PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Drug Overdose”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 55 records · Page 3Linked to original sources
PubMed1999

Flumazenil in drug overdose: randomized, placebo-controlled study to assess cost effectiveness.

OBJECTIVE: To investigate cost effectiveness of administration of flumazenil to patients presenting with suspected acute drug overdose. DESIGN: Double-blind, prospective, placebo-controlled randomized study. SETTING: University teaching hospital. PATIENTS: Forty-three adults presenting with suspected drug overdose and having a Glasgow Coma Scale (GCS) score of <13. Patients with known benzodiazepine/tricyclic ingestion were excluded. INTERVENTIONS: Intravenous administration of flumazenil (up to 2 mg) or placebo. MEASUREMENTS AND MAIN RESULTS: Individual patient costs were assessed and data aggregated for each treatment group. Major diagnostic and therapeutic interventions were recorded and between group comparisons performed. Clinical response to study drug administration was assessed by obtaining pre- and post-drug GCS scores and observation of the patient for at least 180 mins for signs of resedation. Aggregate cost or number of major diagnostic and therapeutic interventions were not different between groups. Patients randomized to the flumazenil group showed a marked increase in GCS score (7.4 to 11.8) compared with those in the placebo group (8.2 to 8.6). CONCLUSION: Use of flumazenil in intentional drug overdose of unknown etiology is not cost effective.

Adolescent↗
PubMed1996

Accidental fatal drug overdoses in New York City: 1990-1992.

This study of all accidental fatal drug overdoses (N = 1,986) in New York City from 1990 to 1992, using medical examiner data, found that cocaine, often with opiates and ethanol, caused almost three-fourths of deaths, while opiates without cocaine caused roughly one-fourth of fatal overdoses. Only 5% of accidental drug fatalities were caused by drugs other than cocaine or opiates. This is a marked departure from the results of studies in the early 1980s when opiates prevailed as a cause of accidental fatal overdoses. In this study the highest cocaine overdose rates were found among males, African-Americans, and Latinos. Rates of opiate overdose without cocaine did not differ in regard to race/ethnicity except for low rates among Asians and other ethnic groups. There was a marked increase in the rate of combined cocaine and opiate overdoses from 1990 to 1992 and a more gradual but steady increase of overdoses due to opiates without cocaine during that time period. Overdoses due to drugs other than cocaine or opiates showed no increase during that time period.

Accidents↗
PubMed2006

Unintentional prescription drug overdose deaths in New Mexico, 1994-2003.

BACKGROUND: New Mexico has the highest rate of drug-induced mortality in the United States. The contribution of prescription drugs to the total overdose death rate has not been adequately described. METHODS: A total of 1,906 unintentional drug overdose deaths occurring in 1994 to 2003 in New Mexico were analyzed. Unintentional drug overdose death was defined as death caused by prescription, illicit, or a combination of drugs, as determined by a pathologist. Deaths were investigated annually by the medical examiner and data were analyzed in 2004-2005. Rates and trends of total and prescription drug overdose death were calculated, decedent characteristics were analyzed, and common drug combinations causing death were described. RESULTS: The rate of unintentional prescription drug overdose death increased by 179% (1.9 to 5.3/100,000) from 1994 to 2003. A high percentage of prescription drug overdose decedents were white non-Hispanic (63.2%) and female (43.9%). These decedents were older and less frequently had alcohol listed as an additional cause of death than decedents of other drug overdose categories. Of all deaths caused by prescription drug(s) (n =765), 590 (77.1%) were caused by opioid painkillers, 263 (34.4%) by tranquilizers, and 196 (25.6%) by antidepressants. CONCLUSIONS: The rate of prescription drug overdose death in New Mexico increased significantly over the 10-year study period. Comprehensive surveillance of drug overdose deaths is recommended to describe their occurrence in the context of both medical and diverted use of prescription drugs. Understanding decedent profiles and the potential risk factors for prescription drug overdose death is crucial for effective drug overdose prevention education among healthcare providers.

Adult↗
PubMedDate not supplied

Intentional drug overdose: predictors of clinical course in the intensive care unit.

OBJECTIVE: To examine the characteristics of patients admitted to the Medical Intensive Care Unit (MICU) after intentional drug overdose. DESIGN: Retrospective chart review, descriptive. SETTING: Midwestern teaching hospital. SUBJECTS: Convenience sample of 43 patients admitted to the MICU after intentional drug overdose. OUTCOME MEASURES: Survival and disposition of those patients who survived and were discharged from the MICU. RESULTS: Ninety-five percent of the patients survived and were discharged from the MICU; Acute Physiology and Chronic Health Evaluation II scores ranged from 1 to 29 (mean, 8); Glascow Coma Scale scores ranged from 3 to 15 (mean 12.5); five patients were intubated and two patients had serious electrocardiograph changes requiring pharmacologic intervention for dysrhythmia. CONCLUSIONS: Neurologic findings were the best indicators of serious complications after drug overdose. THerefore, patients with a Glascow Coma Scale score of more than six, and who are not intubated, may not need admission to an intensive care unit.

APACHE↗
PubMed1980

Psychological effects caused by drugs in overdose.

Drug overdose is a common occurrence which accounts for up to 25% of medical inpatient admissions. Intentional overdose or attempted suicide is the most common cause of overdose, but there are other types of overdose which are often unrecognised as are the effects caused by these overdoses. Iatrogenic overdose occurs frequently and is often unavoidable. Many patients will make mistakes with their treatment and unwittingly suffer from the toxic effects of the drugs they are taking. About 7% of intentional overdose patients who are admitted to hospital have taken the drug for some psychological effect they have been seeking and have taken too much. This group is described as those who take 'drugs for kicks'. As many of the drugs taken cross the blood-brain barrier and exert some toxic effect on the cerebral cortex, secondary psychological disturbances frequently occur in all of these groups of patients, and can sometimes be the only sign of dangerous toxicity. It is important to recognise the patient's gross disturbances of behaviour, thinking and perception as a manifestation of drug toxicity which can be life threatening and often requires intense medical treatment. The range of the psychological response is somewhat limited and there is not a specific psychological disturbance characteristic of the toxicity of each group of drugs. However, there are some reactions which, coupled with the physical symptoms shown by the patient, can help to identify the patient as suffering from the toxic effects of drugs and even give some indication as to the type of drugs taken. This article describes the various psychiatric syndromes caused by drugs in overdose and attempts to identify these with most of the commonly encountered groups of drugs.

Analgesics↗
PubMed2004

Out-of-hospital care of critical drug overdoses involving cardiac arrest.

OBJECTIVES: Death from acute drug poisoning, also termed drug overdose, is a substantial public health problem. Little is known regarding the role of emergency medical services (EMS) in critical drug poisonings. This study investigates the involvement and potential mortality benefit of EMS for critical drug poisonings, characterized by cardiovascular collapse requiring cardiopulmonary resuscitation (CPR). METHODS: The study population was composed of death events caused by acute drug poisoning, defined as poisoning deaths and deaths averted (persons successfully resuscitated from out-of-hospital cardiac arrest by EMS) in King County, Washington, during the year 2000. RESULTS: Eleven persons were successfully resuscitated and 234 persons died from cardiac arrest caused by acute drug poisoning, for a total of 245 cardiac events. The EMS responded to 79.6% (195/245), attempted resuscitation in 34.7% (85/245), and successfully resuscitated 4.5% (11/245) of all events. Among the 85 persons for whom EMS attempted resuscitation, opioids, cocaine, and alcohol were the predominant drugs involved, although over half involved multiple drug classes. Among the 11 persons successfully resuscitated, return of circulation was achieved in six following EMS cardiopulmonary resuscitation alone, in one following CPR and defibrillation, and in the remaining four after additional advanced life support. CONCLUSIONS: In this community, EMS was involved in the majority of acute drug poisonings characterized by cardiovascular collapse and may potentially lower total mortality by approximately 4.5%. The results show that, in some survivors, return of spontaneous circulation may be achieved with CPR alone, suggesting a different pathophysiology in drug poisoning compared with cardiac arrest due to heart disease.

Adult↗
PubMed2005

Circumstances of witnessed drug overdose in New York City: implications for intervention.

Drug users frequently witness the nonfatal and fatal drug overdoses of their peers, but often fail to intervene effectively to reduce morbidity and mortality. We assessed the circumstances of witnessed heroin-related overdoses in New York City (NYC) among a predominantly minority population of drug users. Among 1184 heroin, crack, and cocaine users interviewed between November 2001 and February 2004, 672 (56.8%) had witnessed at least one nonfatal or fatal heroin-related overdose. Of those, 444 (67.7%) reported that they or someone else present called for medical help for the overdose victim at the last witnessed overdose. In multivariable models, the respondent never having had an overdose her/himself and the witnessed overdose occurring in a public place were associated with the likelihood of calling for medical help. Fear of police response was the most commonly cited reason for not calling or delaying before calling for help (52.2%). Attempts to revive the overdose victim through physical stimulation (e.g., applying ice, causing pain) were reported by 59.7% of respondents, while first aid measures were attempted in only 11.9% of events. Efforts to equip drug users to manage overdoses effectively, including training in first aid and the provision of naloxone, and the reduction of police involvement at overdose events may have a substantial impact on overdose-related morbidity and mortality.

Adolescent↗
PubMed1993

Surveillance of poisoning and drug overdose through hospital discharge coding, poison control center reporting, and the Drug Abuse Warning Network.

There is no gold standard for determining poisoning incidence. We wished to compare four measures of poisoning incidence: International Classification of Diseases 9th Revision (ICD-9) principal (N-code) and supplemental external cause of injury (E-code) designations, poison control center (PCC) reporting, and detection by the Drug Abuse Warning Network (DAWN). We studied a case series at two urban hospitals. We assigned ICD-9 N-code and E-code classifications, determining whether these matched with medical records. We ascertained PCC and DAWN system reporting. A total of 724 subjects met entry criteria; 533 were studied (74%). We matched poisoning N-codes for 278 patients (52%), E-code by cause in 306 patients (57%), and E-code by intent in 171 patients (32%). A total of 383 patients (72%) received any poisoning N-code or any E-code. We found that PCC and DAWN reporting occurred for 123 of all patients (23%) and 399 of 487 eligible patients (82%), respectively. In multiple logistic regression, factors of age, hospital admission, suicidal intent, principal poisoning or overdose type, and mixed drug overdose were statistically significant predictors of case match or report varying by surveillance measure. Our findings indicate that common surveillance measures of poisoning and drug overdose may systematically undercount morbidity.

Adolescent↗
PubMed2005

Psychiatric disorders and their comorbidity in subjects with parasuicide by intentional drug overdose: prevalence and gender differences.

The aims of the present study were to assess the prevalence and comorbidity of psychiatric disorders in subjects with intentional drug overdose and to explore whether there were gender differences in prevalence and comorbidity. A standardized psychiatric evaluation was performed in 100 randomly selected subjects, 18 years old and older, with intentional drug overdose referred to an emergency department. The prevalences of psychiatric morbidity and comorbidity were very high in both genders: 88% presented with at least one psychiatric diagnosis, and three-quarters presented with comorbid psychiatric disorders. Affective and anxiety disorders were the most prevalent diagnoses. One patient out of three presented with alcohol or substance misuse. Compared to females, males suffered five times more often from substance misuse and three times more often from psychotic syndrome and were three times less likely to present with anxiety disorder. When subjects are referred to hospital for intentional drug overdose, medical management should systematically involve a psychiatric assessment in order to identify not only affective and anxiety disorders, but also alcohol and substance misuse, due to the high prevalence of these disorders, especially in male subjects.

Adolescent↗
PubMed1976

Six unusual cases of drug overdose.

Six patients out of a total of 1,137 adults treated for drug overdose died during the period May, 1968 to June, 1973. Their case histories are summarized, and the conclusion drawn that, whilst death from drug overdose is unusual, increased vigilance particularly for the unsuspected secondary diagnosis or complication, is needed if there is to be any further reduction in the already small mortality rate.

Adult↗
PubMed2005

A randomized clinical trial of activated charcoal for the routine management of oral drug overdose.

BACKGROUND: Activated charcoal (AC) is commonly used for the routine management of oral drug overdose. AIM: To determine whether the routine use of activated charcoal has an effect on patient outcomes. DESIGN: Randomized controlled unblinded trial. METHODS: We recruited all adult patients presenting with an oral overdose at The Canberra Hospital, excluding only transfers, late presenters, those who had ingested drugs not adsorbed by activated charcoal or where administration was contraindicated, and very serious ingestions (at the discretion of the admitting physician). Patients were randomized to either activated charcoal or no decontamination. RESULTS: The trial recruited 327 patients over 16 months. Of 411 presentations, four refused consent, 27 were protocol violations and 53 were excluded from the trial. Only seven were excluded due to the severity of their ingestion. The most common substances ingested were benzodiazepines, paracetamol and selective serotonin reuptake inhibitor antidepressants. More than 80% of patients presented within 4 h following ingestion. There were no differences between AC and no decontamination in terms of length of stay (AC 6.75 h, IQR 4-14 vs. controls 5.5 h, IQR 3-12; p=0.11) or secondary outcomes including vomiting, mortality and intensive care admission. DISCUSSION: Routine administration of charcoal following oral overdose did not significantly influence length of stay or other patient outcomes following oral drug overdose. There were few adverse events. This does not exclude a role in patients who present shortly after ingestion of highly lethal drugs.

Acetaminophen↗
PubMed1996

Carbohydrate-deficient transferrin for identification of drug overdose patients at risk of an alcohol withdrawal syndrome.

BACKGROUND: Chronic alcohol abuse is frequent in patients admitted to the intensive care unit with acute drug overdose. During detoxification, an alcohol withdrawal syndrome may develop in patients with a history of chronic alcohol abuse. Withdrawal or delirium is associated with serious risks, necessitating early identification of patients at risk. Since the information obtained from the patients or their relatives on alcohol consumption is often unreliable, biochemical markers may be helpful. Carbohydrate deficient transferrin is considered a highly specific marker (reported maximum specificity 97%, sensitivity 40-85%) for identifying alcohol abuse. METHODS: In 20 patients with acute drug overdose and suspected alcohol abuse, carbohydrate deficient transferrin was determined by an immunoturbidimetric assay on admission to the intensive care unit. Eight of the patients had carbohydrate deficient transferrin levels above the "positive" threshold and nine in a suspicious range. A "false" negative carbohydrate deficient transferrin was found in three patients who were thought to have changed their drinking habits prior to hospitalization. A "positive" carbohydrate deficient transferrin test is assumed to be associated with ingestion of more than 60-80 g ethanol/d for a period of more than seven days. RESULTS: In all patients, clonidine (30-210 micrograms/h i.v.) was started. None developed delirium. Since alcohol addiction is frequently denied, determination of carbohydrate deficient transferrin may be useful for its early diagnosis but the sensitivity of this parameter requires further evaluation.

Alcohol Withdrawal Delirium↗
PubMed1988

Clinical experiences with Ro 15-1788 (anexate) in benzodiazepine and mixed-drug overdoses.

Benzodiazepine overdose is the most common of admission to the Toxicological Unit of the University of Florence. The aim of this study has been to evaluate the efficiency of Ro 15-1788 in benzodiazepine and mixed drug overdoses. The administration of Ro 15-1788 was followed by a quick reversal of central nervous system depression and was more effective in benzodiazepine overdoses than in mixed drug overdoses. The dose was titrated individually and the range 2-10 mg was effective according to the conditions of the patient. In some cases, the comatose state relapsed; further administration of Ro 15-1788 again promptly reversed the condition. On awakening, two patients displayed anxiety and restlessness.

Adult↗
PubMed1978

Fixed-bed charcoal hemoperfusion. Treatment of drug overdose.

Fixed-bed activated charcoal cartridges were used for hemoperfusion in the treatment of 54 patients with overdose of one or more drugs, including barbiturate, glutethimide, ethchloryvnol, meprobamate, methyprylon, methaqualone, salicylate, and diazepam. The most dramatic improvement was noticed in patients with phenobarbitol intoxication; they were admitted in stage 3-4 coma and were either awake or arousable by verbal communication at the end of 1 1/2 to 3 1/2 hours of hemoperfusion. Other intoxications improved slowly and required longer duration of treatment. The clearance rates of the drugs with hemoperfusion were greater than those usually achieved with hemodialysis. The data demonstrate the efficacy and usefulness of charcoal hemoperfusion for the management of drug overdose.

Adolescent↗
PubMed1984

Drug overdose during pregnancy: an overview from a metropolitan poison control center.

Suicide attempts during pregnancy usually present as intentional drug overdoses after interpersonal conflicts. During a recent four-year period, 119 (0.07%) of all 179,893 telephone inquiries at a metropolitan poison control center involved drug overdoses by 111 pregnant women. This was usually the first such attempt and telephone notification occurred primarily within the first hour. The ingested substance was known in 109 (98%) cases and consisted mostly of an excess of a single drug. The 50 different types of over-the-counter and prescription medications consisted primarily of analgesics (most notably acetaminophen), vitamins or iron, sedatives, antibiotics, and antihistamines or decongestants. No maternal deaths were reported. Signs or symptoms were nonexistent or mild in 61 (55%) women, and major or life-threatening in 50 (45%) women. Compliance with recommendations given by telephone and referral to the primary physician or emergency room was good, especially when major symptoms or life-threatening illnesses were apparent. Close emotional support and a search for depression during pregnancy and the postpartum period are recommended.

Adolescent↗
PubMed1987

Efficacy of ipecac-induced emesis, orogastric lavage, and activated charcoal for acute drug overdose.

The efficacy of ipecac-induced emesis, large-bore orogastric lavage, and activated charcoal as gastrointestinal decontamination procedures after acute drug overdose is unknown. Using an ampicillin overdose model, these three procedures were compared with one another and to a control ingestion in ten human volunteers. Serial serum ampicillin levels were used to compute the areas under the concentration vs time curves (AUC) for each study. The reductions of ampicillin absorption compared to control were as follows: orogastric lavage 32% (NS), ipecac-induced emesis 38% (P less than .01), and activated charcoal 57% (P less than .01). This model examines each intervention in a mutually exclusive fashion. It supports activated charcoal administration as the primary gastrointestinal decontamination procedure after acute drug overdose.

Acute Disease↗