General Management

Ipecac is contraindicated due to excessive vomiting-induced risk of preterm labor. Coma cocktails should contain dextrose and naloxone.

Activated charcoal (AC) is very useful because of gastric axis shift with gastric content stasis. Whole-bowel irrigation (WBI) with polyethylene glycol-electrolyte solution (PEG-ELS) is indicated for iron (Fe) overdose to flush out slow-release tablets; Fe is not AC-adsorbed. Most antidotes are FDA category C or better; only ethanol is category D. Never withhold specific antidotes in pregnancy, especially NAC for acetaminophen (APAP) overdose, a commonly ingested suicidal agent.

Increased dermal absorption: Hexachloro-phene-vacuolar encephalopathy, aniline dyes may cause methemoglobenemia (MetHb), iodine-containing antiseptics may cause hypothyroidism.

Increased protein binding: Sulfonamides and ceftriaxone displace bilirubin from albumin and cause kernicterus in neonates. Reduced hepatic P-450 metabolism: High concentrations of phenytoin, phenobarbital, theophylline cause reduced glucuronidation of chloramphenicol with resulting gray baby syndrome; benzyl alcohol = gasping baby syndrome.

General management: No ipecac or lavage due to existing electrolyte and temperature losses; consider exchange transfusion > hemodialysis > hemoperfusion for drug overdoses.

Coping with Asthma

Coping with Asthma

If you suffer with asthma, you will no doubt be familiar with the uncomfortable sensations as your bronchial tubes begin to narrow and your muscles around them start to tighten. A sticky mucus known as phlegm begins to produce and increase within your bronchial tubes and you begin to wheeze, cough and struggle to breathe.

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