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PubMed1989

Substances involved in fatal drug overdoses in Brisbane, 1979-1987.

Suicide rates may be reduced by decreasing the availability, cultural acceptance or lethality of certain methods of suicide. With these principles in mind fatal overdoses in Brisbane 1979-1987 were surveyed for substances involved. Psychotropic agents, especially barbiturates predominated. Chloral hydrate was far the most commonly implicated single compound. A case is put for curtailing the availability of barbiturates and chloral hydrate. This combined with increasing detection of depressed persons may lead to a further rise in overdoses involving antidepressants which as a group require reduction in their lethality.

Cause of Death↗
PubMed2002

Using trade names: a risk factor for accidental drug overdose.

Medication errors due to the exclusive use of trade names of drugs may lead to life-threatening complications. We report the case of a patient with verapamil overdose as a result of this. This case illustrates that the use of trade names, omitting the international nonproprietary names of the active moiety, carries the risk of serious adverse drug events by overdose.

Adverse Drug Reaction Reporting Systems↗
PubMed1993

Diagnostic and therapeutic utility of flumazenil in comatose patients with drug overdose.

From July 1, 1990 and June 30, 1991, 61 unconscious patients with drug intoxication were prospectively enrolled into this study in order to evaluate the efficacy and safety of flumazenil in the management of this patient population. Flumazenil was injected intravenously as a 0.3-mg bolus in the first minute followed by 0.2-mg and 0.3-mg doses every minute until a total dose of 1 mg was given or until the patient responded. The Glasgow coma scale and a sedation-level scoring system were checked prior to and at 1, 5, and 30 minutes after the dose eliciting response or on completion of the full dose of flumazenil. The patients were divided into two groups based on their response to flumazenil: group 1, responders (N = 55), and group 2, nonresponders (N = 6). Eleven patients from group 1 allowed us to retrieve drug information from these patients once mental status had recovered and patients were treated accordingly. In two cases endotracheal intubation and artificial ventilation were rendered unnecessary by the use of flumazenil. No undesirable hemodynamic effects were noted after flumazenil injection in this study, although none of the patients overdosed on antidepressants. Flumazenil may serve as a useful diagnostic and therapeutic tool in the management of selected cases of drug-induced coma.

Adolescent↗
PubMed1985

Drug overdose in children.

This paper reviews epidemiological factors, drugs taken, management and outcome of 478 children admitted to the Royal Children's Hospital with drug poisoning during the 5 years 1978-82. Accidental ingestion in young children is still common whilst self poisoning is increasing in the age group 8-17 years. Suicide attempts and self destructive ingestion accounted for 11.5% of all cases with two deaths. A significant number in this group were less than 10 years of age. Iatrogenic poisoning accounted for 11% of all cases with metoclopramide or prochlorperazine frequently involved. Benzodiazepines, major tranquillizers and antihistamines were the most commonly taken groups of drugs whilst the greatest number of admissions to Intensive Care Unit were due to tricyclic poisoning. Principles of management are discussed.

Accidents↗
PubMed1987

Obtundation in the elderly patient: presentation of a drug overdose.

The case of an obtunded elderly woman is presented. The patient initially was thought to have suffered a cardiovascular accident but was discovered to have taken an overdose of flurazepam hydrochloride. Depression is a common and under-recognized problem in the geriatric population. As a consequence, suicide rates are highest in the elderly. Over- and underdosing of both prescription and nonprescription drugs are common means available to the suicidal elderly patient. These overdoses are often attributed to unintentional patient errors and overlooked for what they are, attempted suicides, or they are missed entirely as a cause of the patient's presentation. This case illustrates the need to consider drug overdose in the obtunded elderly patient.

Aged↗
PubMed1993

Seizures associated with poisoning and drug overdose.

A retrospective review of cases consulted by the San Francisco Bay Area Regional Poison Control Center during a 2-year period was performed to determine the causes and consequences of seizures associated with poisoning and drug intoxication. Of 233 charts coded as involving seizures, 191 occurred in humans and were available for analysis. The leading causes of seizures reported to the Poison Control Center were cyclic antidepressants (55 cases, 29%); cocaine and other stimulants (55 cases, 29%); diphenhydramine and other antihistamines (14 cases, 7%); theophylline (10 cases, 5%); and isoniazid (10 cases, 5%). Stimulants and diphenhydramine were more likely than other drugs to produce brief, self-limited seizures. In contrast, poisoning by cyclic antidepressants, cardiodepressant antiarrhythmic agents, or theophylline was more likely to be associated with death. Seizures in elderly patients were more likely to result in complications and death. The frequency of seizure-related cases by substance type was also compared with the results of an earlier survey performed in 1981, and found a striking increase in the proportion of seizures caused by cocaine and (23% in 1988 to 1989 compared with 4% in 1981). Poison Control Center data can provide valuable information about the causes and consequences of drug-related medical complications, as well as highlight changing trends in drug-related injury.

Adolescent↗
PubMed1994

Seizures associated with poisoning and drug overdose.

A retrospective review of cases consulted by the San Francisco Bay Area Regional Poison Control Center during a 2-year period was performed to determine the causes and consequences of seizures associated with poisoning and drug intoxication. Of 233 charts coded as involving seizures, 191 occurred in humans and were available for analysis. The leading causes of seizures reported to the Poison Control Center were cyclic antidepressants (55 cases, 29%); cocaine and other stimulants (55 cases, 29%); diphenhydramine and other antihistamines (14 cases, 7%); theophylline (10 cases, 5%); and isoniazid (10 cases, 5%). Stimulants and diphenhydramine were more likely than other drugs to produce brief, self-limited seizures. In contrast, poisoning by cyclic antidepressants, cardiodepressant antiarrhythmic agents, or theophylline was more likely to be associated with death. Seizures in elderly patients were more likely to result in complications and death. The frequency of seizure-related cases by substance type was also compared with the results of an earlier survey performed in 1981, and found a striking increase in the proportion of seizures caused by cocaine and (23% in 1988 to 1989 compared with 4% in 1981). Poison Control Center data can provide valuable information about the causes and consequences of drug-related medical complications, as well as highlight changing trends in drug-related injury.

Adolescent↗
PubMed2005

Drug overdose in a young man: a not-so-happy face.

Patients who are found comatose and remain in this state are a diagnostic challenge for neurologists and emergency room (ER) physicians. In this case, a drug addict, who was found comatose, had to be intubated when he arrived in the ER. Diagnostic strategies focus on using neuroimaging to establish the cause, especially when characteristic abnormalities appear. Therapeutic options also are discussed.

Adult↗
PubMed1996

Management of drug overdoses in accident and emergency departments in the United Kingdom.

A questionnaire consisting of 10 overdose scenarios was sent to 190 career accident and emergency staff in the United Kingdom, asking in each case how the respondents would treat a patient to prevent drug absorption. The responses showed lack of consensus in treatment methods. There was extensive use of both ipecacuanha induced emesis and gastric lavage despite a lack of experimental evidence to support these techniques.

Adolescent↗
PubMed2002

Measuring plasma paracetamol concentrations in all patients with drug overdoses; development of a clinical decision rule and clinicians willingness to use it.

OBJECTIVES: The study proposed a clinical decision rule: In patients who have taken a deliberate overdose, but deny taking paracetamol or paracetamol containing compounds, who have a GCS of 15, understand English well, and have not taken excessive alcohol, there is no need to take blood for paracetamol estimation. METHODS: 307 consecutive emergency department patients were followed up, and the history of their overdose was correlated to blood paracetamol concentrations. In addition, clinicians were asked what level of confidence they required from such a clinical decision rule before they would use it. RESULTS: 152 admitted paracetamol and 155 denied it. Of the 155 that denied it, 13 had concentrations detected in the blood, but needed no treatment with antidote. Eighty three per cent of clinicians require a false negative rate of less than 1%. CONCLUSIONS: Using this decision rule, only 46 of 307 patients would not have required paracetamol concentrations to be measured. To show a negative rate of less than 1% a sample size of 20,000 patients would be needed. BOTTOM LINE: All patients who allege taking an overdose need paracetamol concentrations checking.

Acetaminophen↗
PubMed1992

Drug overdose--reducing the load.

OBJECTIVE: To review available information about various methods for reducing gastrointestinal absorption of a poison or drug. DATA SOURCES: Articles on overdose and accidental poisoning generated by the Australian Medlars Service and concentrating on the period between 1985 and 1990 were surveyed. Earlier studies were included if relevant. STUDY SELECTION AND DATA EXTRACTION: English language articles with an emphasis on studies using objective methods to measure individual and comparative efficacy of gastrointestinal decontamination techniques were selected. A total of 65 articles were reviewed. DATA SYNTHESIS: Gastric emptying procedures (gastric lavage or emesis caused by syrup of ipecac) are only effective if performed within one hour of drug ingestion. Gastric lavage is superior to syrup of ipecac. Oral administration of activated charcoal is more effective than either gastric emptying procedure, and is recommended for most cases of poisoning. Cathartics (sorbitol) can be used with activated charcoal. Whole bowel lavage with polyethylene glycol is indicated in selected cases of potentially lethal overdose where the toxic substance cannot be absorbed by charcoal and has passed the pylorus. CONCLUSIONS: Children--syrup of ipecac can be given at home to children older than 12 months. Most children who reach hospital can be treated by charcoal alone. ADULTS--Most patients are managed with supportive care and, in the absence of contraindications, a single dose of activated charcoal if seen within four hours of ingestion of the poison or drug. Gastric lavage is used if the patient presents within one hour of ingestion and has clinical features of toxicity.

Adult↗
PubMed1986

The bodystuffer syndrome: a clandestine form of drug overdose.

The case histories of five people who ingested drugs in an attempt to conceal illegal substances when they were confronted by police are reported. They presented to an emergency department in various clinical states ranging from asymptomatic to comatose. This syndrome has been called "bodystuffing" by the authors, who differentiate it from "bodypacking," which is the ingestion of drugs for the purpose of smuggling. Bodystuffers may ingest one or more drugs, usually deny the ingestion, and are often not discovered until symptoms develop. Bodystuffers tend to be known drug dealers and are often drug abusers themselves. The ingestion is often unsuspected by authorities, but the act may also be witnessed but regarded as trivial. A common scenario is that of a person who is in an asymptomatic state when arrested and is later found comatose in jail. A variant of the syndrome is the ingestion of drugs to produce a medical condition that could defer incarceration.

Adult↗