Substance overdose
Substance overdose describes the ingestion of a substance in quantities greater than is recommended or generally practiced.
An overdose may result in toxicity or death. Signs and symptoms of an overdose vary depending on the substance or toxin exposure. The symptoms can often be divided into differing toxidromes. This can help one determine what class of substance or toxin is causing the difficulties.
Below is a list of some common types of substance overdose, their symptoms and treatment. It is not meant to be comprehensive, nor is it meant to be taken as medical advice. If in doubt of whether you are someone you know is experiencing an overdose do not hesitate to call emergency services as it can mean the difference between life and death.
Opioid overdose
Symptoms
- Respiratory depression - Very slow and shallow breathing or no breathing at all. A snore-like gurgling noise may also be noted.
- Loss of consciousness - The user may be unresponsive to outside stimulus, even if the stimulus is painful under normal circumstances.
- Skin discoloration (cyanosis) - The skin may become blueish or gray, especially around the mouth and extremities.
- Nausea - The user may vomit without warning, especially dangerous if not in the recovery position.
- Decreased heart rate - The pulse is significantly decreased or may be absent.
- Miosis - Pupils may be constricted so small they can be called "pin prick pupils."
- Seizures
- Muscle spasms - The body may convulse and become rigid.
Treatment
Opioid overdoses are treated with naloxone. Naloxone will not be effective against some opioids such as sufentanil, and naltrexone must be administered in a hospital setting. If the individual does not respond to naloxone, give further doses until 10mg is reached, as well as start CPR. Place the individual in the recovery position and immediately call emergency services. Inform the dispatcher or EMS personnel what substances were ingested and approximately when.
Stimulant overdose
Symptoms
- Abnormal heartbeat
- High blood pressure
- Confusion
- Nausea
- Anxiety - The anxiety caused by an amphetamine overdose is extreme and may end up in panic attacks
- Paranoia
- Delusion
- Shaking - The user may shake uncontrollably
- Rapid breathing
- Painful urination
- Increased bodily temperature
- Stereotypy - Repetitive and compulsive movement may be noted
- Seizures
- Psychosis
- Serotonin syndrome
Treatment
Treatment of a stimulant overdose consists of administering a benzodiazepine to counter the agitation and physical cooling to counter the hyperthermia and hydration to account for water loss.
Alcohol overdose
Symptoms
- Confusion
- Nausea - The user may vomit without warning, especially dangerous if not in the recovery position.
- Seizures
- Respiratory depression - Very slow and shallow breathing or no breathing at all. A snore-like gurgling noise may also be noted.
- Skin discoloration (cyanosis) - The skin may become blueish or gray
- Temperature regulation suppression - Low body temperature occurs. Even though alcohol makes the body feel warm because of vasodilating action, core body temperature is actually dropped.
- Motor control loss - The user may not be able to stand up without falling over
- Loss of consciousness
- Dizziness
Treatment
Reassure the individual if they are agitated or anxious. Give them a steady supply of water and a bathroom to urinate in if needed. Immediately call emergency services if the condition gets worse or persists for an unusual amount of time. Inform the dispatcher or EMS personnel what substances were ingested and approximately when.
GHB and GBL overdose
Symptoms
- Motor control loss
- Nausea
- Loss of consciousness - This can occur rapidly and unexpectedly because of the steep dose response curve
- Double vision
- Confusion
- Dizziness
Treatment
Place the individual in the recovery position and immediately call emergency services. Inform the dispatcher or EMS personnel what substances were ingested and approximately when.
Synthetic cannabinoid overdose
Symptoms
- Increased heart rate
- Increased blood pressure
- Nausea
- Anxiety - This is commonly presented as panic attacks. The victim may believe they are not getting enough air due to a chest heaviness; breathing slowly is better than hyperventilating.
- Feelings of impending doom
- Psychosis
- Seizures
- Motor control loss
Treatment
If agitation and anxiety are present, reassure the individual. If they are unconscious, place the individual in the recovery position and immediately call emergency services. Inform the dispatcher or EMS personnel what substances were ingested and approximately when.
Anticholinergic overdose
Symptoms
- Dry skin - Anticholinergics in larger doses cause the user to not be able to sweat, causing noticeably dry skin
- Pupil dilation - Pupil dilation which doesn't respond to changing light levels and inability to focus eyes at certain distances.
- Increased bodily temperature - The inability to remove excess body heat through sweating can cause a life-threatening fever.
- Delirium
- Psychosis
- Increased heart rate and Increased blood pressure - Anticholinergic overdose can cause life-threatening tachycardia and hypertension.
- External hallucination - The user may complain or be extremely fearful of visuals such as bugs and spiders, people melting, or shadow people.
- Panic attacks
- Feelings of impending doom
Treatment
Immediately contact emergency services. Do not give them any other substances. Inform the dispatcher or EMS personnel what substances were ingested and approximately when. Reassure the individual.
Legal issues
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Most countries have either Good Samaritan laws or duty to rescue laws which grant immunity or even make it a legal obligation to contact emergency services for someone in need, meaning one should contact emergency services without hesitation when dealing with substance-related emergencies.
See also
