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Predicting the Clinical Course in Intentional Drug Overdose

Allan R. Tunkel, MD, PhD; Joseph D'Antonio, MD; Suzanne Engel-Kominsky, MD; Barbara Browne, MD
Arch Intern Med. 1988;148(1):253. doi:10.1001/archinte.1988.00380010255036.
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To the Editor.  —The article by Brett et al in the January 1987 issue of the Archives classifies patients with a drug overdose into high- and low-risk groups based on the following criteria: need for intubation, seizures, unresponsiveness to verbal stimuli, arterial carbon dioxide pressure greater than or equal to 45 mm Hg, any rhythm except sinus rhythm, secondor third-degree atrioventricular block, QRS interval greater than or equal to 0.12 s, or a systolic blood pressure less than 80 mm Hg.1 They concluded that patients observed for several hours and placed into the low-risk category did not develop high-risk conditions necessitating admission to the intensive care unit. An exception to their findings is the patient with acute lithium overdose. We recently cared for a patient with severe lithium intoxication who manifested a delayed rise of serum lithium levels.

Report of a Case.  —A 33-year-old man was seen at our


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