MedBugs: SAQ #152

Case: Webster pack overdose

A 75-year-old male with mild dementia is BIBA after accidentally taking 2 days’ worth of his Webster pack 3 hours ago. As the team leader taking handover, you are informed he has ingested : Candesartan 32mg x 2 tablets Metformin 500mg x 5 tablets

1. Which medication is the most concerning overdose given the vitals? What is considered a lethal/severe toxicity ingestion? 2 marks

2. List (5) investigations you would perform and provide a rationale for each. 5 marks

3. Give a specific indication for intubating this patient. (1 mark) 0 marks

4. State (3) initial interventions you would undertake to improve the patient’s 0 marks

Unfortunately, these manoeuvres fail to improve the patient’s haemodynamic parameters. The on-call toxicologist recommends starting high-dose insulin euglycaemic therapy (HIET).

5. List (2) benefits and (2) complications of HIET. 4 marks

You commence HIET as per your local protocol, but the patient’s condition does not appear to be improving

6. List (3) further options for haemodynamic support in a patient with refractory 0 marks

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