THE MEDICAL MANAGEMENT OF INTOXICATION
- Institute general supportive management - maintain airway, support breathing and cardiac function as required.
- Treat hyperthermia (over 102ºF) aggressively with ice packs, cold water and hypothermic blankets if available.
- Treat seizures with parenteral or per rectal diazepam.
- 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.
- Arrange emergency transfer to A&E if indicated by baseline physical examination or behavioural disorder.
- If history is available from relatives or friends establish the amount and type of drug used as well as time of last use.
- 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).
- Confirm the presumptive diagnosis on physical examination.
- Collect urine (or if not possible blood) for toxicological analysis, bearing in mind the possibility of poly-drug misuse.
- 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.
- 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
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.
Why DryOutNow.com
Alcoholism Services
