An intentional overdose is both a poisoning and a psychiatric emergency, and patients may hide what or how much they took. Care focuses first on the airway and antidotes, then on keeping the patient safe and assessing suicide risk with respect and without judgment.
Key symptoms
- Drowsiness, confusion or agitation
- Nausea, vomiting or belly pain
- Slow breathing with opioids or sedatives
- Ringing ears and fast breathing with aspirin
What you find on exam
- Airway, breathing, circulation and Glasgow Coma Scale
- Pupils, skin, temperature and toxidrome signs
- Self-harm marks and other injuries
- Suicide risk: intent, plan, access to means and protective factors
Tests
- Acetaminophen and salicylate levels in every intentional overdose
- ECG for QRS and QT prolongation
- Glucose, electrolytes, anion gap, kidney and liver tests
- Pregnancy test and specific drug levels as needed
Treatment basics
- Stabilize airway, breathing and circulation; call poison control
- Antidotes: naloxone for opioids, acetylcysteine for acetaminophen
- Activated charcoal if early and the airway is protected
- One-to-one observation and removal of means of self-harm
- Psychiatric assessment and a safety plan before discharge
Red flags
- Falling consciousness or slow breathing
- Wide QRS, arrhythmia or seizure
- Patient trying to leave or still voicing intent
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Related guides
Sources: NCCPA PANCE Content Blueprint; NCSBN 2026 NCLEX-RN Test Plan; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.