A drug overdose occurs when a person takes more of a medication than their body can safely process. Overdoses can be accidental or intentional, and they can have life-threatening consequences.
In this article, we will discuss the most common symptoms and treatment options for a patient who has drug overdosed.
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What is a Drug Overdose?
A drug overdose refers to the ingestion or application of a drug or other substance in greater amounts than are recommended.
The drug could be prescription, over-the-counter, or illegal, and the ingestion could be intentional or accidental.
An overdose may result in a fatal outcome, or it may merely cause temporary discomfort. In either case, it is considered a medical emergency and requires immediate medical attention.
Signs and Symptoms
The symptoms of a drug overdose may vary depending on the specific substance that is involved, as well as the route by which it enters the body.
However, some general examples include:
- Shallow breathing
- Altered level of consciousness
- Agitation
- Anxiety
- Confusion
- Delirium
- Dizziness
- Drowsiness
- Nausea and vomiting
- Seizures
- Apnea
Each patient will experience different symptoms depending on the type of drug, amount taken, and the patient’s physiology.
For example, someone who has overdosed on opioids may have pinpoint pupils and slow, shallow breathing. Someone who has overdosed on stimulants may be hyperactive and have a rapid heartbeat.
Treatment
The treatment of a drug overdose will also vary depending on the specific circumstances. It depends on the type of drug involved, the amount taken, and the patient’s individual response to the overdose.
In general, treatment for a drug overdose will involve supportive care, which means keeping the patient comfortable and monitored while the drug leaves the system. This may include:
- Oxygen therapy
- IV fluids
- Monitoring vital signs
- Medications to control symptoms
In some cases, more aggressive treatment may be necessary. For instance, if a patient has overdosed on opioids, they may require naloxone (Narcan), which is a medication that can reverse the effects of opioids.
Common Overdose Drugs
There are many different types of drugs that can lead to an overdose. Some of the most common include:
- Alcohol
- Opioids (heroin, fentanyl, and prescription painkillers)
- Stimulants (cocaine and methamphetamine)
- Sedatives (benzodiazepines and barbiturates)
Narcotic opioids are responsible for the majority of overdose deaths in the United States, including morphine, heroin, and oxycodone.
When a patient overdoses on one of these drugs, it can cause apnea and respiratory depression, which is a very serious condition.
This may require intubation and mechanical ventilation, which is performed and managed by respiratory therapists.
Drug Overdose Practice Questions:
1. What is a drug overdose?
An accidental or intentional use of a drug or medicine in an amount that is higher than recommended. It is the ingestion or application of a drug or substance in quantities greater than recommended that can lead to a toxic state and death.
2. What is the major pharmaceutical that causes the most overdose deaths?
Opioids.
3. What drug is given to someone suspected of a drug overdose?
Naloxone (Narcan).
4. When ventilation gets worse on NIV, is it better to wait another 30 mins to see if the patient gets better?
No, proceed with intubation and mechanical ventilation.
5. What will be the interpretation of a drug overdose ABG?
Respiratory acidosis.
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6. What is the brand name of Naloxone?
Narcan.
7. What is important in figuring out the cause of an emergency?
Patient’s medical history is important in figuring out what caused them to come into the ED.
8. What is not important when treating a patient?
It is not important to come up with a diagnosis first.
9. Why intubate a patient who may have a drug overdose?
Protect the airway and stop possible aspiration.
10. What breathe sounds that can be heard for a drug overdose?
Diminished.
11. What is a good RSBI score?
<105.
12. What time of day do overdose patients present to the ER?
Late night.
13. What are the common routes of exposure to a drug?
Inhalation, ingestion, and injection.
14. What is the most common drug people overdose on?
Heroin and OxyContin.
15. Is death from drug overdoses continue to rise?
Yes.
16. What is the description of a drug overdose with hypoventilation?
Also known as respiratory depression, it is taking in a larger quantity of drugs that
17. What can cause hypoventilation when taken accidentally or intentionally?
A medication or drug overdose.
18. What are the most common and particular drugs that cause respiratory depression, especially when combined with other depressants?
Opioids.
19. What can be a potentially life-threatening side effect in medication and recreational drugs?
Overdose and hypoventilation.
20. What are some common drugs that depress the CNS causing hypoventilation leading to respiratory acidosis?
Ethanol, benzodiazepines (alprazolam), barbiturates, sedatives, opioids (also called narcotics), methadone, glutethimide
21. What are common examples of opioids?
Oxycodone, fentanyl, heroin, morphine, and codeine.
22. What are the clinical manifestations of a drug overdose?
Nausea, vomiting, diarrhea, pale skin, possible cyanosis, abdominal pain, dizziness and loss of balance, seizures, drowsiness, confusion (disorientation), hypoventilation leading to hypoxia, rapid shallow respirations, decreased BP with vasodilation, signs and symptoms with hypercapnia, dyspnea (sob), headache, hyperkalemia (signs and symptoms associated with increased K+), dysrhythmias (due to increased K+), muscle weakness, hyperreflexia, hallucinations, disturbed vision, abnormal pupil dilation, impaired memory, possible coma, constipation and irritability.
23. What are the risk factors for drug overdose resulting in respiratory acidosis?
Drug addicts, addiction personality, people with memory loss (mistakenly taking medications 2x or more due to forgetfulness) and elderly due to aging (toxicity- body systems slowing down).
24. What are the common antidotes for a drug overdose?
Naloxone (
25. What are the diagnostics testing for drug overdose patients?
ABG: ph < 7.35, PaCO2 > 45, monitor electrolytes carefully, especially K+, daily weights, I and O; and, EKG possible due to potassium levels.
26. What is the prevalence of a drug overdose?
Drug-induced death now outnumbers suicide, injury by firearms, and homicide. Emergency room visits from prescription drug overdoses doubled from 2004 to 2009. Overdose deaths from painkillers have risen from less than 2,901 in 1999 to 11,499 in 2007. By 2007, more teenagers used opioid analgesics recreationally than used marijuana.
27. What are the adverse reactions of a drug overdose?
Occur when individuals accidentally or intentionally misuse drugs. Misuse means self-administered without medical control for proper or sterile preparation-self prescribed. It may result in compulsive use.
28. What are examples of opiates?
Heroin, Dilaudid, OxyContin, Demerol, morphine, oxycodone (Percocet), hydrocodone (Vicodin), codeine and Tylenol #3.
29. How do opiates work in the
Bind to the site to turn off pain centers in the brain. Commonly causes euphoria. Produce drowsiness. May result in CNS depression (depress respiration) which is the reason why we are called to all OD patient rooms.
30. How do opiates work in GI receptor sites exist as well?
Decreased motility of GI tract results, constipation is common.
31. What are some signs of opiate abuse?
Tolerance to a substance occurs over time. Once addicted, the withdrawal will ensue restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes, anger and combative and behavior, and, paranoia.
32. What are the treatments for an opiate overdose?
For recent PO ingestion, activated charcoal, and gastric lavage. Narcan: late stage PO ingestion, indicated for IV injection victims, doses high enough to reverse respiratory depression, available OC, reverse too far and the patient can seize, and O2 when necessary. Prevent detox with low doses.
33. What do stimulants counter?
Suppressants.
34. What are benzodiazepines and what are some examples?
Used as antianxiety medications and hypnotics (sleep meds). Nembutal is one example that is used for anxiety and sleep disorders.
35. What are the effects of benzodiazepines?
Seizures from withdrawal are common, since brain activity is slowed down, stopping the drug will cause the brain to rebound and race out of control leading to seizures. The hypnotic/amnesiac effect which is common in accidental OD. Drug combination creates a high risk for respiratory depression, especially with alcohol, opiates, barbiturates; combining with other drugs such as cold and allergy medications, alcohol, and painkillers enhances the respiratory depression. Give O2 support.
36. What is the treatment for a benzodiazepines overdose?
For recent PO ingestion, emesis when indicated, gastric lavage, activated charcoal (PO / NG /OG). For IV or late phase PO ingestion,
37. What does alcohol have to do with drug overdoses?
It accounts he largest amount of ED admissions for any drug on record. Greatest complications result from mixing with other drug classes. BAC: 0.05, 0.08, 0.15, and 0.20 extreme.
38. What is the treatment for alcohol abuse?
Volume replacement, electrolyte replacement, prevents self-injury, monitor level of consciousness, monitor for shock, ventilatory support if needed and benzodiazepines to fight DT’s.
39. What are stimulants?
It enhances brain activity that causes an increase in alertness, attention, and energy. Amphetamine, Ritalin, caffeine, and cocaine.
40. What are the effects of stimulants?
Increased BP, increased HR, and increased respiration.
41. Why do we use stimulants?
Narcolepsy, ADD/ADHD, asthma, depression
42. What are the effects of stimulants in the body?
High energy, increases blood glucose, euphoria, nausea/vomiting, convulsions/seizures, bronchodilation, paranoia, anxiety and leads to fast cardiac deterioration.
43. What are the treatments for stimulant use?
Primary concerns are controlling blood pressure and prevent CVA/stroke, controlling heart rate where you may use beta blockers, loss of consciousness leading to aspiration risk and may need to be intubated, bag-mask ventilate and evaluate neurological status through head CT.
44. What are hallucinogens?
Affects sight, sound and emotion. Rapid, intense emotional swings are common. Disrupts serotonin levels in the brain affecting behavior, perception of reality, body temperature, muscle control and sensory perception.
45. What are common examples of hallucinogens?
Dextromethorphan (cough suppressant), PCP, Ketamine (general anesthetic), LSD- 1939, Peyote and Psilocybin.
46. What is LSD (lysergic acid diethylamide)?
It is the most known potent mood and perception-altering drug. Dramatic effects on colors, smells, sounds, and other senses intensified. Produces longer term psychosis and flashbacks.
No treatment and may be used as antidepressants and psychotherapy.
47. What is PCP?
It was developed as a surgical anesthetic, low doses result in shallow rapid breathing, high blood pressure, and heart rate. High doses can cause dangerous blood pressure and decreased awareness of pain. Muscle contractions can break
48. What are the first three steps when a patient presents to ER with a suspected overdose?
Assess airway. Assess breathing. Assess circulation.
49. What is the process for securing the airway?
Assess airway and breathing. Give 02 if necessary. Head-tilt chin-lift, bag valve mask and may require advanced airway support in nasal trumpet and endotracheal tube (intubation).
50. What is the process for checking circulation?
Monitor BP and support if necessary with IV fluids, norepinephrine if not fluid responsive and NTG or nitroprusside.
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51. What is the process for checking circulation/treatment for dysrhythmias?
12 lead ECG, sodium bicarb for dysrhythmia and Mg sulfate for torsades.
52. What is screened on toxicology?
Opiates, benzos, salicylates, acetaminophen, and ethanol.
53. What are the causes of an overdose?
Therapeutic drug toxicity, accidental (for children), environmental exposure, occupational exposure, recreational abuse, medication error (physician error), and purposeful self-harm.
54. What is an anticholinergic overdose?
Signs: blurred vision, mydriasis, decreased bowel movement, urinary retention, dry skin, fever, flushing, delirium, memory loss, and tachycardia. Substances: antihistamines, antipsychotics, and antidepressants.
55. What is a cholinergic overdose?
Symptoms: bronchorrhea (watery sputum), sweating, diarrhea, vomiting, tears, miosis (pupil constriction), salivation and urination, and muscle twitch. Substances: insecticides, cholinesterase inhibitors neostigmine, and organophosphates.
Final Thoughts
A drug overdose is a serious medical emergency that requires immediate treatment. The specific symptoms and treatment options will vary depending on the type of drug involved, as well as the patient’s individual condition.
Respiratory therapists play a vital role in the treatment of patients who have overdosed on drugs, as they are responsible for establishing and maintaining a patent airway.
We have similar guides on cardiovascular drugs and mucolytic agents that I think you’ll find helpful. Thanks for reading!
Written by:
John Landry, BS, RRT
John Landry is a registered respiratory therapist from Memphis, TN, and has a bachelor's degree in kinesiology. He enjoys using evidence-based research to help others breathe easier and live a healthier life.
References
- Rau’s Respiratory Care Pharmacology. 10th ed., Mosby, 2019.
- Egan’s Fundamentals of Respiratory Care. 12th ed., Mosby, 2020.
- “Acute Drug Overdose: Clinical Profile, Etiologic Spectrum and Determinants of Duration of Intensive Medical Treatment.” PubMed Central (PMC), 1 Nov. 2012, www.ncbi.nlm.nih.gov/pmc/articles/PMC3515042.