thereafter. Symptomatic patients require ECG monitoring.
In chronic accumulation, stopping lithium is often all
that is needed to alleviate symptoms; however, patients
may require other treatments for bipolar disorder.
In acute severe toxicit
7 Hyperthermia is initially treated with sedation and
cooling, but if it is persistently >39C, ice baths and
dantrolene may be used.
8 In severe liver failure seek advice froma liver unit, liver
transplantation has been used.
Overdose and poisoning
isknownbymany streetnamesincluding H, gear, smack,
junk, skag, white stuff, sugar. Health care professionals
with access to opiates may abuse drugs like fentanyl.
Heroin abuse fell during the late 1990s, but rose again
rapidly in 2000
appropriate to start N-acetylcysteine prior to blood
levels are known if very high doses have been taken or
if presentation is delayed.
Severe hepatotoxicity may necessitate liver transplantation.
If acute hepatic failure occurs, mortality is
cramps, diarrhoea, watery eyes and nose and muscle
twitching. Seizures may occur.
Social problems include loss of job, deterioration in
relationships and criminal activities to obtain money
to buy drugs, including stealing, prostitution and drug
drugs. They are not physically addictive in the same
way as opiates, but cocaine addictswill compulsively take
doses in a binge in order to keep experiencing the highs
and to avoid the depression and fatigue that occur when
the drugwears off. Tolerance do
haemorrhage may require blood replacement and
metabolic acidosis should be corrected. Liver and renal
support may be required.
In absence of symptoms, serum levels are monitored
every 2 hours until levels fall or symptoms develop.
Symptomatic patients w
of amphetamine depends on urine pH acid urine
increases its clearance.
Physical effects of an amphetamine-intoxicated state include
tachypnoea, tachycardia, decreased appetite and
increased motor activity. A history should be taken of re
Accidental or deliberate overdose of paracetamol, causing
Currently the commonest drug used for deliberate overdose.
528 Chapter 15: Overdose, poisoning and addiction
Mercaptopuric acid Cell death
of salicylate increases the risk of bleeding.
Patients may appear asymptomatic even in the presence
of significant overdose. In moderate overdose patients
may present with deep respiratory movements
and tinnitus as early signs, and later