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Management of Overdose

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Acetaminophen:
Hepatotoxicity peaks at 72–96 hrs. Complete recovery generally day 4, but injury worse for alcoholics. Mortality: 1%–2%.
Antidote/treatment: N-Acetylcysteine. Acetaminophen: Potential lethal dose: 140 mg/kg
Alcohol:
Respiratory depression.
Antidote/treatment: Fluid rehydration, respiratory support if needed, prevention of aspiration Alcohol: Potential lethal dose: 350–700 mg (serum)
Amphetamines:
HTN, psychosis, cardiac arrhythmia, pulmonary edema, seizures.
Antidote/treatment: Supportive care; control BP, prevent patient harming self or others Amphetamines: Potential lethal dose: 20–25 mg/kg
Barbiturates:
Respiratory depression.
Antidote/treatment: Respiratory support if needed. Barbiturates: Potential lethal dose (short-acting long-acting): 3 g 6 g
Benzodiazepine:
Sedation, respiratory depression, hypotension, coma
Antidote/treatment: Flumazenil reverses effects (but it may induce W/D in the dependent)Benzodiazepine:
Carbon monoxide:
Headaches, dizziness, weakness, N/V, diminished visual acuity, tachycardia, tachypnea, ataxia, seizures. Possible hemorrhages (cherry red spots on the skin), metabolic acidosis, coma, and death.
Treatment: Hyperbaric oxygenCarbon monoxide:
Cocaine:
Peak toxicity 60–90 min. after use; systemic sympathomimetics & seizures, acidosis. Later cardiopulmonary depression, possible pulmonary edema. Treatment of acidosis, seizures, & HTN is imperative.
Antidote/treatment: Symptomatic management, particularly HTN control (NO Beta-Blockers!)Cocaine:
Opioids:
Miosis, resp. depression, obtundation, pulmonary edema, delirium, death.
Antidote/treatment: Naloxone, nalmefene helpful. Opioids: Potential lethal dose: Varies with tolerance
Phencyclidine/ketamine:
HTN, nystagmus, rhabdomyolysis
Antidote/treatment: None. Don’t attempt forced diuresis in O/D w/ suspected rhabdomyolysis.Phencyclidine/ketamine:
Phenothiazines:
Anticholinergism, extrapyramidal side effects, cardiac effects
Antidote/treatment: monitor for 48 hours for cardiac arrhythmia. Lidocaine for cardiac arrhythmia, norepinephrine for hypotension, sodium bicarbonate for metabolic acidosis, and Dilantin for seizures. Phenothiazines: Potential lethal dose: 150 mg/kg
Salicylates:
CNS, acidosis
Antidote/treatment: Alkalinization of urine (sodium bicarb) Salicylates: Potential lethal dose: 500 mg/kg
Tricyclics:
Cardiac effects, hypotension, anticholinergism
Antidote/treatment: Sodium bicarb, magnesium (to prevent Torsades) Tricyclics: Potential lethal dose: 35 mg/kg
Hallucinogens:
Ring-substituted amphetamines; LSD / mescaline may lead to rhabdomyolysis, hyperthermia, hyponatremia
Antidote/treatment: Reduce temperature, administer fluids; supportive careHallucinogens:
Inhalants:
Cardiotoxicity, arrhythmias
Antidote/treatment: Cardiac monitoringInhalants: