Oto przepis dla lekarza prowadzacego (english):Treatment Overview:
0.4.2 ORAL/PARENTERAL EXPOSURE
A) EMESIS: Ipecac-induced emesis is not recommended because
of the potential for seizures.
B) ACTIVATED CHARCOAL: Administer charcoal as a slurry (240
mL water/30 g charcoal). Usual dose: 25 to 100 g in
adults/adolescents, 25 to 50 g in children (1 to 12
years), and 1 g/kg in infants less than 1 year old.
C) SEIZURES: Administer a benzodiazepine IV; DIAZEPAM
(ADULT: 5 to 10 mg, repeat every 10 to 15 min as needed.
CHILD: 0.2 to 0.5 mg/kg, repeat every 5 min as needed)
or LORAZEPAM (ADULT: 2 to 4 mg; CHILD: 0.05 to 0.1
mg/kg).
1) Consider phenobarbital if seizures recur after diazepam
30 mg (adults) or 10 mg (children > 5 years).
2) Monitor for hypotension, dysrhythmias, respiratory
depression, and need for endotracheal intubation.
Evaluate for hypoglycemia, electrolyte disturbances,
hypoxia.
D) Liquid antacids should be administered as needed for
gastrointestinal irritation.
E) FLUID AND ELECTROLYTE BALANCE - Monitor fluid and
electrolyte status and correct abnormalities.
Hypokalemia is common.
F) RHABDOMYOLYSIS - Ensure adequate hydration and urine
output.
G) CARDIAC DYSRHYTHMIAS - Sinus tachycardia is common and
usually does not require any specific antiarrhythmic
therapy. Life-threatening dysrhythmias or those that
compromise hemodynamic status should be treated
aggressively. Dysrhythmias often respond to treatment
with beta-blockers.
1) VENTRICULAR DYSRHYTHMIAS/SUMMARY: Institute continuous
cardiac monitoring, obtain an ECG, and administer
oxygen. Evaluate for hypoxia, acidosis, and electrolyte
disorders. Lidocaine and amiodarone are generally first
line agents for stable monomorphic ventricular
tachycardia, particularly in patients with underlying
impaired cardiac function. Sotalol is an alternative.
Amiodarone and sotalol should be used with caution if a
substance that prolongs the QT interval and/or causes
torsades de pointes is involved in the overdose.
Unstable rhythms require cardioversion.
2) If severe tachycardia results in hemodynamic
instability use of a short acting cardioselective
beta-blocker, like esmolol, is advised. Patients have
been successfully managed with propranolol.
H) HYPOTENSION: Infuse 10 to 20 mL/kg isotonic fluid. If
hypotension persists, administer dopamine (5 to 20
mcg/kg/min) or norepinephrine (ADULT: begin infusion at
0.5 to 1 mcg/min; CHILD: begin infusion at 0.1
mcg/kg/min); titrate to desired response.