Overdose, causing death

Activity C-T. 1 is probably the most effective peripheral muscle relaxant. It is hardly used in current therapy because the corresponding diallylnortoxiferinium chloride (alcuronium chloride, Alloferin ) has a shorter duration of action. The muscle relaxant effect results from a (competitive) expulsion of acetylcholine from the receptors of the motoric endplates with paralysis of the transversely striated musculature (overdoses cause death by asphyxiation). 

The side effects of barbiturates include sedation, poor physical coordination, and impaired mental performance. They also potentiate the intoxicating effects of alcohol. Barbiturates can be extremely dangerous in overdose, causing anesthesia, coma, and even death. In addition, barbiturates can cause dangerous suppression of breathing in patients with sleep apnea or other respiratory disorders. With repeated use over just a few weeks, physical dependence and tolerance to their effects can develop, leading to increasing doses to maintain the desired therapeutic effect. If a... 

In low and moderate doses, the methylxanthines—especially caffeine—cause mild cortical arousal with increased alertness and deferral of fatigue. The caffeine contained in beverages—eg, 100 mg in a cup of coffee—is sufficient to cause nervousness and insomnia in sensitive individuals and slight bronchodilation in patients with asthma. The larger doses necessary for more effective bronchodilation commonly cause nervousness and tremor in some patients. Very high doses, from accidental or suicidal overdose, cause medullary stimulation and convulsions and may lead to death. 

Recall that scopolamine, an ingredient in henbane, blocks muscarinic acetylcholine receptors. This blockade essentially removes the influence of the parasympathetic nervous system on the body. In the absence of this influence, the balance of forces is upset and the sympathetic nervous system gains the upper hand thus, your heart rate increases, your pupils dilate, salivation stops, your ability to urinate is impaired, and you become constipated overall, things get very uncomfortable. But none of this is directly lethal (unless the constipation makes one commit suicide). If you do die from an overdose of henbane, it is believed to result from either a complex series of events in your brain that lead to the loss of control of your diaphragm, causing death from asphyxiation, or from cardiac arrest. This is why the deadly nightshade is so deadly and how Shakespeare chose to kill King Hamlet with henbane. 

Morphine depresses all phases of respiration (respiratory rate, tidal volume, and minute volume) when given in subhypnotic and subanalgesic doses (Figure 47.6). In humans, a morphine overdose causes respiratory arrest and death. Therefore, morphine and other narcotic analgesics should be used with extreme caution in patients with asthma, emphysema, and cor pulmonale, and in disorders that may involve hypoxia, such as chest wound, pneumothorax, or bulbar poliomyelitis. 

Tragically, while the older antidepressant drugs cannot prevent suicide and can cause it, in relatively small amounts, they can become lethal instruments in the hands of suicidal patients. As little as 1 week s supply of most tricyclics can cause death, often due to cardiac dysfunction. In combination with other drugs, their lethality increases. Thus millions of depressed, suicidal patients are given the tool with which to kill themselves. By 1981, the tricyclics were overtaking the barbiturates as the medications most frequently involved in serious overdoses ( Tricyclics, 1981). The tricyclics remain a major public health problem as agents of suicide (Henry et al., 1995). 

In both cases, the blood metamfetamine concentration was less than the lethal concentration of 4.5 pg/ml. Morphine concentrations were higher than the non-toxic concentration of 0.3 pg/ml. It is unlikely that morphine was the cause of death, because it would have caused hypothermia instead of hyperthermia. It is more likely that morphine interacted with metamfetamine, increasing the hyperthermic effect that is typical of metamfetamine overdose. This would explain why hyperthermia caused death, despite a non-lethal blood concentration of metamfetamine. 

There is one published report of unintentional tramadol overdose causing acute fulminant hepatic necrosis and death. The exact amount taken was not known, but may have been more than twice the maximum daily dose of 100 mg four times a day for a period of days. Hepatitis and liver failure are listed as possible adverse effects in some US, but no UK product information [54]. 

The crucial facts to be determined are the identity, and then the level(s), of the chemical(s) in the blood and when they were taken. The poisoning due to the most dangerous chemical that is at the highest level in the blood can then be treated. For example, if someone has taken an overdose of the drug combination Distalgesic, which contains paracetamol and dextropropoxyphene, the immediate treatment would be for the latter drug which can rapidly cause death from depression of the respiratory system. 

Any drug taken in overdose is likely to cause death and illness, and there are many other drugs readily available over the counter that are... 

All chemicals produce toxicity however, only a few of them cause death every time if taken in overdose carbon monoxide is one of them. The toxicity of CO has been extensively reviewed (Drinker, 1938 Gorman et al, 2003 Hamilton, 1921 Kao and Nanagas, 2006 Lilienthal, 1950 Mannaioni and Vannacci, 2006 McGrath, 2006 Prockop and Chichkova, 2007 Putz et al, 1976 Robkin, 1997 Ryter and Otterbein, 2004 Samoli et al, 2007 Thom and Kleim, 1989) or contained in monographs (IPCS, 1999 Penny, 2000 Shephard, 1983). 

Overdose. Depression is a risk factor for both parasuicide and completed suicide, and TCAs are commonly taken by those who deliberately self-harm. Dothiepin (dosulepin) and amitriptyline are particularly toxic in overdose, being responsible for up to 300 deaths per year in the UK despite the many alternative antidepressants that are available. Lofepramine is at least 15 times less likely to cause death from overdose clomipramine and imipramine occupy intermediate positions. 

But despite the frequency of such "poisonings", physicians frequently noted, "an overdose has never produced death in man or the lower animals. Not one authentic case is on record in which Cannabis or any of its preparations destroyed life... Cannabis does not seem capable of causing death by chemical or physiological action."... 

Opiates are used clinically because of their analgesic properties. Opiates also cause sedation, euphoria, respiratory depression, orthostatic hypotension, diminished intestinal motility, nausea, and vomiting. The major manifestations of morphine overdose are coma, miosis (pinpoint pupils), and respiratory depression. Pulmonary edema often is a complication of morphine overdose, and death may result from cardiopulmonary arrest. Treatment for morphine overdose includes administration of the opiate antagonist naloxone (Narcan), which dramatically reverses the effects of morphine. 

The half-life of caffeine in humans is approximately 3.5 to 5 hours. It is metabolized extensively according to a complex metabolic pathway occurring primarily in the liver. Serious problems rarely result from overdoses of caffeine. In fact, the amount of caffeine needed to cause death in an average adult male is 5 to 10 g, the equivalent of 50 to 100 cups of regular brewed coffee. Thus the risk of overdose from dietary sources of caffeine is virtually nonexistent. 

Action on the Economy.—Ether is largely used in medicine for producing ansesthesia, either locally by diminution of temperature due to its rapid evaporation, or generally by inhalation. When taken in overdose it causes death, although it is by no means as liable to give rise to fatal accidents as is chloroform. Patients suffering from an overdose may, in the vast majority of cases, be resuscitated by artificial respiration and the induced current, one pole to be apphed to the nape of the neck, and the other carried across the body just below the anterior attachments of the diaphragm. 

Propoxyphene (e.g., Darvon) Weak analgesic (less potent than aspirin). Relief of minor pain. Dizziness, sedation, nausea, vomiting. Overdose causes convulsions, CNS depression, coma, death. 

Mescaline is a psychedelic agent, causing hallucinations. It promotes psychosis in predisposed individuals. The mechanism of action probably involves its function as serotonin 5-HT agonist (Nichols 1986). Toxic symptoms include drowsiness, dilation of pupil, hyperreflexia, and restlessness. These symptoms progress with increasing doses, resulting in euphoria, distorted perceptions, and hallucinations. Such an illusion effect in humans may be manifested from intramuscular administration of about 150 mg of mescaline. The toxicity of this alkaloid, is otherwise, moderate, rarely causing death from overdose. 

Hernandez AF, Montero MN, Pla A, Villanueva E. Fatal moclobemide overdose or death caused by serotonin syndrome J Forensic Sci (1995) 40,128-30. 

Overdose of morphine can cause death through respiratory arrest (Kapoor 1995). 

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