ABSTRACT
Early aggressive treatment of attempted suicide during pregnancy is associated with better outcomes than late or passive treatment. Fetal monitoring should begin as early as possible. If a specific antidote exists, it should be given as soon as possible. If there is no specific antidote, a nonspecific aggressive treatment should be instituted as early as possible (see Appendix II). Toxicology should be ordered as soon as possible to empirically ascertain the exposure(s) and potential toxicity. Time since ingestion is a very important data point, but it is infrequently published (e.g., see Appendix II for Acetaminophen overdoses for paucity of reporting).
Most drug overdoses may be managed with supportive care, including airway management, IV fluids, gastric lavage, whole bowel irrigation, and electrolyte balance. Sedatives and anticonvulsants are commonly associated with loss of consciousness, and may require airway assistance. Other drugs (salbutamol, theophylline) stimulate the sympathetic nervous system, often presenting with hypertension and tachycardia.. Fluid replacement and sedation (e.g., benzodiazepines) may be used to manage hyperirritability. Serotonin syndrome may be induced by SSRI overdoses, and have hyperthermia and muscle rigidity. Hydration and cooling are warranted.
In general, overdoses with not-sustained-release drugs should be monitored for 6–8 hours. Signs and symptoms should appear by this time lag. However, sustained-release drugs may produce symptoms as late as 18–24 hours post-ingestion.
