I is for Investigations
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BSL, ECG and Paracetamol
Carbamazepine, Digoxin, Ethanol, Iron, Isoniazid, Lithium, Methotrexate, Paracetamol, Phenobarbitone, Phenytoin, Potassium, Salicylate, Theophylline and Valproic acid. Methanol and Ethylene glycol can be measured but will rarely be back in a clinically useful time.
Carbamazepine – may require Multi-dose activated charcoal or haemodialysis
Isoniazid – may require pyridoxine
Opioids – not doing levels but if they look like an opiate toxidrome then giving naloxone may improve the patient’s GCS to the point they no longer require intubation.
Organophosphates – Cholinersterase levels maybe possible in some hospitals but you will treat on clinical grounds if the patient is cholinergic with atropine +/- pralidoxime.
Phenobarbitone – may need multi-dose activated charcoal or haemodialysis
Salicylate – urinary alkalisation and haemodialysis (in severe poisoning)
Sulfonylureas – again levels may not be possible but if requiring large amounts of dextrose and there is clinical suspicion of sulfonylurea use, giving octreotide will be beneficial.
Toxic Alcohols – either specific levels of looking for a high anion gap metabolic acidosis (HAGMA). Treatment options are ethanol as temporary treatment and haemodialysis. Foempazole is quoted as the antidote but is not available in NZ or Australia.
Valproic acid – may require haemodialysis
- Ashbourne JF, Olson KR, Khayam-Bashi H. Value of rapid screening for acetaminophen in all patients with intentional drug overdose. Annals of Emergency Medicine 1989; 18(10):1035-1038
- Sporer KA, Khayam-Bashi H. Acetominophen and salicylate serum levels in patients with suicidal ingestion or altered mental status. American Journal of Emergency Medicine 1996; 14(5):443-446
- Murray L, Little M, Pascu O, Hoggett K. Toxicology Handbook 3rd Edition. Elsevier 2015. ISBN 9780729542241