![]() and solve for x, which = 1.3x10^-9 then solve for pH using x = 8.88 which is exactly what was obtained in the video. I then calculated Ka using (Ka)(Kb)=(Kw), with the given Kb value. Initial concentration = 0.35 nothing 0 0.15Ĭhange in concentration = -x nothing +x +xĮnd concentration = 0.35-x nothing x 0.15+x Patients with symptoms or an abnormal ECG will require monitoring until symptoms resolve.For the second example problem pertaining NH3 and NH4+NO3-, instead of having the NH3 react with water to form NH4+ and -OH, I had NH4+ react with water to form H3O+ and NH3.All patients with a deliberate overdose require 6 hours observation and cardiac monitoring. If asymptomatic with a normal ECG they are medically cleared.If asymptomatic with a normal ECG they are medically cleared. Children who have ingested >600mg of quinine must be observed and monitored for 6 hours post ingestion.Multiple-dose activated charcoal is indicated in any patient who has ingested >5 g of quinine or who has any degree of visual disturbance.Children: ingestion of 600mg (two tablets) in a child 5g of quinine has been consumed due to the risk of blindness.Cardiotoxicity, CNS disturbance and blindness are commonly observed in doses over 5 grams and universal in doses over 10grams.If heart rate is 1g usually produces some cinchonism.Correct hypoxia, hypokalaemia and hypocalcaemia.Administer magnesium sulfate 10 mmol (0.05 mmol/kg in children) IV over 15 minutes.Wide-complex tachydyshythmias: Urgent serum alkalisation with sodium bicarbonate (aiming for QRS 7.45) followed by intubation and hyperventilation (aiming for a pH 7.5 – 7.55).Coma: Urgent intubation and ventilation.Can be managed with benzodiazepines (varying doses in the textbooks, easy method is 0.1mg/kg IV for lorazepam (max 4mg) / midazolam (max 10mg) / diazepam (max 10mg).Check the patient is not in a dysrhythmia.Elimination half life is >24 hours in overdose and largely via hydroxylation with 20% being excreted in the urine unchanged.Highly protein bound in adults but less so in the paediatric population (wherefore increased risk in children).Rapid absorption with a 70% bioavailability.In overdose it is toxic to the retina which can result in permanent blindness. Think of it as aspirin (the salicylism) that causes blindness.Ĭlass 1A antidysrhythmic with both sodium and potassium blocking properties thereby prolonging the QRS and QT intervals. Quinine causes cinchonism (nausea, vomiting and tinnitus) in overdose but also blindness which is delayed and sometimes not noticed until the morning after the acute toxicity has resolved. The Jesuits were the first to bing cinchona to Europe using it to treat malaria in Rome, this was in fact the first effective treatment against Plasmodium falciparum and the drug of choice until the 1940s when other drugs such as chloroquine emerged . The Quechua people of Peru used the bark of the Cinchona to prevent shivering by creating a mix of ground bark with a sweetened water thus producing tonic water. The 2nd countess of Chinchon in Peru c.1742. Quinine comes from the Cinchona tree, named as all good things are after a woman. ![]()
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