Symptoms
Paracetamol: pallor of the skin, decreased appetite, nausea, vomiting; hepatonecrosis (the severity of necrosis due to intoxication directly depends on the degree of overdose). Toxic effect in adults is possible after taking more than 10-15 g of paracetamol: increased activity of "liver" transaminases, an increase prothrombin time (12-48 hours after administration); a detailed clinical picture of liver damage manifests itself after 1-6 days. Rarely, liver failure develops at a lightning speed and can be complicated by renal insufficiency (tubular necrosis).
Dextromethorphan: nausea, vomiting, dizziness, drowsiness, visual impairment, inhibition, impaired coordination of motion, difficulty breathing.
Caffeine: gastralgia, agitation, anxiety, agitation, motor anxiety, confusion, delirium, dehydration, tachycardia, arrhythmia, hyperthermia, frequent urination, headache, increased tactile or pain sensitivity, tremor or muscle twitching; nausea and vomiting, sometimes with blood; ringing in the ears, epileptic seizures (with acute overdose - tonic-clonic). Caffeine in doses of more than 300 mg / day (including against the background of the abuse of coffee - more than 4 cups of natural coffee of 150 ml) can cause anxiety, tremor, headache, confusion, extrasystole.
Ascorbic acid: diarrhea, nausea, irritation of the mucous membrane of the gastrointestinal tract, flatulence, abdominal pain of a spastic nature, frequent urination, nephrolithiasis, insomnia, irritability, hypoglycemia.
Chlorphenamine: nausea, vomiting, anorexia, dry mouth, dry nasal mucosa, abdominal pain or in the liver, heart rhythm disturbances (arrhythmias, bradycardia or tachycardia), in severe cases - liver failure.
Treatment: gastric lavage in the first 6 hours, followed by the appointment of activated charcoal, laxatives. Symptomatic therapy. Maintain a balance of fluid and salts, ventilation and oxygenation; with epileptic seizures - intravenously diazepam, phenobarbital or phenytoin.
Introduction of donors of SH groups and precursors of glutathione-methionine synthesis for 8-9 hours and acetylcysteine for 12 hours after an overdose.
The need for additional therapeutic measures (further introduction of methionine, intravenous injection of acetylcysteine) is determined depending on the concentration of paracetamol in the blood, as well as on the time elapsed after its administration.
Naloxone is a specific antidote for dextromethorphan. In the case of respiratory depression and difficulty of coordination of movements, it is necessary to appoint naloxone and artificial ventilation.