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66 - Overdoses

from Section 11 - Environmental emergencies

Published online by Cambridge University Press:  05 November 2013

By
Daniel Herbert-Cohen  and
Daniel J. Lepp
Edited by
Kaushal Shah ,
Jarone Lee ,
Kamal Medlej  and
Scott D. Weingart
Kaushal Shah
Affiliation:
Department of Emergency Medicine, Mount Sinai School of Medicine, New York
Jarone Lee
Affiliation:
Department of Emergency Medicine, Massachusetts General Hospital, Boston
Kamal Medlej
Affiliation:
American University of Beirut
Scott D. Weingart
Affiliation:
Department of Emergency Medicine, Mount Sinai School of Medicine, New York
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Summary

This chapter discusses the diagnosis, evaluation and management of overdoses. It covers a selection of drug overdoses such as acetaminophen, aspirin, tricyclic antidepressants, beta-blockers, calcium channel blockers, and digoxin. In acetaminophen overdose, normal metabolic pathways are saturated and glutathione is depleted, resulting in N-acetyl- p-benzoquinone imin (NAPQI) accumulation and subsequent hepatocellular damage. Aspirin is normally metabolized by the liver through conjugation. In overdose, enzymes become saturated and renal elimination becomes important. In tricyclic antidepressant overdose, transient hypertension is followed by hypotension and bradycardia as catecholamines are depleted. In overdose of beta-blockers, selectivity for beta receptors is lost, and beta 1 and beta 2 effects are seen. Calcium channel blocker toxicity shifts myocardial metabolism from free fatty acids to carbohydrates. Digoxin toxicity can cause lethal ventricular dysrhythmias including ventricular tachycardia, torsades de pointes, and ventricular fibrillation.

Keywords

thrombotic thrombocytopenic purpurarenal dysfunctionthrombosisdialysishemolytic uremic syndromeneurological signs
Type
Chapter
Information
Practical Emergency Resuscitation and Critical Care , pp. 431 - 450
Publisher: Cambridge University Press
Print publication year: 2013

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