Poisoning & Drug

Poisoning and Drug Overdose
Objectives
At the end of this session, the learners will be able to :

• Define poisoning.
• Define drug overdose.
• Explain the causes of a drug overdose.
• Enlist some common drugs that can be overdosed.
• Explain the general management of drug overdose.
• Discuss the antidotes of some commonly used
overdosed drugs.
What is Poisoning?
• A poison is any substance that is harmful to the body.

• One might swallow it, inhale it, inject it, or absorb it
through the skin.
• Intentional or accidental.
• Any substance can be poisonous if too much is taken.
What is a Drug Overdose?
The term drug overdose (or simply overdose or OD)

describes the ingestion or application of a drug or other
substance in quantities greater than are recommended or
generally practiced. An overdose may result in a toxic
state or death.
What are the causes of drug
overdose?
The cause of a drug overdose is either accidental

overuse or intentional misuse. Accidental overdoses
result from either a young child or an adult with
impaired mental abilities swallowing a medication left
within their grasp.
What is the most common drug used to
overdose?
• The most frequent drugs that people overdose on

are:
• Over-the-counter (OTC) drugs.
• Prescription pain relievers.
• Sedatives and antidepressants.
• Heroin.
• Methamphetamines.
• Cocaine.
• Drug combinations (i.e. heroin and alcohol)
General- Management
• Provision of supportive care

• Prevention of poison absorption
• Enhancement of elimination of poison
• Administration of antidotes
Supportive Care
• ABC
• Vital signs, mental status, and pupil size
• Pulse oximetry, cardiac monitoring, ECG
• Protect airway
• Intravenous access
• cervical immobilization if suspect trauma
• Rule out hypoglycemia
• Naloxone for suspected opiate poisoning
History
• Pill bottles
• Alcohol
• Drug history including access
• Remember OTC drugs
• Suicide note
• National Poisons Information Centre *
Examination
• Physiologic excitation –
anticholinergic, sympathomimetic, or central
hallucinogenic agents, drug withdrawal
• Physiologic depression –
cholinergic (parasympathomimetic), sympatholytic,
opiate, or sedative-hypnotic agents, or alcohols
• Mixed state –
polydrugs, hypoglycemic agents, tricyclic
antidepressants, salicylates, cyanide
Preventing Absorption
Gastric lavage
• Not in an unconscious patient unless intubated (risk aspiration)
• Flexible tube is inserted through the nose into the stomach
• Stomach contents are then suctioned via the tube
• A solution of saline is injected into the tube
• Recommended for up to 2 hrs in TCA & up to 4hrs in Salicylate
OD
Induced Vomiting
• Not routinely recommended
• Risk of aspiration
Preventing Absorption
Activated charcoal
• Adsorbs toxic substances or irritants, thus inhibiting GI
absorption
• Addition of sorbitol →laxative effect
• Oral: 25-100 g as a single dose
• repetitive doses useful to enhance the elimination of certain
drugs (eg, theophylline, phenobarbital, carbamazepine, aspirin,
sustained-release products)
• not effective for cyanide, mineral acids, caustic alkalis, organic
solvents, iron, ethanol, methanol poisoning, lithium
Elimination of Poisons
Renal elimination
• Medication to stimulate urination or defecation may be given to try to flush the
excess drug out of the body faster.
Forced alkaline diuresis
• Infusion of a large amount of NS+NAHCO3
• Used to eliminate acidic drugs that are mainly excreted by the kidney eg
salicylates
• Serious fluid and electrolytes disturbance may occur
• Need expert monitoring
Hemodialysis:
• Reserved for severe poisoning
• Drug should be dialyzable i.e. protein bound with a low volume of distribution
• may also be used temporarily or as long term if the kidneys are damaged due to
the overdose.
Antidotes
• Is the drug taken known?
• Does an antidote exist?

Opiates
• Antidote – naloxone
• MOA: Pure opioid antagonist competes and displaces
narcotics at opioid receptor sites
• I.V. (preferred), I.M., intratracheal, SubQ: 0.4-2 mg every 2-3
minutes as needed
• Lower doses in opiate dependence
• Elimination half-life of naloxone is only 60 to 90 minutes
• Repeated administration/infusion may be necessary
• S/E BP changes; arrhythmias; seizures; withdrawal
Benzodiazepines
• Antidote – flumazenil
• MOA: Benzodiazepine antagonist
• IV administration 0.2 mg over 15 sec to max 3mg
• S/E N&V; arrhythmias; convulsions
• C/I concomitant TCAD; status epilepticus
• Should not be used for making the diagnosis
• Benzodiazepines may be masking/protecting against
other drug effects
TCAD Overdose -Treatment
• ABC – many require intubation

• Consider gastric lavage if taken < 2hrs
• Activated charcoal
• Treatment of hypotension with isotonic saline
• Sodium bicarbonate for cardiovascular toxicity
• Alpha adrenergic vasopressors (norepinephrine) for
hypotension refractory to aggressive fluid resuscitation
and bicarbonate infusion
• Benzodiazepines for seizures
How much does it take to overdose on
paracetamol?
The lowest amount of Paracetamol to cause death was

found by one study to be 10g. As for Paracetamol of
500mg per tablet, it is generally recommended to take
no more than 8 tablets (500mg) within 24 hours, and 24
to 30 tablets taken at one time can lead to overdose or
even death.
Paracetamol
• Widely available
• Potential toxicity underestimated
• Toxicity unlikely to result from a single dose of less than 150
mg/kg in children or 7.5 to 10 g for adult
• Toxicity is likely with single ingestions greater than 250
mg/kg or those greater than 12 g over a 24-hour period
• Virtually all patients who ingest doses in excess of 350 mg/kg
develop severe liver toxicity unless appropriately treated
Paracetamol Overdose Treatment
• Activated charcoal within four hours of ingestion

• May reduce absorption by 50 to 90 percent
• Single oral dose of one gram per kilogram
• Inhibits absorption of oral methionine
Cont.….
• A person has alcohol poisoning if they have
consumed a toxic amount of alcohol, usually over a
short period. Their blood alcohol level is so high it is
considered toxic (poisonous). The patient can become
extremely confused, unresponsive, disoriented, have
shallow breathing, and can even pass out or go into a
coma.
How long do the effects of alcohol
poisoning last?
A major cause of alcohol poisoning is binge drinking —

a pattern of heavy drinking when a male rapidly
consumes five or more alcoholic drinks within two
hours, or female downs at least four drinks within two
hours. An alcohol binge can occur over hours or last up
to several days
How do you stop vomiting after
drinking?
• Drink water to dilute the alcohol currently in your

system. Avoid physical activity as much as possible.
Eat some cereal or bread. Carbohydrates can slow
down alcohol absorption and the salt will help to
replace electrolytes.
Can you die from alcohol poisoning?
• Hypothermia may become dangerous. If the

individual loses too much fluid (severe dehydration)
there is a risk of brain damage. If blood glucose
levels drop they might have fits (seizures). If
the alcohol poisoning is extreme the patient can go
into a coma and eventually die.
Treatment
• This typically includes:
• Careful monitoring.
• Prevention of breathing or choking problems.
• Oxygen therapy.
• Fluids are given through a vein (intravenously) to
prevent dehydration.
• Use of vitamins and glucose to help prevent serious
complications of alcohol poisoning.
How we can avoid Drug overdose?
References
1. Center for Behavioral Health Statistics and Quality. 2014 National Survey on Drug Use and Health: Detailed
Tables. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2015.
2. Translational research focus of NIDA organizational shift [news release]. Rockville MD: National Institute on Drug
Abuse; October 1, 2015.
https://archives.nida.nih.gov/news-events/news-releases/2015/10/translational-research-focus-of-nida-organizational-shi
ft
. Accessed September 24, 2015.
3. U.S. Department of Justice National Drug Intelligence Center. National Drug Threat Assessment 2011.
http://www.justice.gov/archive/ndic/pubs44/44849/44849p.pdf. Published August 2011. Accessed September 24, 2015.
4. U.S. Department of Health and Human Services. The Health Consequences of Smoking: 50 Years of Progress. A Report
of the Surgeon General. http://www.surgeongeneral.gov/library/reports/50-years-of-progress/full-report.pdf. Revised
January 2014. Accessed September 24, 2015.
5. Volkow ND, Baler RD. Addiction science: Uncovering neurobiological complexity. Neuropharmacology. 2014;76:235-
249.
6. Jinek M, Chylinski K, Fonfara I, Hauer M, Doudna JA, Charpentier E. A programmable dual-RNA-guided DNA
endonuclease in adaptive bacterial immunity. Science. 2012;337(6096):816-821.
7. HIPAA administrative simplification: enforcement. Office of the Secretary, HHS. Federal Register, Rules and
Regulations, Vol. 74. No.29; October 30, 2009. http://www.hhs.gov/sites/default/files/ocr/privacy/hipaa/administrative/
enforcementrule/enfifr.pdf. Accessed September 24, 2015.

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Poisoning and Drug Overdose

At the end of this session, the learners will be able to :

• A poison is any substance that is harmful to the body.

The term drug overdose (or simply overdose or OD)

The cause of a drug overdose is either accidental

• The most frequent drugs that people overdose on

• Provision of supportive care

• Is the drug taken known?

• Does an antidote exist?

• ABC – many require intubation

The lowest amount of Paracetamol to cause death was

• Activated charcoal within four hours of ingestion

A major cause of alcohol poisoning is binge drinking —

• Drink water to dilute the alcohol currently in your

• Hypothermia may become dangerous. If the

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