- initial euphoria, followed by apathy or dysphoria (low mood)
- psychomotor agitation or retardation (get jittery or slow down a lot)
- impaired judgment or functioning
- constricted "pinpoint" pupils (key sign to intoxication)
- drowsiness (or coma with higher doses)
- slurred speech
- impaired attention or memory
- slowed breathing (or stopped breathing with higher doses)
- dysphoric mood
- nausea or vomiting
- muscle aches
- watery eyes
- runny nose
- dilated pupils
- goosebumps
- sweating
- diarrhea
- yawning
- fever
- insomnia
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Last updated May 26, 1999
The Cascade Hospital is a resource website designed specifically to help FANFIC and other FICTION WRITERS who want to make their stories more medically authentic. It is NOT for people seeking answers to personal medical questions -- that is a job for your private physician.
Division
of Toxicology
~ poisons, gases, illicit drugs ~
Please read the Sentinel and Medical Disclaimers.
Carbon monoxide poisoning (gas
leak from a stove)
Drug overdose from hallucinogenic
drug
Time to eliminate/absorb drug
Chloroform
Street drugs that make recipient
frightened
Paramedic response
to partial dose of drug
Heroin Use, Addiction,
and Withdrawal
Chloral hydrate --
the drug that Lash used
Alcohol (ethanol) intoxication
Sedative withdrawal
(alcohol, benzodiazepines, barbiturates)
Drugs that can
cause symptoms of Parkinsonism
Treatment
after inhaling or swallowing polluted water
Carbon monoxide poisoning (gas leak from a stove)
The gas used in most homes for gas stoves and heaters (you know, the blue flame) purposely has a small amount of sulfur added to it so you would be able to smell it if there were a gas leak or the gas got left on without being lit. Most people (including non-sentinels like Blair and us) would smell this gas and know something was wrong (it smells pretty unpleasant if you ask me).
However, you can pass out and even die from a carbon monoxide gas leak in your house because carbon monoxide is odorless and colorless. Carbon monoxide is a product of incomplete combustion and can be produced by old heaters or old stoves (usually in older homes). Many people have carbon monoxide detectors in their homes today along with a smoke detector. Carbon monoxide is also the poisonous gas that can be lethal when someone starts their car up with the garage door closed. Carbon monoxide kills because it has a higher affinity for hemoglobin (the oxygen-carrying molecule in the blood) than oxygen. You die from lack of oxygen.
The symptoms of carbon monoxide poisoning are -- none at first! Some (but not all) people begin to get a headache as the gas levels rise. This eventually progresses to confusion and coma and death from lack of oxygen if the person doesn't get out to fresh air. There have been stories of people who get so weak and disoriented before they realize what is happening that they can barely make it out of the building to fresh air. The treatment for carbon monoxide poisoning is 100% oxygen by mask (or at least fresh air). Most people can recover with this if they are found soon enough. An interesting feature of carbon monoxide poisoning is that people can turn a bright pink color (the color of the hemoglobin molecule in the blood when it binds with carbon monoxide).
Drug overdose from a hallucinogenic drug -- symptoms, treatment, flashbacks
The classic hallucinogen in the US is LSD. Other naturally-occuring hallucinogens include the peyote cactus and certain mushrooms.
The acute effects of hallucinogen intoxication include hallucinations which are often visual and colorful and can be very complex. They may include geometric forms, images in the peripheral field of vision, flashes of color, intense colors, hallucinations of objects, afterimages, halos around objects, and perceptions that an object is getting larger or smaller. In most cases the user retains awareness that these things are not real.
The user may also experience something called "synesthesias." (I'd like to see Jim experience this.) This is when a sensation is experienced by the wrong sense, such as hearing colors or tasting smells.
Other behavioral changes include anxiety, depression, paranoia, impaired judgment, impaired function, the feeling that you are detached from yourself, that you are detached from reality, and illusions (when something is acutally physically there, but you think you are seeing something else).
Physical signs and symptoms include dilated pupils, racing heart, sweating, blurry vision, tremors, and being uncoordinated.
Treatment of hallucinogen intoxication generally consists of "talking down" the user. This means reassuring and calming them, reminding them they are not going crazy, and telling them that what they are experiencing is the result of the drug and will go away shortly.
Sometimes a user will experience "a bad trip," which can be extremely disturbing. This is where the person loses insight into the fact that the hallucinations are not real. These people usually panic and can do bizarre things. The bad trip may last as long as it takes for the drug to be cleared from the body. Again the treatment is "talking down" the user and making sure they don't hurt themselves.
There is no withdrawal syndrome associated with someone who stops using hallucinogens.
Fifteen to eighty percent of users report flashbacks. This is where they experience hallucinations and other symptoms similar to being intoxicated even when they haven't used the drug. Flashbacks can be triggered by the person thinking about the phenomenon, using alcohol or marijuana, fatigue, anxiety, or stress. Flashbacks are usually brief and last only a few seconds to a few minutes. People can have flashbacks for as long as five years or more after stopping drug use, although most people stop having flashbacks after several months. People usually don't seek treatment for flashbacks unless they don't know what they are and then the treatment is to educate them and reassure them they will eventually go away if they don't do the drug anymore.
Time to eliminate/absorb a harmful drug
It depends on what part of the digestive system the drug is going to be absorbed in (stomach, small intestine). The great majority of substances are absorbed in the small intestine, so they are not absorbed until the stomach empties. The time it takes for the stomach to empty is variable and depends on a lot of things like pH, osmolarity, size of particles, etc. The maximum amount of time it takes for the stomach to empty is about 1 hour, when the stomach undergoes a "cleansing wave" of peristalsis and dumps out everything left in it into the small intestine.
Chloroform is a clear, colorless, volatile liquid that often comes in a solution mixed with ethanol. I've never smelled it, but apparently it has been described as having a "sweet, burning taste" and a "heavy ethereal odor" (i.e. it smells like ether, if you've ever smelled it). Ether kinda smells sweetish, but the smell gets to a lot of people after a while and you get a headache. The pungent smell is partially due to the volatile nature of the liquid (it evaporates very quickly).
Chloroform (real chemical name trichloromethane) is often used on TV by nefarious characters who want to put people to sleep. Usually they pour it onto a rag and then hold it against the victim's nose so they smell it and eventually pass out. Doctors also used to use it as an anesthetic in the olden days to put people to sleep for surgery. It is no longer used for several reasons: 1) it's toxic to the lungs and very irritating to the skin and respiratory tract lining 2) it's carcinogenic 3) we've got a lot better anesthetic agents now that are not so irritating and not carcinogenic.
I don't know the exact statistics on how long it takes to pass out from chloroform or how long it takes to recover, but here's some general guidelines. If you used enough chloroform (i.e. on a rag) and concentrated on inhaling it, you'd probably be pretty confused and then unconscious in a matter of minutes (modern inhalational anesthetics take less than a minute to act), so probably less than 15 minutes. Old anesthetics like chloroform aren't as "clean" acting, so they may take longer than modern ones. Also, you don't feel too great when you wake up -- more like nauseated, maybe vomiting, with a headache and cloudy mind. The chloroform will stay active as long as the person's breathing it. As for recovery time, you'd probably start coming out in 15 to 30 minutes, give or take a few minutes.
You asked how chloroform works. Basically you inhale it and the gas becomes partially dissolved in your blood. That gas and blood travels to your brain and somehow that puts the little neurons to sleep. Truth is, no one really knows how modern anesthetics work -- just that they do. I think part of the anesthetic properties of chloroform have to do with the chlorine atoms in it, because all inhalational anesthetics are halogenated.
Other nasty side effects of chloroform (besides nausea, vomiting, irritation to skin and mucous membranes) include liver and kidney damage from metabolism of chloroform to other nasty substances. And if you breathe too much chloroform and not enough oxygen, or if your breathing slows down too much and you don't get rid of enough carbon dioxide or get enough oxygen, then you could very well die from it.
Also, here's a web page if you want more picky details on the chemical structure and its physical properties -- National Toxicology Program. I got some of this information from it. It's not too friendly in the way of layperson's language, but worth a try if you're brave. :-)
Street drugs that make the recipient frightened
A hallucinogenic drug such as LSD (not PCP -- people often get really violent with that drug) would be most likely to make the user frightened. That is, of course, what happened in Blind Man's Bluff with the Golden drug -- Blair started freaking out at the hallucinations and was shooting at them to defend himself. I have some information on the effects of LSD and other hallucinogenic drugs. See Blind Man's Bluff Q&A.
A lot of designer drugs out there now are chemically related to the standard ones like LSD but have a slightly different molecular structure. You could always make up a name and have effects similar to LSD, but make the person more scared, or whatever you want. It would be totally plausible. Designer drugs are actually a problem for law enforcement because every time they make a law that a certain chemical is illegal, drug dealers create one with a slightly different chemical structure (but with similar effects) that isn't illegal. So one of the ways they catch these people is to stake out a place while they are making the drug and catch them at a certain stage when they are at an in-between step. The chemicals existing at the in-between steps have been made illegal.
Paramedic response to partial dose of drug
In general, if someone was worried enough to call 911 in the first place, the paramedics will generally take the person to the hospital ER whether they're found responsive or not. The paramedics' job is to stabilize the patient and take them to the ER for further evaluation by a physician. The physician can then decide whether the person is okay enough to go back home or not. I suppose if the patient outright refused to go to the hospital and appeared to be in their right mind, they couldn't *force* them to go, but in general they will take the person to the hospital. From a doctor's point of view, it would be important for the patient to be evaluated by a physician even if it was only a partial poisoning.
Heroin Use, Addiction, and Withdrawal
Heroin is an illegal narcotic (a.k.a. opioid) drug and is related to the legal narcotics used for pain relief (codeine, morphine, Demerol, etc.). People get addicted to narcotics in three main ways: experimental or recrational use; via medical treatment (prescribed by a doctor for pain relief, although not usually a problem if given under close medical supervision); or as health care practitioners taking the drug to treat themselves. Heroin is taken either by intravenous injection (IV) where you get a greater "rush" or "thrill" from the drug (greater with heroin than other narcotics), or injecting it subcutaneously -- right beneath the surface of the skin ("skin-popping") with less euphoric effects. Addiction can develop quickly in some individuals -- as fast as 3 to 4 days.
Symptoms of intoxication (what happens right after you take the drug) basically give you an initial "rush", then everything slows down:
These signs can be easily reversed by injecting the person with naloxone, an opioid antagonist. A person found comatose without known reason is usually given a dose of naloxone in the ER in case they are comatose from a heroin (or other narcotic) overdose. Naloxone with precipitate immediate withdrawal symptoms (below).
Opioid withdrawal symptoms are like a really bad case of the flu. The person feels awful but the symptoms are not life-threatening, unlike withdrawal from alcohol or other depressants.
Treatment of opioid withdrawal is just supportive -- i.e. try to make the person as comfortable as possible until it's over. Unless they are in a coma or have stopped breathing, Naloxone should NOT be given to a known heroin addict because naloxone with cause a more severe withdrawal in an addict.
How long does it take for someone addicted to heroin to get over withdrawal? The withdrawal symptoms themselves usually last a few hours (less than a day, anyway). However, it may take much longer (days or months) for the person to stop craving the substance and get over the addiction itself.
Chloral hydrate -- the drug that Lash used
Chloral hydrate is a common sedative that can be taken orally or rectally, or intravenously. Chloral hydrate is the stuff that you see bad guys in movies adding as a little white pill to someone's alcoholic drink when they're not looking, and they drink it and fall asleep. Ever heard of someone "slipping someone a Mickey"? That's the chloral hydrate plus alcohol. Anyway, chloral hydrate's active metabolite is trichloroethanol, thus its effects would be very similar to trichloroethanol.
In doses used for hypnosis, chloral hydrate produces mild cerebral depression and quiet, deep sleep with little or no hangover effects... Chloral hydrate is rapidly absorbed following oral or rectal administration. Following a hypnotic dose, drowsiness occurs within 10 to 15 minutes and sleep usually occurs within 30 to 60 minutes, which lasts about 4 to 8 hours. The most frequent adverse effect of chloral hydrate is gastrointestinal irritation, manifested by nausea, vomiting, diarrhea and stomach pain.
Basically the person would get very sleepy/go to sleep, then wake up when the drug wore off. They might feel a little woozy ("hangover") but this apparently doesn't usually happen. The person may have nausea, vomiting, diarrhea, and stomach pain as a side effect, but this doesn't happen too often. Chloral hydrate is often used in the pediatric population to provide sedation for procedures where the child or infant has to stay very still for the exam (i.e. CT scan, MRI, EEG, etc.), and the great majority of times there is no problem with side effects. It's a very safe drug and considered "conscious sedation" because it doesn't make the person go totally unconscious (just go to sleep) and doesn't usually depress the person's breathing or heart rate (very important).
Alcohol (ethanol) intoxication
It takes approximately 3-4 drinks (a "drink" is a can of beer, a glass of wine, or a shot glass of liquor/whiskey) to produce a blood ethanol level of 0.1g/dL, considered legally drunk in most states. The number of drinks needed to cause deep coma or respiratory depression is highly variable and depends on the individual's degree of tolerance to alcohol. In a novice drinker , a level above 0.3g/dL would probably cause a coma (equal to 9-12 drinks). Chronic alcoholics can often stay awake with levels of 0.5 to 0.6 g/dL or higher.
The first signs of (mild to moderate) intoxication are "feeling good", mild incoordination and trouble walking, impaired judgment, losing social inhibitions, and sometimes boistrous or aggressive behavior.
With severe intoxication, alcohol causes respiratory depression (person's breathing slows down and could even stop) and coma.
If the person is found in a coma, he might need CPR/rescue breaths if he isn't breathing. The person who finds him should first call for help (911) or have someone else call for help, then proceed to give rescue breaths if the victim is not breathing. When the paramedics arrive, they would assess the person for airway, breathing and "bag" them with an Ambu bag and oxygen if they aren't breathing, and rush them to the hospital.
In the ER, the person would be quickly assessed for vital signs (see the ER page) and intubated (put on a ventilator) if necessary (if they aren't breathing). The diagnosis of alcohol intoxication is usually fairly easy because the person often smells like alcohol and has a characteristic breath smell. They should also be checked for any signs of trauma to their head or body. A blood alcohol level, blood glucose (sugar) level, electrolytes, and UDS (urine drug screen) should also be obtained.
The person would be given IV fluids of D5W (sugar water) *and* thiamine/other vitamins (usually called a "banana bag" because the liquid looks the same color as a banana!). If seizures occur (sometimes happens with alcohol intoxication), those would be treated as well, usually with a shot of Ativan, and a Dilatin infusion if needed.
Most people will recover (wake up) within 4-6 hours.
Sedative withdrawal (alcohol, benzodiazepines, barbiturates)
When we're talking sedatives, the most common ones are alcohol, barbiturates, and benzodiazepines. Withdrawal symptoms for all of these are similar, but most life-threatening with alcohol and barbiturates as opposed to benzos (benzos are considered "safer" and given to a person going through alcohol withdrawal because it will stop the symptoms and can be tapered more safely). Basically the withdrawal symptoms are the opposite of the sedative's effect. A sedative calms you down, suppressed your nervous system, can make you go into a coma, etc. Sedative withdrawal means your body goes just the opposite -- jittery, shaky, nervous system on overload, etc. Here's quick list of symptoms: fast heart rate, sweating, shaky hands, insomnia, nausea/vomiting, hallucinations, agitation, anxiety, grand mal seizures. With benzos, the time course of the withdrawal depends on the half-life of the specific drug. For example, Valium is intermediate in its half-life -- 1-2 hours to reach full effect, 6 to 8 hours before levels start decreasing.
Drugs that can causes symptoms of Parkinsonism
The most notable drug that can cause Parkinsonism is a drug called "MPTP." MPTP is a toxic chemical produced accidentally during an attempt to make a synthetic illegal narcotic like heroin (you can guess how they found out about this drug and its effects). MPTP destroys cells of the substantia nigra in the brain, producing symptoms very similar to Parkinson's disease. The parkinsonism caused by MPTP is irreversible and treated similar to regular Parkinson's disease with drugs like Sinemet and Amantidine.
Most people with Parkinsonism symptoms have Parkinson's Disease, which is not caused by a drug but by a disease process in which that area of the brain simply degenerates (no one knows why; genetics probably play a role). The symptoms of parkinsonism include a characteristic "pill-rolling" tremor of the hands at rest that goes away with movement; shuffling walk; difficulty beginning movements (difficulty getting out of a chair or taking the first steps to walk, for example, but once they get going they can keep going); difficulty turning (they have to take a lot of little steps to turn around), soft quiet voice, smaller handwriting, mask-like face (very little facial expression), etc. Basically everything slows down and the person can't move. Ever see the movie "Awakening" with Robin Williams? The patients in that movie had Parkinson's Disease.
Treatment after inhaling or swallowing polluted water
The first thing you have to decide is if they actually *inhaled* the stuff ("aspirated" it, meaning it went down the wrong pipe (trachea) and into the lungs), OR if they just *swallowed* it (it went down their esophagus into their stomach), OR both. If the person lost consciousness while they were in the water, they would be more likely to truly aspirate into their lungs. If they did not lose consciousness at all and didn't struggle, then they might be able to keep from aspirating.
Aspiration is worse than swallowing, especially considering the polluted contents of the water. You can get something called "chemical pneumonitis" which can be very serious and cause severe lung damage requiring aggressive supportive care. It might take hours to develop, meaning that the person could develop respiratory distress later. The person should get a chest x-ray and receive a good respiratory exam by a physician, as well as having their oxygen saturation monitored. These people would be more likely to be admitted for monitoring in case they went downhill later.
If the person just swallowed a little bit and then threw up, well, it would depend on the situation. If they swear they didn't swallow much and then threw it up, and they now feel fine, you might be inclined to do nothing and just let them go home. A more conservative approach would be gastric lavage with activated charcoal (put a tube down the person's nose with activated charcoal, then suck it back out), particularly if you think they didn't throw up everything or they swallowed a lot. That wouldn't be pleasant, but it would be a more careful way of trying to make sure you sucked everything out that you could before it got absorbed. After that, the person would be observed for a few hours but shouldn't necessarily need to stay in the hospital unless they continued to vomit or otherwise started to get sick from the stuff they swallowed. The doctor would probably call poison control and ask what to do. They always can tell you specific directions.
Upon discharge, the patient should be instructed to watch for symptoms of infection, particularly pneumonia (shortness of breath, fever, cough) and gastroenteritis (stomach flu -- diarrhea, continued vomiting, fever) and tell them to come back to the hospital they didn't feel good later. They could also be given anti-emetic (anti-nausea/vomiting) meds like Compazine pills or suppositories, just to make them feel more comfortable.