A case of multiple tablets overdose

Multiple tablets overdose

Priya^1*, Subathra Devi², Maha Lakshmi³

¹Nursing in charge, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

²Nurse Educator Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

³Nursing Superintendent, Kauvery hospital, Cantonment, Trichy, Tamil Nadu

*Correspondence

Abstract

Drug overdose, especially from taking multiple tablets, is a common and growing public health problem. In India, intentional overdose is seen more often in young adults and females. Although the death rate is low, these cases are frequently linked to self-harm and increase the workload in emergency departments. Emotional problems such as family issues and relationship stress are common causes. Different drugs have different levels of danger, with older antidepressants being more harmful than newer ones. This article focuses on understanding drug overdose, its causes, and its impact on health care.

Key words: Drug overdose. Mental health issues; Blood tests and ECG

Introduction

Drug overdose is a serious health problem caused by taking too much medicine, either accidentally or intentionally. It is common due to multiple drug use, mental health issues, and easy access to medications. Symptoms include drowsiness, confusion, breathing problems, seizures, and heart changes. Diagnosis is based on history, examination, and tests like blood tests and ECG. Treatment focuses on stabilizing the patient with oxygen, fluids, and medicines like antidotes. Nurses play an important role in monitoring the patient, giving treatment, and preventing complications. Education and proper medication can help prevent overdose.

Case presentation

A 23-year-old female was admitted following an intentional overdose of approximately 50 tablets containing multiple psychotropic and cardiovascular medications, including opipramol (50 mg), desvenlafaxine extended-release, clonazepam, quetiapine (25 mg), propranolol, bupropion, and dextromethorphan. Soon after ingestion, she developed tachycardia and rapidly progressive hypoxemia with severe oxygen desaturation, necessitating endotracheal intubation using a 7.0 mm cuffed tube and initiation of mechanical ventilation.

Relevant Clinical Findings

Social History: He does not have any social history of cigarette smoking or alcohol addiction.

Allergies: No known medicine or environmental allergies.

Past medical history: Know case of Anxiety Neurosis/BPD/BA/Obesity & multiple substance abuse on regular treatment.

Physical examination: Patient drowsy, Arousable.

Vitals signs

Temperature	98.6
HR	81bt/min
RR	24brth/min
BP	90/60 mmhg
Spo2	93% on Room Air
CVS	SIS2 (+)
RS	NVBS (+)
P/A	Soft

Initial Evaluation

POCUS

Abdomen scan (18.10.2025)

Mild hepatomegaly.
Abdomen scan (04.11.2025) Hepatomegaly with grade 1 fatty change Cholelithiasis and sludge in gall bladder.

Neurological Evaluation

Nerve conduction study (10.11.2025)
This nerve conduction study suggestive of sensory motor axonal neuropathy involving predominantly left upper and lower limbs
A Nerve Conduction Study (13/11/2025) indicated predominantly motor axonal neuropathy involving both upper and lower limbs. The neurophysician reviewed the patient and advised continuation of IVIG therapy.

ECHO (21.10.2025)

Normal chambers dimension
No RWMA
Good LV function
Normal Valves
No MR/TR
Septa intact
No pericardial effusion/clot.

Relevant Investigation

Urea Serum	19.26 mg/dL
Creatinine	0.34 mg/dL
Haemoglobin	9.2 g/dl
Platelet Count	336000 cells/µl
Basophil	0.4 %
Absolute Neutrophil Count (ANC)	5430 cells/µl
Mean Corpuscular Volume (MCV)	70.0 fl
(MCH) Mean Corpuscular Haemoglobin	20.6 pg/cell
Total WBC Count	8230 Cells/Cumm
(MCHC) Mean Corpuscular Haemoglobin Concentration	29.5 g/dl
Total RBC Count	4.46 ML/10^9
Platelet Count	179000 cells/µl
Alanine Aminotransferase (ALT/SGPT)	74.1 U/L
Gamma - Glutamyl Transferase (GGT)	51 U/L
Aspartate Aminotransferase (AST/SGOT)	94.7 U/L
Albumin, Serum	3.36 g/dl
Total Protein	5.46 g/dl
Alkaline Phosphatase	109.0 U/L
Total Bilirubin	1.02 mg/dL
Indirect Bilirubin	0.55 mg/dL
Direct Bilirubin	0.47 mg/dL
A/G Ratio	1.60.
Pus cells	2-3
Vitamin D Total 25 Hydroxy	19.3
Creatine Phosphokinase (CPK)	35 U/L
Phosphorous	3.5 mg/dL

Imaging examination (Abdomen scan (04.11.2025)

Diagnosis

Multiple Tablet Overdose ARDS / Aspiration Pneumonitis
Sensory Motor Axonal Neuropathy (Left Upper and Lower Limb)
Initial chest radiography revealed bilateral pulmonary infiltrates consistent with aspiration pneumonitis progressing to acute respiratory distress syndrome (ARDS). Despite high fractions of inspired oxygen and inotropic support, her oxygen saturation remained critically low, fluctuating between 83–87%.

Management

She managed lung-protective ventilation strategies, including prone-position ventilation alternated with supine positioning for the first six days, which resulted in gradual improvement in oxygenation. Thereafter, she was maintained on supine ventilation with SpO₂ stabilizing above 92%. Owing to prolonged ventilator dependence, a tracheostomy was performed on 25/10/2025. Subsequent weaning attempts were complicated by features suggestive of critical-illness neuropathy and myopathy, requiring continued ventilator assistance and intensive physiotherapy. An ophthalmology consultation was sought for exposure to keratitis, which was managed conservatively. Comprehensive medical management included intravenous fluids, broad-spectrum antibiotics, inotropic and cardiac supportive therapy, proton-pump inhibitors, nebulization therapy, corticosteroids, antiemetic’s, potassium chloride infusion, diuretic therapy with Dytor infusion, and regular chest and limb physiotherapy. During the course of hospitalization, the patient developed gluteal pressure sores, for which plastic surgery consultation was obtained, and the lesions healed with appropriate wound care. Between 05/11/2025 and 26/11/2025, she experienced recurrent febrile episodes, and blood as well as urine cultures isolated Acetobacter species, confirming a systemic infection that was treated accordingly. With gradual clinical and respiratory improvement, the tracheostomy tube was successfully decannulated on 19/11/2025, following which she was supported with non-invasive ventilation.

Outcome

The patient showed steady neurological and functional recovery and has been advised to undergo intensive rehabilitation and physiotherapy at Hamsa Rehabilitation Centre for further strengthening and functional improvement.

Nursing Management

Maintained airway patency with proper positioning
Performed sterile tracheostomy suctioning
Monitored cuff pressure regularly to prevent tracheal injury.
Assisted with prone positioning and ensure pressure area protection during prone/supine cycles.
Monitored heart rate, blood pressure, ECG, and perfusion status.
Monitored for seizure activity and altered sensorium due to overdose.
Maintained strict aseptic technique during all invasive procedures.
Monitored temperature trends and signs of sepsis.
Reposition patients every 2 hours, including during prone positioning.
Initiate and monitor enteral feeding as prescribed.
Monitor bowel sounds and prevent constipation.
Provide regular eye lubrication and eye closure techniques to prevent exposure to keratitis.
Assist with chest physiotherapy to improve secretion clearance.
Encourage passive and active range-of-motion exercises.
Performed daily tracheostomy site care using sterile technique.
Monitored serum electrolytes regularly.
Observed for signs of fluid overload or dehydration.

Discharge Medications

Drug name	Strength	Days
Inj. Clexane	60mg	5 days
Tab. Pan	40mg	5 days
Tab. Emeset	4mg	5 days
Tab. Deslar	5mg	5 days
Tab. Sporlac	120 M	5 days
Syp. Cremaffin plus	10ml	5 days
Neb. Duolin + budecort	-	5 days

Educated patients and caregivers regarding breathing exercises and physiotherapy.
Coordinate referral to rehabilitation center (Hamsa Rehabilitation Centre).

Conclusion

Multiple tablet overdoses represent a life-threatening medical emergency requiring rapid identification, prompt stabilization, and comprehensive management. Early airway protection, timely decontamination, appropriate use of antidotes, and vigilant supportive care play a crucial role in reducing morbidity and mortality. The complexity of mixed drug toxicity necessitates continuous monitoring and a multidisciplinary approach involving emergency physicians, nurses, toxicologists, and mental health professionals. Equally important is post-recovery psychiatric evaluation and counseling to prevent recurrence. Effective nursing interventions, accurate documentation, and patient-centered care significantly contribute to favorable clinical outcomes in cases of multiple tablet overdoses.

A case of multiple tablets overdose

Multiple tablets overdose

Priya1*, Subathra Devi2, Maha Lakshmi3

Nightingale Journals

Priya^1*, Subathra Devi², Maha Lakshmi³