Which common substances should I consider in the differential diagnosis of an overdose in adults?

In the differential diagnosis of overdose in adults, common substances to consider include analgesics such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs), sedative-hypnotics including benzodiazepines and barbiturates, opioids, antidepressants (particularly tricyclic antidepressants), antipsychotics, cardiovascular drugs like beta-blockers and calcium channel blockers, and substances of abuse such as alcohol and recreational drugs (e.g., cocaine, amphetamines) ¹. Additionally, toxic alcohols (methanol, ethylene glycol), heavy metals, and household chemicals should be considered depending on the clinical context (Olson et al., 1987). The clinical presentation often guides the suspicion of specific agents, but a broad consideration of these common substances is essential for accurate diagnosis and management (Khan, 2018).

Key substances to consider include:

• Paracetamol and NSAIDs
• Benzodiazepines and barbiturates
• Opioids
• Tricyclic antidepressants and other antidepressants
• Antipsychotics
• Cardiovascular drugs (beta-blockers, calcium channel blockers)
• Alcohol and recreational drugs (cocaine, amphetamines)
• Toxic alcohols and household chemicals

These substances are frequently implicated in overdose cases and should be systematically considered during assessment to guide appropriate investigations and treatment ¹ (Olson et al., 1987; Khan, 2018).