QuestionQA
Concept
Chapter
#### Monitoring

The BNF advises to monitor lung function (in patients with a history of obstructive airway disease).

#### Overdoses

Overdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).
Non-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.

Management
 - Airway protection 
 - Activated charcoal within 1 hour
 - IV Fluids
 
IV glucagon is the first-line management.
 
For symptomatic bradycardia, IV atropine may be used.

2618
2858
Weight-based dosing
Topic
9
Internal Medicine
Based on the patient's weight, the total dose to be given is: 150mg/kg x 60kg = 9000mg. Given that the volume of 5% dextrose used is 200mL , the concentration of the infusion is: 9000mg ÷ 200mL = 45mg/mL. The time period over which the infusion is given (1 hour) and the concentration of the dextrose fluid bag are distractions.
6926
QuestionQAAnswer
45
mg/mL
A 25-year-old patient is brought to the Emergency Department after overdosing on paracetamol. A paracetamol level is taken which is shown to be above the treatment line of the nomogram. N-acetylcysteine is prescribed at a dose of 150mg/kg over 1 hour, which is to be given in a 200mL intravenous infusion of 5% dextrose. Her weight is estimated to be 60kg.


What is the concentration of (in milligrams per millilitre) of the N-acetylcysteine infusion?