Poisoning and Drug Overdose 4th Edition

POISONING& DRUGOVERDOSE

by the faculty, staff and associates of the California Poison Control System

fourth edition

Edited by

Kent R. Olson, MD, FACEP, FACMT, FAACT

Clinical Professor of Medicine, Pediatrics, and Pharmacy,University of California, San Francisco;Medical Director, California Poison Control System,San Francisco Division

Ilene B. Anderson, PharmD

Associate Clinical Professor of Pharmacy,University of California, San Francisco;Senior Toxicology Management Specialist,California Poison Control System,San Francisco Division

Neal L. Benowitz, MD

Professor of Medicineand Chief, Division of Clinical Pharmacologyand Toxicology,University of California, San Francisco;Associate Medical Director,California Poison Control System,San Francisco Division

Paul D. Blanc, MD, MSPH

Professor of Medicine and Chief, Division ofOccupational and Environmental Medicine,University of California, San Francisco

Richard F. Clark, MD, FACEP

Professor of of Medicine,University of California, San Diego;Director, Division of Medical Toxicologyand Medical Director,California Poison Control System,San Diego Division

Thomas E. Kearney, PharmD, ABAT

Professor of Clinical Pharmacy,University of California, San Francisco;Managing Director,California Poison Control System,San Francisco Division

John D. Osterloh, MD, MS

Chief Medical Officer,Division of Laboratory SciencesNational Center for Environmental Health,Centers for Disease Control and Prevention,Atlanta, Georgia

Associate Editors

Lange Medical Books/McGraw-Hill

Medical Publishing DivisionNew YorkChicagoSan FranciscoLisbonLondonMadridMexico CityMilanNew DelhiSan JuanSeoulSingaporeSydneyToronto

Poisoning & Drug Overdose, Fourth Edition

McGraw-Hill Companies

, Inc. All rights reserved. Printedin the United States of America. Except as permitted under the United StatesCopyright Act of 1976, no part of this publication may be reproduced or distributed inany form or by any means, or stored in a data base or retrieval system, without theprior written permission of the publisher.Previous editions copyright ©1999, 1994, 1990 by Appleton & Lange1234567890DOC/DOC09876543ISBN: 0-8385-8172-2ISSN: 1048-8847The book was set by Pine Tree Composition, Inc.The editors were Shelley Reinhardt and Barbara Holton.The production supervisor was Phil Galea.The illustration manager was Charissa Baker.The index was prepared by Kathy Pitcoff.RR Donnelly was printer and binder.This book is printed on acid-free paper.

Notice

Medicine is an ever-changing science. As new research and clinical experiencebroaden our knowledge, changes in treatment and drug therapy are required. Theauthors and the publisher of this work have checked with sources believed to bereliable in their efforts to provide information that is complete and generally inaccord with the standards accepted at the time of publication. However, in view ofthe possibility of human error or changes in medical sciences, neither the authorsnor the publisher nor any other party who has been involved in the preparation orpublication of this work warrants that the information contained herein is in everyrespect accurate or complete, and they disclaim all responsibility for any errors oromissions or for the results obtained from use of the information contained in thiswork. Readers are encouraged to confirm the information contained herein withother sources. For example and in particular, readers are advised to check theproduct information sheet included in the package of each drug they plan toadminister to be certain that the information contained in this work is accurate andthat changes have not been made in the recommended dose or in thecontraindications for administration. This recommendation is of particularimportance in connection with new or infrequently used drugs.

Authors

Timothy E. Albertson, MD, PhD

Professor of Medicine, Pharmacology, Toxicology and Anesthesiology, University ofCalifornia, Davis School of Medicine; Medical Director, California Poison Control System,Sacramento Divisiontealbertson@ucdavis.edu

Section II: Amphetamines; Barbiturates; Dextromethorphan; Opiates and Opioids

Judith A. Alsop, PharmD, DABAT

Associate Clinical Professor, School of Pharmacy, University of California, San Francisco;Associate Clinical Professor, School of Medicine, University of California, Davis; Director,California Poison Control System, Sacramento Division jalsop@calpoison.org

Section II: Plants; Section III: Metoclopramide; Ondansetron; Potassium

Ilene B. Anderson, PharmD

Associate Clinical Professor of Pharmacy, University of California, San Francisco; SeniorToxicology Management Specialist, California Poison Control System, San FranciscoDivisioniba@itsa.ucsf.edu

Section II: Botulism; Camphor and Other Essential Oils; Ethylene Glycol and Other Glycols; Lomotil and Other Antidiarrheals; Methanol; Warfarin and Related Rodenticides

John Balmes, MD

Professor, Department of Medicine, University of California, San Francisco; Chief, Divisionof Occupational and Environmental Medicine, San Francisco General Hospital jbalmes@itsa.ucsf.edu

Section II: Asbestos; Formaldehyde; Gases, Irritant; Molds; Phosgene; Sulfur Dioxide

Shireen Banerji, PharmD

Specialist In Poison Information, Rocky Mountain Poison and Drug Center, Denver,Coloradoshireen.banerji@rmpdc.org

Section II: Angiotensin Blockers & ACE Inhibitors; Vasodilators

James David Barry, MD

Fellow, Division of Medical Toxicology, and Clinical Instructor of Emergency Medicine,University of California, San Diego Medical Center jdavebarr@aol.com

Section II: Phenytoin

Neal L. Benowitz, MD

Professor of Medicine and Chief, Division of Clinical Pharmacology and Toxicology,University of California, San Francisco; Associate Medical Director, California PoisonControl System, San Francisco Divisionnbeno@itsa.ucsf.edu

Section II: Anesthetics, Local; Antiarrhythmic Drugs; Antidepressants, General (Noncyclic); Antidepressants, Tricyclic; Beta-Adrenergic Blockers; Calcium Antagonists; Cardiac Glycosides; Chloroquine and Other Aminoquinolines; Cocaine; Ergot Derivatives; Lithium; Marijuana; Monoamine Oxidase Inhibitors; Nicotine; Nitrates and Nitrites; Nitroprusside; Pseudoephedrine, Ephedrine and Other Decongestants; Quinidine and Other Type IA Antiarrhythmic Drugs; Quinine; Vacor (PNU); Section III: Dopamine; Epinephrine; Norepinephrine

Kathleen Birnbaum, PharmD

Toxicology Management Specialist, Department of Clinical Pharmacy, University ofCalifornia, San Franciscokbirnbaum@calpoison.org

Section III: Insulin; Leucovorin Calcium

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