25th June 2023

A 16-year-old boy is brought in by ambulance drowsy following an overdose. Paramedics report no seizures

A 16-year-old boy is brought in by ambulance drowsy following an overdose. Paramedics report no seizures and a normal blood glucose.

On arrival to resus, he has the following observations:

RR 8

SaO2 99% on 15L O2

BP 95/30

HR 62

AVPU: P

GCS E2, V2, M4 = 8/15

Temp 35.8

NEWS 14

You insert an oropharyngeal airway and contact ITU, as you feel he might need intubation and ventilation.

His ECG shows sinus bradycardia with no other abnormalities.

On neurological examination, you find he has dilated pupils and is ataxic with reduced deep tendon reflexes.

An overdose of which medication is the most likely cause of this presentation?

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