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Drugs and toxins commonly affect the nervous system. They cause a spectrum of disorders of which most are potentially reversible on withdrawal of the causal agent. Diagnostic suspicion is especially dependent upon history:

- Availability of drugs.

- Occupational/industrial exposure to toxins. Drug toxicity may result from:

- The chronic abuse of drugs, e.g. barbiturates, opiates.

- The side effects of drug therapy, e.g. anticonvulsants, steroids.

- The wilfull overdosage of drugs, e.g. sedatives, antidepressants. Toxin exposure may be:

- Accidental: industrial or household poisons, e.g. organophosphates, carbon monoxide, turpentine.

- Wilful: solvent abuse. History and examination

When acute intoxication is suspected, the following clinical features are supportive.

Seizures overdose or drug withdrawal

Multisystem dysfunction Cardiac, respiratory, hepatic and gastrointestinal systems may be involved

Mental state Confusion, delirium, coma

Pupillary findings Opiates

Parasympathomimetics Phenothiazines Sympathomimetics Antihistamines Tricyclic antidepressants small, unreactive

(dose-dependent)

large, unreactive

(dose-dependent)

v Brain stem reflexes e.g. Doll's eye reflex - may be transiently lost.

Also: Note

- Puncture marks in narcotic addicts

- The presence of a snout area rash in solvent abusers

- Rashes in barbiturate poisoning

- Respiration rate in salicylate poisoning

- Skin colour in carbon monoxide poisoning.

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Defeat Depression

Defeat Depression

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