This document discusses drug overdoses and poisoning. It notes that drug overdose was the leading cause of injury death in the US in 2012, especially among those aged 25-60. Common substances involved in human poisoning include drugs, cleaning substances, and plants. Symptoms of poisoning can include blistering, breathing problems, confusion, and convulsions. Treatment of poisoning focuses on supportive care, preventing further absorption, enhancing elimination, and administering antidotes as needed.

1. Dr. Jibin Mathew
Clinical Pharmacologist

2.  Poisoning is an adverse effect from a chemical that has been
taken in excessive amounts.
 The body can tolerate and, in some cases, detoxify a certain
dose of a chemical; however, once a critical threshold is
exceeded, toxicity results.
 Drug overdose can be accidental or intentional. They occur
when a person takes more than the medically recommended
dose of a drug, which eads to poisoning

3. Epidemiology
Drug overdose was the leading cause of injury death in 2012
Among people 25 to 60 years old, drug overdose caused
more deaths than motor vehicle traffic crashes
The drug overdose death rate has more than doubled from
1999 through 2013
In 2013, 84.1% of the drug overdose deaths in the United
States were unintentional, 15.4% were of suicidal intent
Highest death rate was among people 45-49 years of age

4. Definition of Terms
Toxicology - the study of poisons
Toxicologist - one who studies poisons
Risk - the probability that an event will occur based on patient
vulnerability
Toxic substance - poisons
Poison - any chemical substance which can cause harm
Drug overdose - taking a harmful amount of a drug

5. Definition of Terms
•Antidotes: from the Greek anti - against and didonai - to give the
remedy for counteracting a poison
• 3 types:
Mechanical - prevents absorption, ie. activated charcoal
Physiologic - counteracts the effects of the poison by producing opposite
physiologic effects, ie. atropine and organophosphate poisoning
Universal antidote –
Activated charcoal, magnesium oxide and tannic acid

6. Substance Abuse and Overdose
Addiction
Habituation
Physiological dependence
Psychological dependence
Tolerance
Withdrawal
Drug Overdose

7. Types of Poisoning
 Drug poisoning
 Insecticide poisoning
 Herbicide poisoning
 Fungicide poisoning
 Rodenticide poisoning
 Spermicide poisoning

8. Substances most frequently
involved in Human Poisoning
 Drugs – 61 %
 Cleaning substances – 12 %
 Cosmetics and personal care products – 10 %
 Foreign bodies – 5 %
 Plants – 5 %
Bites and envenomation's – 4 %

9. Categories with largest number of deaths
Analgesics & Pain killers
- involved in 30% of fatalities
- acetaminophen, aspirin, Naproxen, Celecoxib= 72%
- 84% of the fatalities were intentional
Antidepressants
- 69% involved TCA’s
Sedatives/hypnotics/antipsychotics
- benzodiazepines account for 36%
Cardiovascular drugs
Alcohols

10. Symptoms of Poisoning
 Blistering of the mouth or lips
 Bad odor from mouth
 Burning of the mouth
 Breathing problems
 Dizziness
 Confusion or unconsciousness
 Vomiting or diarrhea
 Convulsions

11. Measures to prevent poison ingestion
Always put medicines away after use & not leave on tables,
nightstands etc.
Never take or administer medicines in the dark
Store all poisons in locked containers
Store all medicines out of children’s reach
Never allow kids to take medicines without supervision
Do not keep poisonous plants in the house
Keep medicines in original containers
Never keep outdated meds
Always give or take the whole prescription

12. History: Find out all of this information
Which drug(s) were taken?
When was it taken?
How much was taken?
 How was it taken?
Why was it taken?
Was anything else taken? (Consider co-ingestants: other things
which may be in this person’s medicine cupboard.)

13. Vital signs: Pulse
Bradycardia Tachycardia
Propranolol Anticholinergics
Calcium channel blockers Antihistamines
Clonidine Amphetamines
Digoxin Theophylline

14. Vital signs: Temperature
Hypothermia Hyperthermia
Carbon monoxide N.M.S., Nicotine
Opiates Antihistamines
Oral hypoglycemics Aspirin, Paracetamol
Alcohol Antihistamines
Sedatives/Hypnotics Anticholinergics

15. Vital signs: Blood pressure
Hypotension Hypertension
Clonidine, CCB’s Cocaine
Reserpine Thyroid supplements
Antihypertensives Sympathomimetics
Antidepressants Caffeine
Sedative/Hypnotics Amphetamines
Heroin (opiates) Nicotine

16. Vital signs: Respiration rate
Hypoventilation Hyperventilation
Sedative/Hypnotics Toxic met. acidosis
Alcohol Pneumonitis
Opiates Noncardiogenic
Weed (marijuana) pulmonary edema

17. Physical: Neurologic exam
Mental status Seizures
Alcohol Organophosphates
Endocrine/Epilepsy Ethanol
Intoxication INH/Insulin
Oxygen Sympathomimetic
Trauma/Tumor Amphetamine
Shock/Strokes Benzodiazepines withdrawal

18. Physical exam: Pupils
Miosis Mydriasis
Sedatives & hypnotics Antihistamines
Clonidine Antidepressants
Opiates Atropine
Cocaine

19. Bitter almonds: Cyanide
Garlic: Organophosphates, Arsenic
Peanuts: Rodenticide
Carrots: Water hemlock
Rotten eggs: Sulfur dioxide, HS
Gasoline: Hydrocarbons
Fruity: DKA, Isopropanol

20. Laboratory Examinations
Arterial blood gases
Plasma electrolytes
Laboratory tests for renal function
Laboratory tests for hepatic function
Instrumental Examinations
ECG
Endoscopic examination
X ray examination
CT scan

21. •Fundamentals of Poisoning Management includes-
••Supportive Care
••Prevention of Further Poison
•Absorption
••Enhancement of Poison Elimination
••Administration of Anti-dotes
••Prevention of Re-exposure

22. Supportive Care
• • It include support of ABC & vital signs.
• • And also to prevent and treat secondary complications such as
aspiration, cerebral and pulmonary edema, pneumonia, renal
failure, sepsis, thromboembolic disease, and generalized organ
dysfunction due to hypoxemia or shock

23. Decontamination
•A. Decontamination of the skin
Cleansing with soap + water: used after dermal exposure to organophosphates
Cleansing with acetic acid (vinegar): for Nicotine
•B. Decontamination of the stomach
 Emesis
 Gastric lavage
Activated Charcoal
Endoscopic surgical removal
C. Decontamination of the intestines by whole bowel irrigation (WBI)

24. Enhancement of Toxicant Elimination
•A. Intracorporal techniques
Forced diuresis and alkalization
Repeated administration of a charcoal
•B. Extracorporeal techniques
Hemodialysis (Lithium)
Hemoperfusion (carbamazepine, theophylline,
digitoxin, phenobarbital, valproic acid
Plasmapheresis (Verapamil, Thyroxine)

25. Antidotes

26. Causative drugCausative drug AntidoteAntidote
Acetaminophen Acetylcysteine
Anticholinergics Physostigmine
Beta blocker Glucagon
Warfarin Phytonadione
Benzodiazepines Flumazenil
Tricyclic antidepressants Sodium Bicarbonate
Cyanide
Cyanide antidote kit
(amyl nitrite, sodium nitrate, and sodium thiosulfate)
Digoxin Digoxin immune Fab
Iron Deferoxamine
Isoniazid Pyridoxine
Methemoglobinemia Methylene blue
Opiods Nalaxone
Methotrexate Leucovorin
Snake bite polyvalent immune Fab
Heparin Protamine Sulfate
Valproic Acid Levocarnitine

27. THANK YOU