Poisoning and Overdose Answers 253(a)Theoretically, one can continue bag-valve-mask ventilation until the
effects of the heroin wears off; however, this is not practical. If the patient
overdosed on a long-acting opioid, respiratory depression can last for more
than 24 hours. (b)Similar to continued bag-valve-mask ventilation, the
cause of this patient’s respiratory depression is reversible with the adminis-
tration of naloxone. If there is a delay to administration of naloxone or bag-
valve-mask ventilation is unsuccessful, the patient can be intubated. (d)
Flumazenil is the antidote for acute benzodiazepine overdose. (e)Activated
charcoal should not be administered in patients with CNS depression who
are not intubated owing to the risk of emesis and aspiration.
223.The answer is e.(Goldfrank et al, pp 656-660.)An overdose of any of
these agents can lead to seizures. However, INHis notorious for causing
seizures that are refractory to standard therapy. Marked acidosis and respi-
ratory compromise may also be present. Pyridoxine (vitamin B 6 ) is the
treatment of choice for INH overdose. INH is used for the treatment of
tuberculosis, which is seen with a greater incidence in patients with AIDS.
All of the other substances listed as answer choices should respond to stan-
dard therapy with benzodiazepines.
224.The answer is c.(Goldfrank et al, pp 593-603.)Glyburideis a com-
monly prescribed sulfonylurea.Sulfonylureas are oral agents that stimulate
the beta cells of the pancreas to produce insulin.Many of the sulfonylureas
have relatively long durations of action.Glyburide can act up to 24 hours
after ingestion. Hypoglycemia secondary to sulfonylureas generally requires
hospital admissionto monitor for recurrent hypoglycemia.
(a)Excess insulin is the most common cause of hypoglycemia in patients
who present to the ED. Often, the hypoglycemia results from the unintentional
overdose of short- or intermediate-acting insulin. After correcting the initial
hypoglycemia, a meal and observation is usually enough for patients to be dis-
charged. (b)Metformin, a biguanide, acts by increasing peripheral sensitivity to
insulin and suppressing gluconeogenesis. Metformin should not produce hypo-
glycemia.(d)Rosiglitazone, a thiazolidinedione, also reduces insulin resistance,
and decreases endogenous glucose production. Rosiglitazone should not pro-
duce hypoglycemia. (e)Acarbose is an α-glucosidase inhibitor that acts to
decrease GI absorption of carbohydrates. It does not cause hypoglycemia.
225.The answer is d.(Goldfrank et al, pp 507-516.)The patient most likely
ingestedaspirin.Patients with an acute salicylate overdose maypresent with