Template:ICD10 Guideline drugs and substances

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{{ICD10 Guideline drugs and susbstances}}

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Sorting Out the Different Options About Problematic Use of Drugs and Substances

• There are 5 different types of codes, with the following formats:
  • Drug/substance intoxication, acute
  • Drug/substance overdose/poisoning
  • Drug/substance chronic abuse/dependence/addiction
  • Drug/substance withdrawal
  • Drug/substance used appropriately, adverse effect (reaction, allergy, hypersensitivity)

• Regarding confusion between intoxication, acute vs. overdose/poisoning
  • Acute intoxication indicates just that. Being drunk is a good example of acute alcohol intoxication. These generally require just observation, not treatment.
  • On the other hand, an overdose/poisoning indicates that the patient either has a medical consequence, or is at high risk of getting one -- so that some medical treatment is given. These treatments might include: substance removal via activated charcoal, gastric lavage or dialysis; use of an antidote or neutralizing agent; life support if the overdose caused shock or respiratory failure; or others.
  • But clearly there can be some overlap. A common example is the drunk person who is felt in the ED to be "not protecting their airway" and so is intubated for this rationale. Because it is so difficult to judge the "need" for such things, the rule we will use to distinguish between them is to use intoxication, acute if no treatment is given, and to use overdose/poisoning if treatment is given.
• Regarding confusion between withdrawal vs. chronic abuse/dependence/addiction
  • Withdrawal refers to the presence of withdrawal symptoms or signs.
  • Chronic abuse/dependence/addiction does not necessarily indicate that anything acute is currently occurring.
  • These 2 codes can be used together, if appropriate.
• Regarding confusion between used appropriately, adverse effect (reaction, allergy, hypersensitivity) vs. overdose/poisoning
  • The difference here is that used appropriately refers to use of a pharmaceutical used in the correct dose. While if that drug is given or taken in excess amount, an overdose/poisoning can occur.
• Regarding confusion between used appropriately, adverse effect (reaction, allergy, hypersensitivity) vs. intoxication, acute
  • These 2 codes can be used together, if a pharmaceutical is used in the correct dose, and that leads nonetheless to acute intoxication.