A drug is any substance that when absorbed in the body alters the normally body function. In pharmacies drugs are a chemical substance in the treatment, cure, prevention or diagnosis of disease or otherwise physical or mental well being. All drugs have the potential to be misused whether prescribed by a doctor, bought over the counter or bought illegally off the streets. 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. People who suffer from depression and who have suicidal thoughts are also at high risk for drug overdose. The cause of a drug overdose is either by accidental overuse or by intentional misuse. Accidental drug overdose may be the result of the misuse of prescription medicine such as pain relievers, cough syrup or cold remedies. Accidental overdoses result from either a young child or an adult with damaged mental abilities that are forced to swallow it.
An adult especially the elderly or people taking too many medications can accidently take in the wrong medication or take the wrong dose of a medication. Purposeful overdoses are taken at anyone’s desire to get high or harm oneself. Scenarios have occurred where children at the ages younger than 5 months (6 months to 3 years) have the tendency to put anything in their mouths. Children may take drugs by accident based on their curiosity. Drug overdose is common in this age group when medication is accidently left in arms reach for the children to take.
In fact, when children find medication they often share it with other children. It is a common accusation that if there is an overdose in one child, the other children may have taken it as well. Adolescents and adults are more likely to overdose on one or more drugs in order to harm themselves intentionally or purposely. A tempting to hurt oneself by overdosing on medication or drugs is a suicide attempt. Many people who purposely overdose on medication or drugs are most likely to always suffer from mental health condition. Drugs that initiate these causes are Acetaminophen which is known as 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 are 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 are 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 strokes are serious risks within three days after cocaine overdose. Depressant drugs such as tranquilizers, antianxiety drugs, sleeping pills can 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, and creams for psoriasis, a skin condition.
Initial symptoms are gastrointestinal irritation, fever, and vomiting, possibly blood with vomit in it. 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. Drug overdose takes a major toll on the body.
The effects of overdose can result in high therapeutic effects where the person feels calm and a sense of tranquility. Large overdoses of medication can have minimal side effects. A single dose of medication can be lethal to a child where as some overdoses can increase of person’s chances of being diagnosed with a chronic disease. A person who has had a recent medical history with asthma can have asthma attacks and chest pains triggered. Symptoms can include problems with vital signs such as temperature, pulse rate, respiratory rate, blood pressure are possible and can be life threatening.
Vital sign values can be increased, decreased, or completely absent. Also Sleepiness, confusion, and coma are common and can be dangerous if the person breathes vomit into the lungs (aspirated). Skin can be checked to see if it is cool and sweaty, or hot and dry. Chest pain is possible and can be caused by heart or lung damage. Shortness of breath may occur. Breathing may get rapid, slow, deep, or shallow. Abdominal pain, nausea, vomiting, and diarrhea can be present. Vomiting blood, or blood in bowel movements, can be life threatening.
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 important 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 or 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.
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. Also assess 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, and then put 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 purposely.
Emergency and overdose testing may be used to screen for, measure the quantity of or confirm the presence of a drug. Also toxic substance in someone who is suspected of overdosing, thought to be poisoned, and showing symptoms of toxicity . Drug testing may be used to help decide how to treat someone who is acutely ill. Once a diagnosis is made, testing may sometimes be used to monitor the effectiveness of treatment and/or monitor the level of the drug or substance in the blood or body. Results from emergency and overdose testing are primarily used for purposes of treatment.
If results are needed for legal cases, for example, establishing a cause of death or determining if impairment from drugs was a contributing factor in an accident, then special legal (forensic) procedures in the collection, handling, testing of samples, and reporting of results must be followed. One example is if a blood sample is to be used for ethanol testing in a legal case, then the arm should be cleaned with something other than alcohol before the sample is collected. A variety of different approaches may be used to evaluate someone who is suspected to have overdosed or ingested something toxic.
Exactly which tests are performed will depend upon the situation and the standard practices of the emergency room (ER). Choices may be influenced by the turn-around-time for test results, test sensitivity and specificity, the ability to provide quantitative results, the availability of specific treatments, and the potential for managing the patient’s symptoms effectively in the ER. The first is a group of stat toxicology assays that ideally provides results within an hour and includes tests such as the Acetaminophen where a level is often ordered because overdoses are relatively common and can be missed.
The affected person may initially have no, few, or nonspecific symptoms, even when a significant liver damage is occurring. There is a therapy available for acetaminophen overdose, but it must be given within a few hours of ingestion. Salicylate is a test may be ordered if a person has symptoms consistent with an overdose, an acid base imbalance, or is known to have ingested a significant quantity. Ethyl alcohol (Ethanol) is a breath test is usually performed at the point of care such as an emergency room; a blood test is usually sent to a laboratory. An iron tests is usually only used when iron overdose is suspected in a child or infant.
To prevent accidental overdoses, medications, even over-the-counter pain relievers and vitamins, must be kept in a safe, secure place. Intentional overdoses are harder to prevent, unless the underlying problems are addressed. Unintentional, illicit drug overdose is a serious problem best solved by getting the person away from access to the illicit drug. People with certain mental illnesses need the help of family and friends to assist with medication therapy and to lend social support. Drug abusers also need this same support in order to stay clean and safe.
Poison prevention and injury prevention in children is an important task for parents, grandparents, and others who take care of small children. Make your home safe so children do not have access to medications. Accidental poisoning is a leading cause of death in children from the age of 6 months to 5 years. Make sure elderly people understand how to take their medication and can recognize one medicine from another. It may be safest to provide some sort of supervision for seniors in taking medication. Pills can be sorted into small containers and labeled to show the time they are to be taken.
• http://www.emedicinehealth.com/drug_overdose/page3_em.htm • http://www.mainegeneral.org/body.cfm?id=1783