MedBugs: SAQ #70

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 Verapamil XR 240mg x 3 tablets Perindopril 10mg x 2 tablets Allopurinol 300mg x 2 tablets His observations are as follows :

GCS 14 (baseline mild confusion), HR 40bpm, BP 69/40, RR 16, Sats 95%RA

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

2. List (4) investigations you would perform and provide a rationale for each. 4 marks

You have commenced haemodynamic resuscitation with IVF, calcium replacement and adrenaline infusion.

3. Will this patient end up being intubated at some stage? Give (2) reasons why/why not. 2 marks

4. List (2) benefits and (2) complications of high-dose insulin euglycaemic therapy. 4 marks

You commence HIET as per your local protocol. The patient’s BP dips and a bolus of 10mcg adrenaline is given. You see the following on the monitor and it appears the patient has arrested.

5. State (3) components of your management. 3 marks

The patient successfully reverts to a sinus bradycardia at 40bpm and remains hypotensive at 75/40 despite all your initial measures.

6. List (3) further options for haemodynamic support in a patient with refractory hypotension and bradycardia in the setting of this overdose 3 marks

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