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Caponeri MA, Charles Nicholas AJ, Maio D. 
“Urgenze e Tossicomanie”. 
Clin.Ter.. 1978;86(2):107-18.
Acute drug abuse emergencies are discussed. Multiple drug abuse has become more frequent, e.g. amphetamines and barbiturates, cocaine and heroin, atropine and Marijuana can also cause symptoms. In a drug emergency I.V. treatment, opiates and methadone should be avoided and a visceral spasmolytic bromide, e.g. up to 4 vials/day Riabal i.m., given with diazepam or dipotassium chlorazepate and possibly sulpiride. Patients may be admitted in a confused state following barbiturate, e.g. secobarbital (Immenox), pentobarbital (Nembutal), abuse or withdrawal, heroin withdrawal or abuse of the antiparkinson drugs, e.g. Artane, Disipal, Pagitane. Treatment is by i.v. correction of the fluid and electrolyte balance. The replacement of a slow-acting barbiturate by 1 with a faster action, e.g. 30 mg/day phenobarbital, to be withdrawn over 3 days, is no longer recommended, i.m. or p.o. benzodiazopines, e.g. diazopam, being preferred as they reduce the risk of convulsions. Iatrogenic abuse of Optalidon, which contains a barbiturate and caffeine, is widespread. Its replacement by diazepines, that are then rapidly withdrawn, is recommended. Anxiolytics are usually taken p.o. by drug abusers, often with other drugs. Diazepam and barbiturates may induce deep coma. Given i.v., diazepam can produce a "flash" in addicts. Meprobamate has also been used. Withdrawal over 5-10 days is recommended. Amphetamines are frequently abused, causing paranoid confusion and psychomotor agitatiOn. Treatment is by sedative neuroleptics, particularly phenothiazines, with 20-60 mg diazepam i.m. for milder cases. Phentolamine (2-5 mg Regitin by slow i.v. injection) is sometimes required. Acute LSD25 poisoning should be treated by neuroleptics, e.g. 100 mg chlorpromazine i.m. every 3-4 hr. or 10-20 mg diazopam i.m. every 4 hr. Anticholinergic drugs are being increasingly widely abused, often with barbiturates which potentiate their action. Over-dosage or attempted suicide with orphenadrine (Dismal) is particularly serious and responsible for most deaths under intensive care.
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