OVERDOSES

TCAs

One week's worth of pills is fatal (cardiotoxic Na+ blockade). They will (a) have Convulsions, (b) fall into a Coma, and (c) die from a Cardiac arrhythmia. Treat the arrhythmia with Sodium Bicarbonate. 

Opioids

They will have a dangerously low respiratory rate, be in a coma and have pinpoint pupils. Give Naloxone. 

Benzos

An isolated Benzo OD probably isn’t fatal. But if you add another depressant (booze) it’s a one way ticket to dead town. Symptoms are similar to Opioid OD (the difference is big pupils). Treat with Flumazenil. 

Acetaminophen

Probably accounts for the most overdoses in the world (besides alcohol). Tylenol is an incredibly safe drug at the recommended dose, but it’s so, so easy to overdose on it. Acetaminophen is metabolized into the nasty metabolite NAPQI, which wreaks oxidative havoc on zone 3 of the liver. The liver defends itself with glutathione, but its supply is not infinite. By giving the patient N-acetylcysteine (NAC), you can replenish their store of glutathione. There is a serum test for Acetaminophen levels, in case you were wondering.

Aspirin

More difficult to kill yourself with Aspirin than Tylenol. The patient will experience GI distress, tinnitus and hyperventilation. The Aspirin molecules uncouple oxidative phosphorylation, sending the body into a metabolic overdrive, culminating in a lethal metabolic acidosis. No antidote available but give sodium bicarbonate to alkalinize urine. 

Lithium

Lithium is a metal. All metal poisonings cause GI distress. Severe ODs are fatal. Treat with dialysis

Any OD less than 1 hour ago

Make them drink activated charcoal. Activated charcoal is a nasty black sludge that neutralizes undigested pills in the stomach. It doesn’t work with every poison, unfortunately, and is contraindicated in confused patients.