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Drug Overdose

Author -  <a href='https://www.medindia.net/content-team/madhumathi-palaniappan.asp' target='_blank'>Madhumathi Palaniappan, B.Pharm</a>
Medically Reviewed by <a href='https://www.medindia.net/content-team/dr-simi-paknikar.asp' target='_blank'>Dr. Simi Paknikar, MD</a> on Apr 01, 2016
Medically Reviewed by Dr. Simi Paknikar, MD on Apr 01, 2016


What is Drug Overdose?

Drug overdose is the term that is used for ingestion of prescription drugs, alcohol, over-the-counter (OTC) medications and illegal drugs in larger amounts than recommended.


An overdose may occur due to an:

Accidental overdose: Occurs when a wrong drug is taken in excessive quantity. This type of overdose is common among children as it can happen when someone accidentally leaves the medication unattended or within the child's reach.

Intentional misuse: Occurs when adolescents and adults take an overdose of the drug intentionally to harm themselves as a suicide attempt or to produce euphoria.

Drug Overdose Death Statistics

Overdose can be lethal. According to the National Center for Health Statistics at the Center for Disease Control and Prevention,there were 43,982 drug overdose deaths in the United States in 2013. Among these, 22,767 deaths were due to the overdose of prescription drugs, out of which 16,235 deaths were due to an overdose of opioids.

Accidental drug overdose is stated as the leading cause of injury-related deaths in the United States for people in the age group of 35-54. Studies also show that most people who die of drug overdose often have high levels of benzodiazepines and alcohol in their body. Notable to this is the death of the famous Pop Singer Michael Jackson, who died due to propofol administered along with benzodiazepines like diazepam, lorazepam and midazolam. Celebrity, Actor Cory Monteith (Glee actor) also died due to the simultaneous intake of heroin and alcohol.

In India, Tamil Nadu had the highest number of drug overdose deaths of about 205 in 2014 while Punjab ranked second with 185 drug overdose deaths, according to the National Crime Records Bureau.

In general, people who suffer from depression and suicidal thoughts, children and elderly people who misuse prescription drugs are more prone for overdose.

What are the Signs and Symptoms of Drug Overdose?

The signs and symptoms of drug overdose may vary from person to person depending on the dose and the type of the drug taken by each individual. Sometimes, large overdoses cause only minimal effects and smaller overdoses result in severe effects which may even lead to death. The liver and kidney are organs at high risk of damage due to overdosage.

Common signs and symptoms of an overdose include:

How Do You Diagnose Drug Overdose?

Diagnosis of drug overdose is based on the following:

What are the First Aid Measures for Drug Overdose?


How Do You Treat Drug Overdose?

What is an ANTIDOTE?

An antidote is a drug or an agent that counteracts the effects of a drug or a poison overdose. It helps in neutralizing the harmful effects of the drug or poison.

Some of the antidotes used for reversing the drug overdose are as follows:

DRUG OVERDOSEANTIDOTE USED
OrganophosphateAtropine
ParacetamolN -Acetylcysteine
BenzodiazepinesFlumazenil
OpiatesNaloxone
IronDesferrioxamine
DigoxinDigibind (Digoxin antibody)
CyanidesNitrites
Ethylene glycol/MethanolEthanol/Fomepizole
HeparinProtamine sulphate

Common drugs that need treatment due to overdose include diazepam, morphine, paracetamol, aspirin, barbiturates, iron, digoxin and heparin.

Diazepam Overdose

Diazepam belongs to the class of benzodiazepines. It is commonly used as sedative and hypnotic and is also used as an anti-anxiety and anti-convulsant agent.

An overdose may result in symptoms like:


Specific Treatment:

Morphine Overdose

Morphine is a Schedule X drug and has to be prescribed with precaution. Addiction to morphine has been noted among the public and also medical professionals. However, addicts can tolerate higher dose than a normal person.

Morphine overdose can be accidental, suicidal or seen in drug abusers. The human lethal dose is estimated to be 250 mg.

Some of the signs of morphine overdose include:

Specific Treatment:

Paracetamol Overdose

Doses of paracetamol greater than 150mg/kg or greater than 10g in adults result in an overdose. Poisoning due to paracetamol occurs especially in small children who have a liver enzyme problem called low hepatic glucuronide conjugating ability.

Most common effects include:

Abdominal pain and nausea which later progresses to liver failure.

Specific Treatment:

Aspirin Overdose Or Salicylism

Aspirin, also known as Acetyl Salicylic acid, belongs to the class of Non-steroidal anti-inflammatory agents. It helps in the prevention of heart attack and stroke due to its anti-platelet effect. An overdose will result in the accumulation of salicylates in the body resulting in a condition known as salicylism. Common effects of overdosage include:

Specific Treatment:

Initial measures:

Barbiturate Poisoning

Acute barbiturate poisoning occurs mostly as suicidal and sometimes on accidental overuse. Drugs like butobarbitone and phentobarbitone are short-acting while phenobarbitone is long-acting. Manifestations are due to central nervous system (CNS) depression. The lethal dose is about 2-3g for short-acting barbiturates and 5-10g for long-acting barbiturates.

Specific Treatment:

Iron Poisoning:

This usually occurs when there is an intake of more than 60mg/kg or 10-20g equivalent iron tablets.

Manifestations of iron toxicity include:

Specific Antidote: Desferrioxamine 0.5-1g is given intramuscularly for every 4-12 hours.

Digoxin Overdose

Digoxin overdose may result in serious cardiac effects like irregular heartbeat, ventricular tachycardia (increase in heart rate) and heart blocks.

Specific Treatment: Digibind, an antibody is used in the treatment of digoxin toxicity.

Heparin Overdose

Overdose of heparin may result in severe bleeding after cardiovascular surgery.

Specific Treatment: 1mg of Protamine sulphate is administered by slow IV for every 100 IU of heparin. Protamine sulphate is the specific antidote obtained from the sperm of salmon and certain species of fish for reversing the effects of heparin.

How Do You Prevent Drug Overdose?

Measures to prevent drug overdosage include the following:

Proper patient counseling and awareness about drug overdose and its treatment should be given so that people know the harmful effects of the drug. International Overdose Awareness Day is held on August 31st every year which aims to raise the awareness about overdose prevention, promote policies and reduce the stigma of drug-related death.

Drug Overdose - Infographics


Click to view more Infographics

References:

  1. Overdose Death Rates - (https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates)
  2. Drug overdose - (http://en.wikipedia.org/wiki/drug_overdose)

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