Paeds Cases · clinical-pharmacology-and-therapeutics
Pick the right antidote — poisoning antidotes and toxicology pharmacology
A bedside structured clinical encounter testing recognition of an opioid toxidrome and the weight-based naloxone response, the decision to start N-acetylcysteine for a staggered paracetamol ingestion, and the construction of a safe antidote plan that avoids the flumazenil trap.
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Target exams
RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
A previously well four-year-old boy is found unresponsive at home with pin-point pupils and a respiratory rate of eight, alongside opened bottles of paracetamol and his grandmother's temazepam. The candidate must resuscitate, give naloxone titrated to respiratory rate, decide on N-acetylcysteine for the timed-unknown paracetamol ingestion, and decline flumazenil despite the benzodiazepine exposure.
Candidate instructions
You are the emergency-department registrar receiving a four-year-old, 16-kilogram boy brought in by paramedics after being found unresponsive at home. Opened bottles of paracetamol and his grandmother's temazepam were beside him. You have eight minutes to resuscitate, choose and dose the antidotes, defend your reasoning to the examiner, and build a safe plan. [3] [1]
References4ShowHide
- [1]Dart RC, Mullins ME, Matoushek T, et al. Management of Acetaminophen Poisoning in the US and Canada: A Consensus Statement JAMA Network Open, 2023.PMID 37552484
- [3]Boyer EW Management of opioid analgesic overdose New England Journal of Medicine, 2012.PMID 22784117
- [4]Malmros Olsson E, Lönnqvist PA, Stiller CO, et al. Rapid systemic uptake of naloxone after intranasal administration in children Paediatric Anaesthesia, 2021.PMID 33687794
- [8]Fine JS Iron poisoning Current Problems in Pediatrics, 2000.PMID 10742921