Essential Practical Prescribing by Woodfield et al.

By Woodfield et al.

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7 mL/hour Special situations If there is no response after 10 mg naloxone, an alternative diagnosis should be considered. Be aware that reversal of opioid effect can precipitate acute withdrawal in chronic opioid users and can unmask pain where opioid is used as analgesia. Side effects: arrhythmias, nausea and vomiting, convulsions, pulmonary oedema. Benzodiazepine overdose and flumazenil Features of benzodiazepine overdose: Drowsiness, ataxia, nystagmus, slurred speech, bradycardia, hypotension and respiratory depression.

The regimen shown is only one example and is an example of a fixed-dose reduction regimen, where the doses given depend on the daily alcohol intake prior to admission and diminish day by day to wean the patient. The other main regimen you may come across is the symptom-­triggered regimen. There are pros and cons to each regimen, discussed below. It is suggested that you follow local guidance where available. In addition to chlordiazepoxide, B vitamins are given to prevent the development of Wernicke’s encephalopathy and subsequent Korsakoff’s psychosis.

However, the evidence for its use is very limited and there are no good quality clinical trials demonstrating an improvement in clinical end points. Furthermore, its efficacy decreases sharply with time. It is therefore only recommended for use in patients who have ingested a potentially toxic dose of a substance known to be adsorbed to charcoal, within the first hour after ingestion. Where it is used, the adult dose is 50 g and it is administered orally or via nasogastric tube and only in patients who can maintain their own airway (Chyka and Seger, 1997).

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