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Drug overdose

An overdose of over-the-counter or prescription medicine, or other drugs, may be accidental or intentional.


A person may get their dose wrong, or misread the label.


Illicit drugs, used to get 'high', may be taken in overdose amounts when a person's metabolism cannot detoxify the drug fast enough to avoid unintended side effects.


Exposure to chemicals, plants, and other toxic substances that can cause harm are called poisonings. The higher the dose or the longer the exposure, the worse the poisoning. Two examples are carbon monoxide poisoning and mushroom poisoning.


People respond differently to a drug overdose. Treatment is tailored to the individual's needs.


Drug overdoses can involve people of any age. It is most common in very young children (from crawling age to about five years) and among teenagers to those in their mid-30s.


Drug overdose causes


The cause of a drug overdose is either by accidental overuse or by intentional misuse. Accidental overdoses result from either a young child or an adult with impaired mental abilities swallowing a medication left within their grasp. An adult (especially elderly persons or people taking many medications) can mistakenly ingest the incorrect medication or take the wrong dose of a medication. Purposeful overdoses are for a desired effect, either to get high or to harm oneself.


Young children may swallow drugs by accident because of their curiosity about medications they may find. Children younger than five years (especially six months to three years) tend to put everything they find in their mouths. Drug overdoses in this age group are generally caused when someone accidentally leaves a medication within the child's reach. Toddlers, when they find medications, often share them with other children. Therefore, if you suspect an overdose in one child while other children are around, those other children may have taken the medication too.


Adolescents and adults are more likely to overdose on one or more drugs in order to harm themselves. Attempting to harm oneself may represent a suicide attempt. People who purposefully overdose on medications frequently suffer from underlying mental health conditions. These conditions may or may not have been diagnosed before.


Drug overdose symptoms


Drugs have effects on the entire body. Generally, in an overdose, the effects of the drug may be a heightened level of the therapeutic effects seen with regular use. In overdose, side effects become more pronounced, and other effects can take place, which would not occur with normal use. Large overdoses of some medications cause only minimal effects, while smaller overdoses of other medications can cause severe effects, possibly death. A single dose of some medications can be lethal to a young child. Some overdoses may worsen a person's chronic disease. For example, an asthma attack or chest pains may be triggered.

Problems with vital signs (temperature, pulse rate, respiratory rate, blood pressure) are possible and can be life threatening. Vital sign values can be increased, decreased, or completely absent.

Sleepiness, confusion, and coma are common and can be dangerous if the person breathes vomit into the lungs (aspiration).

Skin can be 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 diarrhoea are possible. Vomitingblood, or blood in bowel movements, can be life threatening.

Specific drugs can damage specific organs, depending on the drug.


When to seek medical care


Your doctor, or the accident and emergency department of your local hospital may be able to help determine the seriousness of a suspected drug overdose. Development of any symptoms after drug overdose requires immediate and accurate information about the specific name of the drug, the amount of the drug ingested, and the time when the drug was taken. Often, the packet the drug came in will have the information needed.


In life-threatening circumstances, call 999 for an ambulance.


You are not expected to know when a drug overdose is serious. If you cannot reach a qualified professional by telephone to discuss the overdose take the overdosed person to the nearest hospital's accident and emergency department, or call 999.


Take appropriate caution when dealing with a drug overdose. Each person responds differently, and reactions are hard to predict. Many people who are directed to go to the accident and emergency department may not develop any physical signs of poisoning. Others will become quite ill.


A person unwilling to go to hospital may need persuasion by trained professionals in emergency medical services (paramedics and ambulance personnel) or the police. Call 999 for these services. Family members are also often helpful in persuading the person to seek medical care.


Anyone who is with a person who overdoses on drugs can assist by finding all medication or chemical containers and bringing them to the hospital.


Examinations and tests


A history and physical examination to look for evidence of poisoning will be performed. The doctor will arrange laboratory tests based on the organ systems that can be harmed by the specific drug overdose.


Family members and friends are an important source of information. They can assist in providing the doctor with names of drugs, amounts taken, and the timing of the overdose.


Specific drug levels in the blood may be measured, depending on the drug taken and the reason for the overdose.


Drug screening may also be done.


Drug overdose treatment


Treatment will be dictated by the specific drug taken in the overdose. Information provided about amount, time, and underlying medical problems will be very helpful.


The stomach may be washed out by gastric lavage (stomach pumping) to mechanically remove unabsorbed drugs from the stomach.


Activated charcoal may be given to help bind drugs and keep them in the stomach and intestines. This reduces the amount absorbed into the blood. The drug, bound to the charcoal, is then expelled in the stool. Often, a cathartic is given with the charcoal so that the person more quickly evacuates stool from his or her bowels.


Agitated or violent people may need physical restraint and sometimes sedating medications in the accident and emergency department until the effects of the drugs wear off. This can be disturbing for a person to experience and for family members to witness. Medical professionals go to great lengths to use only as much force and as much medication as necessary. It is important to remember that whatever the medical staff do, it is to protect the person they are treating. Sometimes the person has to be intubated (have a tube placed in the airway) so that the doctor can protect the lungs or help the person breathe during the detoxification process.


For certain overdoses, other medicine may need to be given either to serve as an antidote to reverse the effects of what was taken or to prevent even more harm from the drug that was initially taken. The doctor will decide if treatment needs to include additional medicines.


Self-care at home


Home care should not be done without first consulting a doctor or expert.


For some accidental drug overdoses home therapy and observation may be recommended. Because of the potential for problems after some overdoses, syrup of ipecac or other therapies should not be given unless directed by a medical professional.


Anyone who has small children at home should have emergency health advice telephone numbers readily available near the telephone.


People who take a drug overdose in an attempt to harm themselves generally require psychiatric intervention in addition to poison management. People who overdose for this purpose must be taken to a hospital's accident and emergency department, even if their overdose seems trivial. These people are at risk of eventually achieving a successful suicide. The sooner you intervene, the better the success of avoiding suicide.


Next steps - follow-up


Everyone who suffers from an overdose needs to be seen by his or her doctor for follow-up. In part this is to ensure that there are no delayed injuries to any organ system. It is also to make sure that prevention against a recurrence is in place.


After an intentional drug overdose has been managed and the person is out of danger, psychiatric care needs to be provided. The abuser of illicit drugs should also be considered for a mental health evaluation. Finding a support group for a psychiatric or substance abuse problem can be very helpful.


For children, the experience of being treated for an overdose may have been frightening. They need help in coping with the trauma as well as learning from the mistake. Following up with their doctor can reduce anxiety and also be a good learning experience. The same is true for their parents. Do not point fingers or assign guilt. Use the follow-up visit to discuss prevention and safety.


Prevention


To prevent accidental overdoses, prescribed and over-the-counter medications, herbal remedies, and vitamins and minerals 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 health 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 six months to five years.


Make sure elderly people understand how to take their medication and can recognise one medicine from another. It may be safest to provide some sort of supervision for pensioners taking medication. Pills can be sorted into small dosage containers and labelled to show the time they are to be taken. Some containers come with clocks that have audible alarms as a reminder to take medications at specific times. Other containers can be filled a week at a time.


Outlook


A person who overdoses generally recovers completely and without lasting physical disability.


Some drugs can cause transient damage to certain organ systems. Improvement is noted first in the hospital and then at home. However, some overdoses can cause permanent damage to certain organ systems. The liver and the kidneys are two organ systems at high risk.


Brain damage resulting from suppression of lung and heart function is generally permanent.


If the mental health problems that led to an intentional overdose are not addressed, then the person remains at risk of repetitive drug overdoses. Multiple overdoses can have a cumulative effect on some organ systems and lead to injury and organ failure. Sometimes this effect is not recognised until later in the person's life.


Source: WebMD

Drug overdose