Management of Suicidal Drug Overdose

Abstract

INCIDENCE AND EPIDEMIOLOGY Suicide is the third leading cause of death among adolescents, and yet for each fatality it is estimated that between 50 to 200 adolescents survive a suicide attempt. Most of the survivors have taken overdoses of drugs commonly found at home. The rate of suicide attempts that do not result in death peaks in adolescence. The male to female ratio is 1/2 and self-poisoning is usually the method. In contrast, suicide fatality rates generally increase with age. Overall, suicide is the ninth leading cause of death in the United States; the male to female ratio is 3/1; and the method used most often is fire-arms. Clearly, suicidal behavior by adolescents is a major health problem in the United States today. The usual challenge for the pediatrician is first managing an acute drug overdose and then facilitating subsequent psychosocial evaluation of the troubled youth. The key challenge is identification of disturbed individuals and their families prior to any suicidal acts. DIAGNOSIS AND PHYSIOLOGIC MANAGEMENT Most young people who present with a suicidal drug overdose are not comatose; many are asymptomatic. In such situations a careful history may be obtained from the patient to determine: the events surrounding the ingestion, which drug or drugs were taken, how much, and when the ingestion occurred.