Treating drug overdose

When there is no quick and reliable assessment of effect, e.g. lithium for mood disorder To check patient compliance on a drug regimen, when there is failure of therapeutic effect at a dose that is expected to be effective, e.g. antiepilepsy drugs To diagnose and treat drug overdose. 

Emetics are used to cause vomiting to empty the stomach rapidly when an individual has accidentally or intentionally ingested a poison or drug overdose Not all poison ingestions or drug overdoses are treated with emetics. 

Paradoxical effects cognitive impairment and perseverative behavior are occasionally seen in children treated with psychostimulants. According to Greenhill et al. (1999) such phenomena are indicative of a drug overdose and will improve at dose reduction. Constriction of attention or overfocusing as a consequence of treatment with psychostimulants has been another critical issue (Breggin, 1999). Based on an extensive review of the literature and their own experience, Wilens and Biederman (1992) assert that there is no evidence of such phenomena at doses up to 1.0 mg/kg of methylphenidate. 

When a 45-year-old man with severe lithium-induced diabetes insipidus developed hyperosmolar, nonketotic hyperglycemia, it was suggested that poorly controlled diabetes mellitus may have contributed to the polyuria (684). Prior contact with a female patient who had developed hyperosmolar coma secondary to lithium-induced diabetes insipidus (685) allowed physicians 4 years later to treat her safely after a drug overdose and a surgical procedure, by avoiding intravenous replacement fluids with a high dextrose content (despite stopping lithium several years earlier, the patient continued to put out 10 liters of urine daily) (686). 

Precautions Use benzodiazepines cautiously in treating patients with liver disease. They potentiate alcohol and other CNS depressants. Benzodiazepines are, however, considerably less dangerous than other anxiolytic and hypnotic drugs. As a result, a drug overdose is seldom lethal, unless other central depressants, such as alcohol, are taken concurrently. 

Alangium lamarckii is a medicinal plant that accumulates tetrahydroisoquinoline monoterpene alkaloids for the production of compounds such as emetine, a constituent of ipecacuantha emetic mixture that is used to for the treatment of drug overdose. Historically, this mixture has also been used to treat amoebic dysentery by South American Indians. 

With the increasing popularity of GHB as both a recreational and date rape drug, the number of overdoses seen in emergency rooms in the United States has also been rising. Reports of methods to treat GHB overdoses have been surfacing in scientific and medical literature. 

Drug overdose Acute toxicity requiring emergency medical treatment is rare. When it occurs there is a typical sympathomimetic syndrome, which should be treated with fluids, control of hyperthermia, bed rest, and, if necessary, sedation with benzodiazepines (1). 

According to the results of one study, it might be expected that in every 1000 patients with drug overdose treated with naloxone, 4—30 serious complications, such as convulsions, asystole, pulmonary edema, and violent behavior, can be expected (SEDA-21, 92). 

Diuretics are used widely for the treatment of hypertension see Chapter 32), and loop diuretics appear to lower blood pressure as effectively as Na+-CL symporter inhibitors e.g., thiazides and thiazide-hke diuretics) while causing smaller perturbations in the Upid profile. However, the short elimination half-lives of loop diuretics render them less useful for hypertension than thiazide-type diuretics. The edema of nephrotic syndrome often is refractory to other classes of diuretics, and loop diuretics often are the only drugs capable of reducing the massive edema associated with this disease. Loop diuretics also are employed in the treatment of edema and ascites of hepatic cirrhosis however, care must be taken not to induce encephalopathy or hepatorenal syndrome. In patients with a drug overdose, loop diuretics can be used to induce a forced diuresis to facilitate more rapid renal elimination of the offending drug. Loop diuretics, combined with isotonic saline administration to prevent volume depletion, are used to treat hypercalcemia. Loop diuretics interfere with the kidney s capacity to produce a concentrated urine. Consequently, loop diuretics combined with hypertonic saline are useful for the treatment of hfe-threatening hyponatremia. Loop diuretics also are used to treat edema associated with chronic renal insufficiency. Most patients with ARE receive... 

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