Drug Overdose: Treatment

If a drug overdose is discovered or suspected, and the person is unconscious, having convulsions, or is not breathing, call for emergency help immediately. If the person who took the drug is not having symptoms, don't wait to see if symptoms develop; call a poison control center immediately. Providing as much information as possible to the poison control center can help determine what the next course of action should be.

The poison control center, paramedics, and emergency room staff will want to know:

• what drug(s) were taken—try to locate the drug's container.
• how much of the drug was taken
• when was the drug taken
• was the drug taken with alcohol or any other drugs or chemicals
• what is the age of the patient
• what symptoms are the patient experiencing
• is the patient conscious
• is the patient breathing

The poison control center may recommend trying to get the patient to vomit. A liquid called ipecac syrup, which is used to induce vomiting, is available from pharmacies without a prescription. Pediatricians may recommend that families keep ipecac syrup on hand in households with children. This medication should be used only on the advice of a medical professional. Vomiting should not be induced if the patient is unconscious.

Emergency medical treatment may include:

• Assessment of the patient's airway and breathing to making sure that the trachea, the passage to the lungs, is not blocked. If needed, a tube may be inserted through the mouth and into the trachea to help the patient breath. This procedure is called intubation.
• Assessment of the patient's heart rate, blood pressure, body temperature, and other physical signs that might indicate the effects of the drug.
• Blood and urine samples may be collected to test for the presence of the suspected overdose drug, and any other drugs or alcohol that might be present.
• Elimination of the drug that has not yet been absorbed is attempted. Vomiting may be induced using ipecac syrup or other drugs that cause vomiting. Ipecac syrup should not be given to patients who overdosed with tricyclic antidepressants, theophylline, or any drug that causes a significant change in mental status. If a patient vomits while unconscious, there is a serious risk of choking.
• Gastric lavage, or washing out the stomach, may be attempted. For this procedure a tube flexible tube is inserted through the nose, down the throat, and into the stomach. The contents of the stomach are then suctioned out through the tube. A solution of saline (salt water) is injected into the tube to rinse out the stomach. This solution is then suctioned out. This is the process used when someone has his/her stomach pumped.
• Activated charcoal is sometimes given to absorb the drug.
• Medication to stimulate urination or defecation may be given to try to flush the excess drug out of the body faster.
• Intravenous (IV) fluids may be given. An intravenous line, a needle inserted into a vein, may be put into the arm or back of the hand. Fluids, either sterile saline (salt water solution) or dextrose (sugar water solution), can be administered through this line. Increasing fluids can help to flush the drug out of the system and to reestablish balance of fluids and minerals in the body. The pH (acid/base balance) of the body may need to be corrected by administering electrolytes like sodium, potassium, and bicarbonate through this IV line. If drugs need to be administered quickly, they can also be injected directly into the IV line.
• Hemodialysis is a procedure where blood is circulated out of the body, pumped through a dialysis machine, then reintroduced back into the body. This process can be used to filter some drugs out of the blood. It may also be used temporarily or long term if the kidneys are damaged due to the overdose.
• Antidotes are available for some drug overdoses. An antidote is another drug that counteracts or blocks the overdose drug. For example, acetaminophen overdose can be treated with an oral medication, N-acetylcysteine (Mucomyst), if the level of acetaminophen found in the blood is extremely high. Naloxone is an anti-narcotic drug that is given to counteract narcotic poisoning. Nalmefen or methadone may also be used.
• Psychiatric evaluation may be recommended if the drug overdose was taken deliberately.

— Altha Roberts Edgren