MedBugs: SAQ #323

Case: Polypharmacy overdose

A 41 year old male (80kg) is brought to your rural ED in an altered conscious state after a polypharmacy overdose 60 minutes prior to your assessment. He was found by his partner with empty packets of the below medications surrounding him. Amitriptyline 10 mg x 20 tablets = 200 mg Amlodipine 5 mg x 50 = 250 mg Candesartan 16 mg x 20 = 320 mg Carbamazepine 200 mg x 20 = 4000 mg Paracetamol 500 mg x 20 = 10 g Their observations are:

Temp 37.0°C
HR 110 bpm
BP 100/40 mmHg
RR 22 /min
SpO2 96 % on Room Air
GCS 11 (E3, V3, M5)

The patient develops worsening haemodynamic instability. They are intubated and have an arterial catheter and central venous catheter placed.

1. Complete the table below listing (2) most concerning aspects of their overdose and provide justification. 4 marks

2. State (5) management steps, in order of escalation, in relation to this patient’s evolving haemodynamic instability as a consequence of their overdose. Give drug doses as required. 5 marks

3. State (3) indications for giving activated charcoal in the setting of paracetamol overdose. 3 marks

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Case: Polypharmacy overdose

1. Complete the table below listing (2) most concerning aspects of their overdose and provide justification. 4 marks

2. State (5) management steps, in order of escalation, in relation to this patient’s evolving haemodynamic instability as a consequence of their overdose. Give drug doses as required. 5 marks

3. State (3) indications for giving activated charcoal in the setting of paracetamol overdose. 3 marks

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