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TABLE 22.9 Assessment and management of specific drug overdoses

Type of poisoning General management Antidote Clinical considerations
CNS depressants Supportive care of airway, Naloxone hydrochloride Action of naloxone may be much shorter than the
(morphine, heroin, breathing, circulation (Narcan); specific reversal effect of the drug; the patient may need to be
methadone, oxycodone) agent observed for return of unconsciousness.
CNS stimulants Supportive care of airway, Benzodiazepines may be Reduce stimulation in the surrounding
breathing, circulation used to reduce symptoms environment; monitor CVS and temperature.
Salicylate Observe for hyperventilation Nil; charcoal may be used Monitor electrolyte changes and increases in fever.
and acid–base disturbances
Paracetamol Careful history required to N-Acetylcysteine Antidote must be given within the specified time
determine time and range; consider the effects of other drugs (e.g.
amount taken; initially paracetamol and codeine combinations);
vague symptoms monitor for signs of hepatotoxicity.
Carbon monoxide Supportive care of airway, High concentrations of Hyperbaric oxygen may be required; monitor
breathing, circulation oxygen therapy carboxyhaemoglobin; oxygen saturation
monitors will give erroneously high readings.
Organophosphates Decontamination; supportive Pralidoxime chloride; Maintain careful decontamination and personal
care of airway, breathing, benzodiazepines safety considerations.
circulation

l CNS depressants may cause peripheral vasodilation, exposure and a depressed immune response also predis-
with a resultant hypotension and tachycardia pose a patient to severe infections (e.g. hepatitis, osteo-
l arrhythmias may occur because of cardiac conduction myelitis, infective bacterial endocarditis, encephalitis/
effects or tissue hypoxia. 112,118,119 meningitis). 112,118,119

Practice tip
Practice tip
Comprehensive assessment of CNS function includes ob serving
for adequate respiratory function and levels of consciousness. Many patients with an overdose will not appreciate that their
narcotics have been reversed, and may awaken suddenly in a
frightened or agitated mood. Reassure them that they are safe
Patients with an altered level of consciousness are at risk and their privacy will be protected.
of injury from decreased sensory ability or prolonged
immobilisation. Reddened areas over bony prominences
or pressure points appear within a short time. Skin blis-
ters indicate altered blood flow, usually due to excessive Management
pressure. Actual skin breakdown can occur within 3 General principles apply for the management of a patient
hours. 112,118,119 If external pressure or altered circulation to with ingestion of a toxic substance with a reduced level
an extremity continues for over 4 hours, compartment of consciousness. Prevent continued absorption by
syndrome may develop. 112,118,119
administering activated charcoal for oral ingestions, and
provide symptomatic care 112,118,119 (see Table 22.9).
Effects of Multiple Drug Use
A patient who ingests a combination of drugs may CENTRAL NERVOUS SYSTEM STIMULANTS
experience toxicity because of additive or synergistic CNS stimulants increase the activity of the reticular acti-
effects. 112,118,119 Illicitly-produced drugs often have sub- vating system, promoting alertness and affecting the med-
stances added (e.g. glucose powders, icing sugar, talcum ullary control centres for respiratory and cardiovascular
powder) to dilute or ‘cut’ them, to increase the quantity function. Individuals using a CNS stimulant have an
of supply and profit for the supplier. 117,118 Users may also increased ability to perform muscular activity and a
intentionally inject other drugs (e.g. antihistamines, general sense of wellbeing. Many illegal stimulants
amphetamines, benzodiazepines) to modify or potenti- are poorly manufactured, with no guarantee of purity
ate the effects of narcotics. 112,118,119
or consistency in dosage. The possibility of overdose
is therefore always present, producing profound CNS
Potential for Acute or Active Infections excitation. 117,120,121 Commonly used stimulants include
The use of non-sterile solutions and equipment and the amphetamines, dextroamphetamine, methyphenidate,
sharing of injection equipment significantly increases the lysergic acid diethyamide (LSD), phencyclidine (PCP),
risk of acute or active infections. 112,118,119 Frequent caffeine, cocaine and methamphetamines. 112,118,119,125