6.7 Overdose
Overdose is the biological response of the human body when too much of a substance is ingested.
Recognizing Alcohol Overdose
An alcohol overdose occurs when there is so much alcohol in the bloodstream that areas of the brain controlling basic life-support functions, such as breathing, heart rate, and temperature control, begin to shut down. Symptoms of alcohol overdose include mental confusion, difficulty remaining conscious, vomiting, seizures, trouble breathing, slow heart rate, clammy skin, dulled responses (such as no gag reflex, which prevents choking), and extremely low body temperature. Alcohol overdose can lead to permanent brain damage or death.
Anyone who consumes too much alcohol too quickly is in danger of an alcohol overdose, especially individuals who engage in binge drinking. Binge drinking is defined as a pattern of drinking that brings blood alcohol concentration (BAC) to 0.08% or higher, which typically occurs after a woman consumes four drinks or a man consumes five drinks in about two hours. Teenagers and young adults who binge drink are at high risk for overdose. Alcohol use and taking opioids or sedative hypnotics also increase the risk of an overdose.[1]
Nurses can play a role in educating clients that if they suspect that someone is experiencing alcohol overdose, they should request emergency assistance or call 911. A potential danger of alcohol overdose is asphyxiation from aspiration of vomit because high levels of alcohol intake hinder the gag reflex, resulting in the inability to protect the airway. For this reason, they should not leave a person alone who has lost consciousness due to alcohol misuse. They should keep them in a partially upright position or roll them onto one side with an ear toward the ground to prevent choking if they begin vomiting.[2]
Medical Treatment
Acute alcohol intoxication can cause hypotension and tachycardia as a result of peripheral vasodilation or fluid loss. Treatment begins with the evaluation of the client’s blood alcohol level (BAC). It is important to know if other drugs like opioids, benzodiazepines, or street drugs have also been ingested because this increases the risk of overdose, and other treatments (such as naloxone) may be required.[3]
Severely intoxicated clients may receive an IV dextrose infusion if hypoglycemia is present. Clients presenting in coma due to alcohol intoxication receive intravenous thiamine, along with dextrose, to prevent an acute, life-threatening neurological condition called Wernicke’s encephalopathy caused by thiamine (B1) deficiency.[4]
Some clients with acute alcohol intoxication can become agitated, violent, and uncooperative. Chemical sedation with administration of benzodiazepines may be required to prevent the client from harming themselves or others. However, benzodiazepines must be used with caution because they worsen the respiratory depression caused by alcohol.[5]
Recognizing and Treating Opioid Overdose
Basic steps are recommended for nurses, first responders, health professionals, and other bystanders to rapidly recognize and treat opioid overdose to prevent death. View a summary of these steps in the following box.
Recognizing and Treating Opioid Overdose[6]:
- Recognize Signs of Opioid Overdose:
- Signs of opioid overdose include unconsciousness or the inability to awaken; pinpoint pupils; slow, shallow breathing; breathing difficulty manifested by choking sounds or a gurgling/snoring noise from a person who cannot be awakened; fingernails or lips turning blue or purple; or respiratory arrest.
- If an opioid overdose is suspected, try to stimulate the person by calling their name or vigorously grinding one’s knuckles into their sternum.
- Obtain Emergency Assistance: If the person does not respond, call 911 or obtain emergency assistance.
- Provide Rescue Breathing, Chest Compressions, and Oxygen As Needed:
- Provide rescue breathing if the person is not breathing on their own.
- If the individual becomes pulseless, provide cardiopulmonary resuscitation (CPR).
- Administer oxygen as needed.
- Administer the First Dose of Naloxone:
- Naloxone should be administered to anyone suspected of an opioid overdose.
- Research has shown that women, older adults, and those without obvious signs of opioid use disorder are undertreated with naloxone and, as a result, have a higher death rate. Therefore, naloxone should be considered for women and the elderly who are found unresponsive.
- Naloxone can be used in life-threatening opioid overdose circumstances in pregnant women.
- Naloxone can be given intranasally, intramuscularly, subcutaneously, or intravenously.
- All naloxone products are effective in reversing opioid overdose, including fentanyl-involved opioid overdoses, although overdoses involving potent or large quantities of opioids may require additional doses of naloxone.
- Withdrawal triggered by naloxone can feel unpleasant; some people may awaken confused, agitated, or aggressive. Provide safety, reassurance, and explain what is happening.
- Administer a Second Dose of Naloxone If the Person Does Not Respond:
- If the person overdosing does not respond within two to three minutes after administering a dose of naloxone, administer a second dose of naloxone.
- People who have taken long-acting or potent opioids (like fentanyl) may require additional intravenous bolus doses or an infusion of naloxone.
- The duration of effect of naloxone depends on dose, route of administration, and overdose symptoms. It is shorter than the effects of some opioids, so a second dose may be required.
- Monitor the Person’s Response:
- Most people respond to naloxone by returning to spontaneous breathing within two to three minutes. Continue resuscitation while waiting for the naloxone to take effect.
- The goal of naloxone therapy is to restore adequate spontaneous breathing but not necessarily achieve complete arousal.
- The individual should be monitored for recurrence of signs and symptoms of opioid toxicity for at least four hours from the last dose of naloxone. People who have overdosed on long-acting opioids like fentanyl require prolonged monitoring.
- Because naloxone has a relatively short duration of effect, overdose symptoms may return. Therefore, it is essential to get the person to an emergency department or other source of medical care as quickly as possible, even if the person revives after the initial dose of naloxone and seems to feel better.
- National Institute on Alcohol Abuse and Alcoholism. (2023, January). Understanding the dangers of alcohol overdose. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-dangers-of-alcohol-overdose ↵
- National Institute on Alcohol Abuse and Alcoholism. (2023, January). Understanding the dangers of alcohol overdose. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-dangers-of-alcohol-overdose ↵
- Cowan, E. & Su, M. K. (2024). Ethanol intoxication in adults. UpToDate. Retrieved July 15, 2024 from https://www.uptodate.com/contents/ethanol-intoxication-in-adults ↵
- Cowan, E. & Su, M. K. (2024). Ethanol intoxication in adults. UpToDate. Retrieved July 15, 2024 from https://www.uptodate.com/contents/ethanol-intoxication-in-adults ↵
- Cowan, E. & Su, M. K. (2024). Ethanol intoxication in adults. UpToDate. Retrieved July 15, 2024 from https://www.uptodate.com/contents/ethanol-intoxication-in-adults ↵
- Substance Abuse and Mental Health Services Administration. (2018). SAMHSA opioid overdose prevention toolkit: Five essential steps for first responders.https://store.samhsa.gov/sites/default/files/five-essential-steps-for-first-responders.pdf ↵
The biological response of the human body when too much of a substance is ingested.
When there is so much alcohol in the bloodstream that areas of the brain controlling basic life-support functions such as breathing, heart rate, and temperature control begin to shut down.