Complications
Most overdoses/ingestions with altered mental status can result in aspiration. This is a significant source of morbidity, and may lead to pneumonia, which should be treated with antibiotics that cover for gram-negative bacteria and gram-positive cocci.
Includes hepatic encephalopathy, sepsis, and gastrointestinal bleeding. Timely referral to a liver unit and assessment of patient candidacy for orthotopic liver transplantation are needed.
Acute kidney injury can occur as a result of overdoses that are either directly nephrotoxic or secondary to rhabdomyolysis from prolonged seizures, hypotension, acidosis, or compartment syndromes.
Diagnosed by monitoring renal function. Management depends on the cause, but hydration is important.
Overdoses that cause prolonged seizures, hypotension, or poor central nervous system perfusion or hypoxia can cause encephalopathy.
Diagnosed by neurological exam of the patient. Management depends on the cause, but many cases may be irreversible.
Onset is 1 to 5 weeks after ingestion, usually after acute effects, but may overlap with intermediate syndrome. A predominantly motor neuropathy, but there may also be upper motor neuron problems and cognitive defects. There is no known treatment, but it may resolve slowly over months to years.
Can result from the increased muscle activity often seen with serotonin syndrome, neuroleptic malignant syndrome, anti-muscarinic toxicity, sympathomimetic toxicity, and others. It can also result from the prolonged immobilisation seen with opioid toxicity, alpha-2 agonist toxicity, and others.
Agents more likely to cause cerebral oedema include salicylates; lithium; sympathomimetics with prolonged hyperthermia, acidosis, and seizures; toxic alcohols; and glycols. Aggressive treatment of the underlying overdose is the mainstay of management.
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