Management of Drug and substance Overdoses:

• Overdoses account for 15% of acute medical emergencies.
• 65% of drugs involved belong to the patient, a relative, or friend.
• 30% of self-poisonings involve multiple drugs.
• 50% of patients will have taken alcohol as well.
• The history may be unreliable. Question any witnesses or family about where a patient was found and any possible access to drugs. Examination may reveal clues as to the likely poison (e.g. pinpoint pupils with opiates) and signs of solvent or ethanol abuse and iv drug use should be noted

Management

• Priorities are
• Resuscitate the patient
• Reduce absorption of the drug if possible
• Give specific antidote if available

·         Clear and Monitor  airways (or place in the recovery position)

·         Take account of any active medical problems that the patient may have

·         Take Measures to reduce gut absorption such as

o   Gastric lavage is only effective if used up to 1 hour post OD but contraindicated if corrosive substances or hydrocarbons have been ingested

o   Activated charcoal (50g single dose) absorb many drugs if given within 1 hour of ingestion but not for iron, lithium, salts, alkalis, acids, ethanol, methanol, ethylene glycol, and organic solvents

o   PEG bowel lavage (whole bowel irrigation) continued until the rectal effluent becomes clear but not safe for  bowel obstruction, perforation, ileus, or in patients seriously ill

o    

 Specific antidotes available for drug and substance overdoses:

Agent/Drug	Antidote
Acetaminophen/Tylenol/Paracetamol	acetylcysteine (Mucomyst)
Antcholinesterase	atrophine sulfate or pralidoxime
Anticholinergics	physostigmine
Benzodiazepines	flumazenil
Beta blockers	glucagon
Calcium channel blockers	glucagon
Coumadin/Warfarin	phytonadione (Vitamin K.)
Cyanide	amyl nitrate, sodium nitrate, sodium thiosulfate
Cyclophosphamide	mesna
Digoxin	digibind digoxine immune fab
Dopamine	phentolamie (Regitine)
Extrapyramidal symptoms (EPS)	diphenhydramine (Benadryl)
Ethylene glycol	fomepizole
Fluorouracil	leucoverin calcium
Heparin	protamine sulfate
Insulin reaction	glucose (Dextrose 50%)
Iron	deferoxamine
Lead	dimercapol, edetate calcium, disodium,
Methotrexate	leucovorin calcium
Narcotics	naloxone (Narcan)
Neuromuscular blockade (paralytics)	anticholinesterase agents
Opioid analgesics	nalmefene or naloxone
Potassium	albuterol inhaler, insulin & glucose, NaHCO3, kayexalate
Tricyclic antidepressants	phyostigmine or NaHCO3