Broad classes of meds include: Anti-epileptics, benzodiazepines, mood stabilizers, anti-psychotics, other sedatives/hypnotics
Can be related to intentional or unintentional overdose
Risk Factors
History of abuse
Depression, suicidality (if intentional)
Medical conditions that lead to use of these meds (e.g. seizure disorder--> dilantin, phenobard, bipolar disorder--> lithium)
Medical conditions that affect normal clearance (e.g. acute or chronic renal dysfunction, other medications that inhibit enzyme systems which normally clear theses substance
Symptoms
Some of these meds are sedating only
Others can initially cause activation, and then sedation; or have paradoxic effects
If intentional overdose, co-ingestions frequently occur and can lead to additional/confusing findings/presentations
Lithium: dizziness, nausea, weakness, diarrhea, agitation, decreased level of consciousness; chronic use can cause hypovolemia/hypernatremia from nephrogenic diabetes insipid us; as well as contributing to chronic kidney disease
Dilantin: sedation, slurred speech
Benzodiazepines: confusion, decreased level of consciousness, altered speech, fall/loss of balance
Physical Exam Findings
Dilantin: depressed level of alertness (degree varies), ataxia, tremor, nystagmus
Lithium: can range from agitation to somnolence, tremor, slurred speech, uncoordinated limb movements, muscle twitching, hyper-reflexia, nystagmus
Benzodiazepines: confusion, decreased level of alertness, slurred speech, ataxia, decreased respiratory rate/absence of breathing, bradycardia
Tests
Drug levels to assist with determining degree of toxicity, best treatments (e.g. Dilantin, Lithium)
Assess for co-ingestions
Chem 7, lfts, CBC, coags: to assess for organ dysfunction, ability to clear toxins