Physiologic and biochemical abnormalities in self-induced drug overdosage

Area of Science:

• Clinical Toxicology
• Emergency Medicine
• Internal Medicine

Background:

• Drug overdosage (OD) is a significant cause of emergency department admissions.
• Understanding the spectrum of physiological abnormalities in OD patients is crucial for effective management.
• Early identification of complications can improve patient outcomes.

Purpose of the Study:

• To document the range of abnormalities observed in patients admitted for drug overdosage.
• To investigate correlations between specific clinical findings and patient characteristics.
• To assess the incidence of pneumonitis in this patient population.

Main Methods:

• Retrospective analysis of 162 drug overdosage episodes in 152 patients.
• Observation of abnormalities within the first 24 hours of admission.
• Correlation analysis of clinical data including temperature, WBC counts, serum enzymes (CPK), chest X-rays, and sputum cultures.

Main Results:

• Common abnormalities included abnormal chest X-rays, elevated WBC counts, increased A-aO2 gradient, elevated serum enzymes, myoglobinuria, skin lesions, and abnormal ECGs.
• Hyperthermia was present in all patients with OD duration < 12 hours.
• Elevated WBC counts correlated with increasing temperature and CPK values. Skin lesions were associated with higher temperatures, CPK, and longer OD duration.
• Myoglobinuria occurred with CPK levels > 10,000 mU/ml. Abnormal chest X-rays correlated with higher temperatures and A-aO2 gradients.
• Despite abnormal findings, pneumonitis incidence was low.
• Abnormal temperatures and leukocytosis were often attributed to stress, hypoxemia, acidosis, or drug effects rather than infection.

Conclusions:

• Drug overdosage frequently presents with diverse physiological derangements.
• Clinical and laboratory abnormalities in OD patients are often multifactorial, with stress and drug effects playing significant roles.
• The low incidence of pneumonitis suggests that abnormal chest X-rays and positive sputum cultures in OD patients may not always indicate infection.