THE MEDICAL MANAGEMENT OF INTOXICATION

1. Institute general supportive management - maintain airway, support breathing and cardiac function as required.
2. Treat hyperthermia (over 102ºF) aggressively with ice packs, cold water and hypothermic blankets if available.
3. Treat seizures with parenteral or per rectal diazepam.
4. If respiratory depression due to opiate overdose is suspected, administer naloxone hydrochloride 0.4 to 0.8mg IV (IM if venous access not immediately obtained). Repeat as required.
5. Arrange emergency transfer to A&E if indicated by baseline physical examination or behavioural disorder.
6. If history is available from relatives or friends establish the amount and type of drug used as well as time of last use.
7. Ask about poly-drug misuse - death associated with opiate overdose is often complicated by concurrent misuse of benzodiazepines which adds to generalised CNS depression - this has immediate implications for acute management as administration of flumazenil may reverse the benzodiazepine-induced component of the CNS depression (although this may cause seizures in benzodiazepine-dependent subjects).

8. Confirm the presumptive diagnosis on physical examination.
9. Collect urine (or if not possible blood) for toxicological analysis, bearing in mind the possibility of poly-drug misuse.
10. Following arrival at hospital and confirmation of toxicology, behavioural disorder may be treated with a combination of a high potency neuroleptic (typically haloperidol) and a benzodiazepine. It is essential to use a high potency neuroleptic (such as haloperidol) to avoid exacerbation of stimulant-induced anticholinergic effects.
11. Patients treated for opiate overdose must be observed for a period of hours - if a longeracting opiate such as methadone is responsible for the overdose, the effects of naloxone may 'wear off ' before those of the methadone, leading to re-occurrence of respiratory depression.

Next page .. THE MANAGEMENT OF WITHDRAWAL SYNDROMES

Alcohol Guidelines index

The above information is copyright of Dr Bruce Trathen MBBS MRCPsych (2006). ISBN 0-9545164-0-0. The author grants permission for these guidelines to be downloaded, copied and distributed freely, but does not grant permission for their sale.