometimes with blood), tinnitus. In severe overdose, hyperglycemia may occur. Cardiac disorders are manifested by tachycardia and arrhythmia.
Treatment - lowering the dose or eliminating caffeine.