Drug Overdose

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.

Acetaminophen is the generic name for the commonly used pain reliever Tylenol. Overdose of this drug causes liver damage with symptoms that include loss of appetite, tiredness, nausea and vomiting, paleness, and sweating. The next stage of symptoms indicates liver failure and includes abdominal pain and tenderness, swelling of the liver, and abnormal blood tests for liver enzymes. In the last stage of this poisoning, liver failure advances and the patient becomes jaundiced, with yellowing of the skin and whites of the eyes. They may also experience kidney failure, bleeding disorders, and encephalopathy (swelling of the brain).

Anticholinergic drugs (drugs that block the action of acetylcholine, a neurotransmitter) like atropine, scopolamine, belladonna, antihistamines, and antipsychotic agents cause the skin and moist tissues (like in the mouth and nose) to become dry and flushed. Dilated pupils, an inability to urinate, and mental disturbances are also symptoms. Severe toxicity can lead to seizures, abnormal heart rhythms, extremely high blood pressure, and coma.

Antidepressant drugs like amitriptyline, desipramine, and nortriptyline can cause irregular heart rate, vomiting, low blood pressure, confusion, and seizures. An overdose of antidepressants also causes symptoms similar to those seen with anticholinergic drug overdoses.

Cholinergic drugs (drugs that stimulate the parasympathetic nervous system) like carbamate and pilocarpine cause nausea, diarrhea, increased secretion of body fluids (sweat, tears, saliva, and urine), fatigue, and muscle weakness. Convulsions are possible. Death can occur due to respiratory failure and heart failure.

Cocaine and crack cocaine overdoses cause seizures, high blood pressure, increased heart rate, paranoia, and other changes in behavior. Heart attack or stroke are serious risks within three days after cocaine overdose.

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.

Digoxin, a drug used to regulate the heart, can cause irregular heart beats, nausea, confusion, loss of appetite, and blurred vision.

Narcotics or opiates are drugs like heroin, morphine, and codeine. Clonidine and diphenoxylate (Lomotil) are also in this category. Overdose with opiate drugs causes sedation (sleepiness), low blood pressure, slowed heart rate, and slowed breathing. Pinpoint pupils, where the black centers of the eyes become smaller than normal, are common in opiate overdose. However, if other drugs are taken at the same time as the opiates, they may counteract this effect on the pupils. A serious risk is that the patient will stop breathing.

Salicylates are found in aspirin and some creams or ointments used for muscle and joint pain (like BenGay), and creams for psoriasis, a skin condition. Initial symptoms are gastrointestinal irritation, fever, and vomiting, possibly with blood in the vomit. This overdose will cause metabolic acidosis and respiratory alkalosis, conditions where the body's acid/base balance is malfunctioning. Symptoms include rapid heart beat and fast breathing. Nervous system symptoms include confusion, hallucinations, tiredness, and ringing in the ears. An increased tendency to bleed is also common. Serious complications include acute renal failure, coma, and heart failure. Acute salicylate poisoning can lead to death.

Diagnosis :

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.

Different drugs have varying effects on the body's acid/base balance and on certain elements in the blood like potassium and calcium. Blood tests can be used to detect changes in body chemistry that may give clues to what drugs were taken. Blood can also be screened for various drugs in the system. Once the overdose drug is identified, blood tests can be used to monitor how fast the drug is being cleared out of the body. Urine tests can also be used to screen for some drugs and to detect changes in the body's chemistry. Blood and urine tests may show if there is damage to the liver or kidneys as a result of the overdose.

Prognosis :

While many victims of drug overdose recover without long term effects, there can be serious consequences. Some drug overdoses cause the failure of major organs like the kidneys or liver, or failure of whole systems like the respiratory or circulatory systems. Patients who survive drug overdose may need kidney dialysis, kidney or liver transplant, or ongoing care as a result of heart failure, stroke, or coma. Death can occur in almost any drug overdose situation, particularly if treatment is not started immediately.