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Biography
other uses2|OverdoseInfobox Disease| Name = Drug overdose| Image = CharcoalPO.jpg| Caption = Activated carbon is a commonly used agent for decontamination of the gastrointestinal tract in overdoses.| DiseasesDB =| ICD10 = T36-T50| ICD9 = ICD9|960-ICD9|979| ICDO =| OMIM =| MedlinePlus =| eMedicineSubj =| eMedicineTopic =| MeshID = D015537The 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 http://www.treatment-now.com/resources/definitions/ or generally practiced. http://www.uphs.upenn.edu/addiction/berman/glossary/ An overdose may result in a toxicity|toxic state or death .
Classification
The word "overdose" implies that there is a common safe dosage and usage for the drug; therefore, the term is commonly only applied to drugs, not poisons , though even certain poisons are harmless at a low enough dosage.
Drug overdoses are sometimes caused intentionally to commit suicide or as self-harm , but many drug overdoses are accidental, the result of intentional or unintentional misuse of medication. Intentional misuse leading to overdose can include using prescribed or unprescribed drugs in excessive quantities in an attempt to produce euphoria .
Usage of illicit drugs of unexpected purity, in large quantities, or after a period of drug abstinence can also induce overdose. Cocaine users who Injection (medicine)#Intravenous infusion|inject intravenously can easily overdose accidentally, as the margin between a pleasurable drug sensation and an overdose is small.Study on http://www.biomedcentral.com/1471-2458/7/31 fatal overdose in New-York City 1990-2000, visited May 11, 2008
Unintentional misuse can include errors in dosage caused by failure to read or understand product labels. Accidental overdoses may also be the result of over-prescription, failure to recognize a drug's active ingredient, or unwitting ingestion by children"What to do with leftover medicines". Medicines Talk , Winter 2005. Available at http://www.nps.org.au/consumers/publications/medicines_talk/mt14/what_to_do_with_left-over_medicines2 A common unintentional overdose in young children involves multi-vitamins containing iron. Iron is a component of the hemoglobin molecule in blood , used to transport oxygen to living cells. When taken in small amounts, iron allows the body to replenish hemoglobin, but in large amounts it causes severe pH imbalances in the body. If this overdose is not treated with chelation therapy , it can lead to death or permanent coma .
The term 'overdose' is often misused as a descriptor for adverse drug reaction s or negative drug interaction s due to polypharmacy|mixing multiple drugs simultaneously .
Signs and symptoms
cite book |author=Goldfrank, Lewis R. |title=Goldfrank's toxicologic emergencies|publisher=Appleton & Lange |location=Norwalk, CT |year=1998 |pages= |isbn=0-8385-3148-2 |oclc= |doi= |accessdate=>
blood pressure
anticholinergic
cholinergic
opioid
sympathomimetic
sedative-hypnotic
Signs and symptoms of an overdose varies depending on the drug or toxin exposure. The symptoms can often be divided into differing toxidrome s. This can help one determine what class of drug or toxin is causing the difficulties.
Symptoms of opioid overdoses include slow breathing, heart rate and pulse.cite web|last=Chandler|first=Stephanie|title=Symptoms of an opiate overdose|url= http://www.livestrong.com/article/68582-symptoms-opiate-overdose/|publisher=Live Strong|accessdate=17 May 2012 Opioid overdoses can also cause pinpoint pupils, and blue lips and nails due to low levels of oxygen in the blood. A person experiencing an opioid overdose might also have muscle spasms, seizures and decreased consciousness. A person experiencing an opiate overdose usually will not wake up even if their name is called or if they are shaken vigorously.
Causes
The Psychoactive drug|drugs or toxin s which are most frequently involved in overdose and death (grouped by ICD-10 ):
* Drug "cocktails" ( Speedball (drug)|Speedballs )
Medications
* Aspirin poisoning (T39.0)
* Paracetamol toxicity (T39.1)
* Tricyclic antidepressant overdose (T43.0)
* Vitamin poisoning
Pesticide poisoning (T60)
* Organophosphate poisoning
* DDT#Effects_on_human_health|DDT
Diagnosis
Determination of the substance which has been taken may often be determined by asking the person. However, if they will not, or cannot, due to an altered level of consciousness , provide this information, a search of the home or questioning of friends and family may be helpful.
Examination for toxidrome s, drug testing, or laboratory test may be helpful. Other laboratory test such as glucose , urea and electrolyte s, paracetamol levels and salicylate levels are typically done. Negative drug-drug interactions have sometimes been misdiagnosed as an acute drug overdose, occasionally leading to the assumption of suicide . http://www.preskorn.com/columns/0207.html Column - Fatal Drug-Drug Interaction As a Differential Consideration in Apparent Suicides
Prevention
The distribution of naloxone to injection drug users and other opioid drug users decreases the risk of death from overdose.cite journal |author=Piper TM |title=Evaluation of a naloxone distribution and administration program in New York City |journal=Subst Use Misuse |volume=43 |issue=7 |pages=858–870 |year=2008 |pmid=18570021 |doi=10.1080/10826080701801261 |url= |author-separator=, |author2=Stancliff S |author3=Rudenstine S |display-authors=3 |last4=Sherman |first4=Susan |last5=Nandi |first5=Vijay |last6=Clear |first6=Allan |last7=Galea |first7=Sandro CDC estimates that US programs for drug users and their caregivers prescribing take-home doses of naloxone and training on its utilization are estimated to have reversed 10,000 opioid overdose deaths.cite web|title=OD Prevention Program Locator.|url= http://www.overdosepreventionalliance.org/p/od-prevention-program-locator.html|publisher=Overdose Prevention Alliance|accessdate=15 May 2012cite journal|title=Community-Based Opioid Overdose Prevention Programs Providing Naloxone — United States, 2010|journal=Centers for Disease Control and Prevention||date=2010 Dec|url= http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6106a1.htm Healthcare institution-based naloxone prescription programs have also helped reduce rates of opioid overdose in the US state of North Carolina, and have been replicated in the US military.cite journal|author=Albert S, Brason FW 2nd, Sanford CK, Dasgupta N, Graham J, Lovette B.|title=Project Lazarus: community-based overdose prevention in rural North Carolina|journal=Pain Medicine|date=2011 Jun|url= http://www.ncbi.nlm.nih.gov/pubmed/21668761cite journal|author=Beletsky L, Burris S, and Kral AH.|title=Closing Death's Door: Action Steps to Facilitate Emergency Opioid Drug Overdose Reversal in the United States|journal=Center for Health Law, Policy and Practice, Temple University School of Law|date=2009 Jul|url= http://papers.ssrn.com/sol3/papers.cfm? abstract_id=1437163|accessdate=2012-05-12 Nevertheless, scale-up of healthcare-based opioid overdose interventions is limited by providers’ insufficient knowledge and negative attitudes towards prescribing take-home naloxone to prevent opioid overdose.cite journal|author=Beletsky L, Ruthazer R, Macalino GE, Rich JD, Tan L, Burris S.|title=Physicians' knowledge of and willingness to prescribe naloxone to reverse accidental opiate overdose: challenges and opportunities|journal=Journal of Urban Health|date=2007 Jan|url= http://www.ncbi.nlm.nih.gov/pubmed/17146712 Programs training police and fire personnel in opioid overdose response using naloxone have also shown promise in the US.cite web|last=Beletsky L, Moroz E.|title=The Quincy Police Department: Pioneering Naloxone Among First Responders.|url= http://www.overdosepreventionalliance.org/2012/05/quincy-police-department-pioneering.html|publisher=Overdose Prevention Alliance|accessdate=15 May 2012cite journal|author=Lavoie D.|title=Naloxone: Drug-Overdose Antidote Is Put In Addicts' Hands|journal=Huffington Post|date=2012 April| http://www.huffingtonpost.com/2012/04/26/naloxone-drug-overdose-antidote_n_1456531.html
Management
Stabilization of the ABC (medicine)|ABCs are the initial treatment of an overdose. Ventilation is considered when there is a low respiratory rate or when blood gases show the person to be hypoxia (medical)|hypoxic . Monitoring of the patient should continue before and throughout the treatment process, with particular attention to temperature, pulse , respiratory rate , blood pressure , urine output, electrocardiography (ECG) and O2 saturation.cite book |title=Oxford Handbook of Clinical Medicine |last=Longmore |first=Murray |coauthors=Ian Wilkinson, Tom Turmezei, Chee Kay Cheung |year=2007 |publisher=Oxford |location=United Kingdom |isbn=0-19-856837-1 Poison control center s and Medical toxicology|Medical toxicologists are available in many areas to provide guidance in overdoses to both physicians and the general public.
Antidotes
Specific antidote s are available for certain overdoses--for example, Naloxone is the antidote for opiate s such as heroin or morphine . Charcoal is frequently recommended if available within one hour of the ingestion and the ingestion is significant.cite journal|last=Vanden Hoek|first=TL|coauthors=Morrison, LJ, Shuster, M, Donnino, M, Sinz, E, Lavonas, EJ, Jeejeebhoy, FM, Gabrielli, A|title=Part 12: cardiac arrest in special situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care|journal=Circulation|date=2010 Nov 2|volume=122|issue=18 Suppl 3|pages=S829–61|pmid=20956228|doi=10.1161/CIRCULATIONAHA.110.971069 Gastric lavage , syrup of ipecac , and whole bowel irrigation are rarely used.
Epidemiology
The National Center for Health Statistics report that 19,250 people died of accidental poisoning in the U.S. in the year 2004 (8 deaths per 100,000 population). http://www.cdc.gov/nchs/fastats/acc-inj.htm National Center for Health Statistics
In 2008 testimony before a Senate subcommittee, Medical Epidemiologist Dr. Leonard J. Paulozzi http://www.cdc.gov/media/subtopic/sme/paulozzi.htm Centers for Disease Control and Prevention of the Centers for Disease Control and Prevention stated that in 2005 (the most recent year for which data was available) more than 22,000 American lives were lost due to overdoses, and the number is growing rapidly. Dr. Paulozzi also testified that all available evidence suggests that unintentional overdose deaths are related to the increasing use of prescription drugs, especially opioid painkillers. http://www.cdc.gov/washington/testimony/2008/t20080312a.htm Centers for Disease Control and Prevention
See also
List of drug-related deaths
Water intoxication
References
reflist|2
Further reading
cite book |author=Nelson, Lewis H.; Flomenbaum, Neal; Goldfrank, Lewis R.; Hoffman, Robert Louis; Howland, Mary Deems; Neal A. Lewin |title=Goldfrank's toxicologic emergencies |publisher=McGraw-Hill, Medical Pub. Division |location=New York |year=2006 |pages= |isbn=0-07-143763-0 |oclc= |doi= |accessdate=
cite book | author = Olson, Kent C. | authorlink = | editor = | others = | title = Poisoning & drug overdose | edition = | language = | publisher = Lange Medical Mooks/McGraw-Hill | location = New York | year = 2004 | origyear = | pages = | quote = | isbn = 0-8385-8172-2 | oclc = | doi = | url = | accessdate =
External links
Wiktionary|overdose
http://www.quihn.org.au Fact sheets on illicit drugs, overdose prevention, detox and harm reduction strategies.
drug usePsychoactive substance usePoisoning and toxicity Category:Drug overdose| Category:Medical emergencies Category:Poisoning by drugs, medicaments and biological substances| Category:Drugs Category:Suicide methods Category:Substance abuse Category:Psychiatric diagnosis
