All drugs have the potential to be misused, whether legally prescribed by a doctor, purchased over-the-counter at the local drug store, or bought illegally on the street. Taken in combination with other drugs or with alcohol, even drugs normally considered safe can cause death or serious long term consequences. Children are particularly at risk for accidental overdose, accounting for over one million poisonings each year from drugs, alcohol, and other chemicals and toxic substances. People who suffer from depression and who have suicidal thoughts are also at high risk for drug overdose.
Causes and symptoms
Accidental drug overdose may be the result of misuse of prescription medicines or commonly used medications like pain relievers and cold remedies. Symptoms differ depending on the drug taken. Some of the drugs commonly involved in overdoses are listed below along with symptoms and outcomes.
Depressant drugs (tranquilizers, antianxiety drugs, sleeping pills) cause sleepiness, slowed or slurred speech, difficulty walking or standing, blurred vision, impaired ability to think, disorientation, and mood changes. Overdose symptoms can include slowed breathing, very low blood pressure, stupor, coma, shock, and death.
Diagnosis of a drug overdose may be based on the symptoms that develop, however, the drug may do extensive damage to the body before significant symptoms develop. If the patient is conscious, he or she may be able to tell what drugs were taken and in what amounts. The patient's recent medical and social history may also help in a diagnosis. For example, a list of medications that the patient takes, whether or not alcohol was consumed recently, even if the patient has eaten in the last few hours before the overdose, can be valuable in determining what was taken and how fast it will be absorbed into the system.
- What drug(s) were taken try to locate the drug's container?
- How much of the drug was taken?
- When was the drug taken?
- Was the drug taken with alcohol or any other drugs or chemicals?
- What is the age of the patient?
- What symptoms are the patient experiencing?
- Is the patient conscious?
- Is the patient breathing?
- Assessment of the patient's airway and breathing to making sure that the trachea, the passage to the lungs, is not blocked. If needed, a tube may be inserted through the mouth and into the trachea to help the patient breath. This procedure is called intubation.
- Assessment of the patient's heart rate, blood pressure, body temperature, and other physical signs that might indicate the effects of the drug.
- Blood and urine samples may be collected to test for the presence of the suspected overdose drug, and any other drugs or alcohol that might be present.
- Elimination of the drug that has not yet been absorbed is attempted. Vomiting may be induced using ipecac syrup or other drugs that cause vomiting. Ipecac syrup should not be given to patients who overdosed with tricyclic antidepressants, theophylline, or any drug that causes a significant change in mental status. If a patient vomits while unconscious, there is a serious risk of choking.
- Gastric lavage, or washing out the stomach, may be attempted. For this procedure a tube flexible tube is inserted through the nose, down the throat, and into the stomach. The contents of the stomach are then suctioned out through the tube. A solution of saline (salt water) is injected into the tube to rinse out the stomach. This solution is then suctioned out. This is the process used when someone has his/her stomach pumped.
- Activated charcoal is sometimes given to absorb the drug.
- Medication to stimulate urination or defecation may be given to try to flush the excess drug out of the body faster.
- Intravenous (IV) fluids may be given. An intravenous line, a needle inserted into a vein, may be put into the arm or back of the hand. Fluids, either sterile saline (salt water solution) or dextrose (sugar water solution), can be administered through this line. Increasing fluids can help to flush the drug out of the system and to reestablish balance of fluids and minerals in the body. The pH (acid/base balance) of the body may need to be corrected by administering electrolytes like sodium, potassium, and bicarbonate through this IV line. If drugs need to be administered quickly, they can also be injected directly into the IV line.
- Hemodialysis is a procedure where blood is circulated out of the body, pumped through a dialysis machine, then reintroduced back into the body. This process can be used to filter some drugs out of the blood. It may also be used temporarily or long term if the kidneys are damaged due to the overdose.
- Antidotes are available for some drug overdoses. An antidote is another drug that counteracts or blocks the overdose drug. For example, acetaminophen overdose can be treated with an oral medication, N-acetylcysteine (Mucomyst), if the level of acetaminophen found in the blood is extremely high. Naloxone is an anti-narcotic drug that is given to counteract narcotic poisoning. Nalmefen or methadone may also be used.
- Psychiatric evaluation may be recommended if the drug overdose was taken deliberately.