Physiologic and biochemical abnormalities in self-induced drug overdosage.

The following abnormalities were observed during the first 24 hours of admission for 162 drug overdosage (OD) episodes in 152 patients: abnormal chest x-ray films; increased A-aO2 gradient; elevated white blood cell (WBC) counts; elevated serum enzyme levels; gross myoglobinuria; skin lesions suggestive of pressure necrosis; and abnormal electrocardiograms. Many sputum cultures were positive for single or multiple potentially pathogenic organisms. These correlations existed: all patients with OD duration of less than 12 hours were hyperthermic; as temperatures increased so did WBC counts; hyperthermic patients had higher creatine phosphokinase (CPK) values than those with hypothermia or normothermia; patients with skin lesions had higher temperatures and CPK values and longer OD duration; serum enzme levels increased with increasing OD duration; patients with CPK levels greater than 10,000 mU/ml had myoglobinuria; and patients with the most abnormal chest x-ray films had higher temperatures and larger A-aO2 gradients. Incidence of pneumonitis is low, even with abnormal chest radiograms, leukocytosis, hyperthermia, and positive sputum cultures. Abnormal temperatures and leukocytosis are probably secondary to stress, hypoxemia, acidosis, and specific drug ingestion rather than infection.