Drug intoxication

Drug intoxication, the acute overuse of a drug (pharmacological or otherwise), is a common cause of admission to hospitals. Many are voluntary but some are accidental.

Specific types

Sympathomimetic (amphetamine, MDMA, cocaine) overdose presents with mydriasis, hyperthermia, tachyarrhythmia, hypertension, seizures, altered mental status. There is no specific treatment.

Opioid intoxication presents with respiratory depression, pinpoint pupils (myosis), and altered mental status. Naloxone is the specific antidote. On my exam I said shallow breathing, but the examiner said that it’s rather deep breathing but bradypnoea. That doesn’t match up with other sources, though.

Benzodiazepine overdose presents with weak pulse, respiratory depression, and altered mental status. Flumazenil is the specific antidote, but it has a short duration of action and is therefore used for diagnosis rather than treatment.

Clinical evaluation

Toxicology does not give an immediate answer, so the suspected toxin should be identified based on lab results, history, and clinical features.

Management

In a patient with suspected drug intoxication, the following general steps are necessary:

• Ensuring stability (ABC)
• Give oxygen
• Apply monitoring
• Obtain venous access
• Assess GCS and intubate if < 8
• ABG
• Decontamination

In any kind of intoxication, the following are options:

• Gastric lavage or activated charcoal – not effective in all intoxications, only effective in ingestion was recent
• Loop diuretics + fluids – to increase renal excretion
• Renal replacement therapy – haemodialysis or haemofiltration