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SYMPTOMS AND TREATMENT OF SPECIFIC POISONS POISON* ACE inhibitors SYMPTOMS Angioedema, hypotension TREATMENT Charcoal, supportive care For angioedema, epinephrine, antihistamines, or corticosteroids possibly effective For hypotension, consideration of naloxone Ingestion: Charcoal; then as for inhalation Skin contact: Clothing removed and area washed with copious soap and water; then as for inhalation Inhalation: O2, respiratory support, blood transfusion For severe cyanosis, methylene blue 12 mg/kg IV

Acephate Acetaminophen Acetanilid Aniline dyes and oil Chloroaniline Phenacetin (acetophenetidin, phenylacetamide)

See Organophosphates See Acetaminophen Poisoning Cyanosis due to formation of methemoglobin and sulfhemoglobin, dyspnea, weakness, vertigo, angina, rashes and urticaria, vomiting, delirium, depression, respiratory and circulatory failure

Acetic acid

Low concentration: Mild mucosal Supportive care with irrigation irritation and dilution High concentration: See Caustic Ingestion

Acetone Ingestion: As for inhalation, Removal from source except for direct pulmonary Ketones Respiratory support, O2 and effect fluids, correction of metabolic Model airplane acidosis glues or cements Inhalation: Bronchial irritation, pneumonia (pulmonary congesNail polish tion and edema, decreased remover respiration, dyspnea), drunkenness, stupor, ketosis, cardiac arrhythmias Acetonitrile Cosmetic nail adhesive Acetophenetidin Acetylsalicylic acid Acids and alkalis Converted to cyanide, with usual symptoms and signs See Acetanilid See Salicylates See specific acids and alkalis (eg, Boric acid, Fluorides) and see Caustic Ingestion Eye contact: See Burns in Eye Injuries Skin contact: See Burns See Acetone, Benzene (toluene), and Petroleum distillates Emotional lability, impaired coordination, flushing, nausea, vomiting, stupor to coma, respiratory depression See Cyanides

Airplane glues or cements (modelbuilding) Alcohol, ethyl (ethanol) Brandy Whiskey Other liquors

Supportive care, IV glucose to prevent hypoglycemia

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SYMPTOMS AND TREATMENT OF SPECIFIC POISONSCONTINUED POISON* Alcohol, isopropyl Rubbing alcohol SYMPTOMS TREATMENT

Dizziness, incoordination, stupor Supportive care, IV glucose, to coma, gastroenteritis, hemorcorrection of dehydration and rhagic gastritis, hypotension electrolyte abnormalities No retinal injury or acidosis For gastritis, IV H2 blockers or proton pump inhibitors Severe toxicity with 60250 mL Fomepizole (15 mg/kg, then (28 oz) in adults or 810 mL 10 mg/kg q 12 h); alternatively, (2 tsp) in children 10% ethanol/5% D/W IV with an initial loading dose of Latency period 1218 h 10 mL/kg over 1 h, then 12 Headache, weakness, leg cramps, mL/kg/h to maintain a blood vertigo, seizures, retinal injury, ethanol level of 100 mg/dL dimmed vision, acidosis, (22 mmol/L) decreased respiration Hemodialysis (which is definitive treatment) See Chlorinated hydrocarbons See Acids and alkalis See Opioids

Alcohol, methyl (methanol, wood alcohol) Antifreeze Paint solvent Solid canned fuel Varnish

Aldrin Alkalis Alphaprodine Aminophylline Caffeine Theophylline

Wakefulness, restlessness, anorex- Ingestion: Charcoal, discontinuaia, vomiting, dehydration, tion of drug, measurement of seizures, tachycardia blood theophylline level, phenobarbital or diazepam for In adults, greater toxicity after acute overdose added to chronic seizures, parenteral fluids, maintenance of BP intake For serum level > 50100 mg/L (> 278555 mmol/L), acidosis, seizures, or coma, possibly dialysis For patients without asthma, possibly -blocker (eg, esmolol) See Tricyclic antidepressants Irritation of eyes and respiratory tract, cough, choking, abdominal pain Flushing of eyes for 15 min with tap water or saline If severe toxicity, positive pressure O2 to manage pulmonary edema, respiratory support

Amitriptyline Ammonia gas (anhydrous ammonia [NH3])

Ammonia water (ammonium hydroxide [NH4OH])

See Caustic Ingestion

Ammoniated mercury See Mercury (NH2HgCl) Ammonium carbonate See Caustic Ingestion ([NH4]2CO3) Ammonium fluoride (NH4F) Amobarbital See Fluorides See Barbiturates

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SYMPTOMS AND TREATMENT OF SPECIFIC POISONSCONTINUED POISON* SYMPTOMS TREATMENT

Charcoal possibly effective long Increased activity, exhilaration, Amphetamines talkativeness, insomnia, irritabil- after ingestion because of Amphetamine recycling via enterohepatic ity, exaggerated reflexes, sulfate or circulation, benzodiazepines for anorexia, diaphoresis, tachyphosphate sedation and seizures, reduction arrhythmia, anginal chest pain, Dextroamphetpsychotic-like states, inability to of external stimuli, external amine cooling, prevention of cerebral concentrate or sit still, paranoia edema Methamphetamine For patients without asthma, Phenmetrazine -blockers possibly helpful but rarely necessary Amyl nitrite Aniline Anticoagulants Dicumarol Superwarfarins Warfarin Antidepressants See Nitrites See Acetanilid Increased PT/INR after repeated ingestions Observation for single ingestion For repeated chronic ingestions, measurement of PT/INR to determine whether vitamin K therapy is needed

See Bupropion, Mirtazapine, SSRIs, Trazodone, Tricyclic antidepressants, and Venlafaxine

Antifreeze Antihistamines

See Alcohol, methyl and Ethylene glycol Anticholinergic symptoms (eg, tachycardia, hyperthermia, mydriasis, warm and dry skin, urinary retention, ileus, delirium) For diagnostic testing or for treatment of severe symptoms refractory to sedation (CAUTION: Seizures see Physostigmine), consideration of physostigmine 0.52.0 mg in adults or 0.02 mg/kg in children IV (slowly)

Antihyperglycemic drugs, oral Antimony Stibophen Tartar emetic

See Hypoglycemic drugs, oral

Chelation with penicillamine, Throat constriction, dysphagia, dimercaprol for patients who burning GI pain, vomiting, cannot take oral drugs, hydradiarrhea, GI hemorrhage, tion, treatment of shock and dehydration, pulmonary edema, pain renal failure, lactic acidosis, liver failure, shock Effects on hematopoiesis, nausea, Supportive care, leucovorin rescue, observation for postavomiting, specific acute vs cute problems (> 2448 h) chronic effects depending on drug

Antineoplastic drugs Methotrexate Mercaptopurine Vincristine > 50 Others

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SYMPTOMS AND TREATMENT OF SPECIFIC POISONSCONTINUED POISON* Antipsychotic drugs (conventional) Chlorpromazine Fluphenazine Haloperidol Loxapine Mesoridazine Molindone Perphenazine Pimozide Prochlorperazine Thioridazine Thiothixene Trifluoperazine Triflupromazine Antipsychotic drugs (2nd-generation) Clozapine Olanzapine Quetiapine Risperidone Ziprasidone Ant poison Arsenic Donovans solution Fowlers solution Herbicides Paris green Pesticides Selenium Sodium arsenate Arsine gas Artificial bitter almond oil Asphalt Aspirin Atropine Automobile exhaust SYMPTOMS TREATMENT

For dystonia, diphenhydramine or A wide range of symptoms benztropine (eg, sedation, seizures, excitement, coma, dystonia, hypoten- For hypotension refractory to sion, tachycardia, ventricular fluids, norepinephrine arrhythmias or torsades de For ventricular arrhythmias, pointes, anticholinergic effects, consideration of alkalinization hyperthermia or hypothermia)

CNS depression (particularly with For dystonia, diphenhydramine olanzapine), miosis, anticholinor benztropine ergic effects, hypotension, dys- For hypotension refractory to tonia, QT prolongation (occafluids, norepinephrine sionally), fatal bone marrow For ventricular arrhythmias, suppression (rare) consideration of alkalinization

See Arsenic (sodium arsenate) and Borates Same as for Antimony

Same as for Antimony

Acute hemolytic anemia See Cyanide See Petroleum distillates See Aspirin and Other Salicylate Poisoning See Belladonna See Carbon monoxide

Transfusions, diuresis

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SYMPTOMS AND TREATMENT OF SPECIFIC POISONSCONTINUED POISON* Barbiturates Amobarbital Meprobamate Pentobarbital Phenobarbital Secobarbital SYMPTOMS TREATMENT

Bradycardia, hypothermia, confu- Charcoal up to 24 h after ingession, delirium, loss of corneal tion, supportive care, forced reflex, respiratory failure, alkaline diuresis for phenobarbidrowsiness, ataxia, coma tal (to aid in elimination) For severe cases, hemodialysis

Vomiting, abdominal pain, Barium compounds diarrhea, tremors, seizures, (soluble) colic, hypertension, cardiac Barium acetate arrest, dyspnea and cyanosis, Barium carbonate ventricular fibrillation, severe hypokalemia, skeletal muscle Barium chloride Barium hydroxide weakness Barium nitrate Barium sulfide Depilatories Explosives Fireworks Rat poisons Belladonna Atropine Hyoscyamine Hyoscyamus Scopolamine (hyoscine) Stramonium Benzene Benzol Hydrocarbons Model airplane glue Toluene Toluol Xylene Anticholinergic symptoms (eg, tachycardia, hyperthermia, mydriasis, warm and dry skin, urinary retention, ileus, delirium)

KCl 1015 mEq/h IV; Na or Mg sulfate 60 g po to precipitate barium in stomach, then possibly gastric lavage Diazepam to control seizures For dyspnea and cyanosis, O2

For diagnostic testing or for treatment of severe symptoms refractory to sedation, which is rarely needed (CAUTION: Seizuressee Physostigmine), consideration of physostigmine 0.52.0 mg in adults or 0.02 mg/kg in children IV (slowly)

Decontamination with water, Dizziness, weakness, headache, euphoria, nausea, vomiting, ven- avoiding vomiting and aspiration; O2; respiratory support; tricular arrhythmia, paralysis, seizures ECG monitoring (ventricular fibrillation can occur early) With chronic poisoning, aplastic anemia, hypokalemia, leukemia, Diazepam to control seizures CNS depression For severe anemia, blood transfusions Replacement of K as necessary Epinephrine contraindicated

Irritability, CNS excitation, mus- Supportive care, activated char-Benzene coal after airway control cle spasms, atonia, tonic-clonic hexachloride Benzene hexachloride seizures, respiratory failure, pul- Diazepam to control seizures monary edema, nausea, vomitHexachloroing, obtundation, coma cyclohexane Lindane Benzine (benzin) See Petroleum distillates

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SYMPTOMS AND TREATMENT OF SPECIFIC POISONSCONTINUED POISON* SYMPTOMS TREATMENT Airway control For hypotension, IV fluids and vasopressors Avoidance of flumazenil (CAUTION: If tricyclic antidepressants are involved, flumazenil may precipitate seizures; in patients who depend on benzodiazepines, flumazenil may precipitate withdrawal.) Close monitoring and attention to airway maintenance For symptomatic patients, consideration of dopamine, epinephrine, other vasopressors, glucagon 35 mg IV followed by infusion, CaCl2, IV insulin and glucose, cardiac pacing, and intra-aortic balloon pump

Sedation to coma, particularly Benzodiazepines if drugs are accompanied by Chlordiazepoxide alcohol Diazepam Hypotension Flurazepam

Benzol Beta-blockers

See Benzene Hypotension, bradycardia, seizures, cardiac arrhythmias, hypoglycemia, altered mental status

Bichloride of mercury See Mercury Bichromates Bidrin (dicrotophos) Bifenthrin Bishydroxycoumarin Bismuth compounds See Chromic acid See Organophosphates See Pyrethroids See Warfarin

Acute: Abdominal pain, oliguria, Respiratory support, consideration of chelation with dimercaprol acute renal failure and succimer (see Table 326-4) Chronic: Poor absorption, ulcerative stomatitis, anorexia, progressive encephalopathy See Cyanides See Hypochlorites See Beta-blockers

Bitter almond oil Bleach, chlorine -Blockers Boric acid

Nausea, vomiting, diarrhea, hem- Removal from skin, prevention or treatment of electrolyte orrhagic gastroenteritis, weakabnormalities and shock, control ness, lethargy, CNS depression, of seizures seizures, boiled lobster rash, shock For severe poisoning (rare), dialysis See Alcohol, ethyl Vomiting, diarrhea, epigastric pain, acidosis, deafness Supportive care, thiosulfate to reduce bromate to less toxic bromide For renal failure, hemodialysis for renal failure

Brandy Bromates

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SYMPTOMS AND TREATMENT OF SPECIFIC POISONSCONTINUED POISON* Bromides SYMPTOMS TREATMENT

Nausea, vomiting, rash (may be Discontinuation of drug, acneiform), slurred speech, atax- hydration and NaCl IV to promote diuresis, furosemide ia, confusion, psychotic behavior, coma, paralysis, negative 10 mg q 6 h anion gap For severe poisoning, hemodialysis Aggressive decontamination, supHighly corrosive portive care With exposure to liquid or vapor, skin and mucous membrane burns Respiratory depression, ataxia, seizures See Nitrites Charcoal, benzodiazepines, supportive care

Bromine

Bupropion HCl Butyl nitrate

Ingestion: Severe gastric cramps, Dilution with milk or albumin, Cadmium respiratory support, hydration, vomiting, diarrhea, dry throat, Cadmium oxide possibly chelation with succimer cough, dyspnea, headache, fumes (eg, from shock, coma, brown urine, renal or dimercaptopropane sulfonate welding) (see Table 326-4) failure Inhalation: Pneumonitis with Dimercaprol contraindicated dyspnea and bilateral pulmonary For inhalation, O , sometimes 2 infiltrates, hypoxia, death bronchodilators, corticosteroids Caffeine See Aminophylline Ca channel blockers Diltiazem Nifedipine Verapamil Others Nausea, vomiting, confusion, bradycardia, hypotension, total cardiovascular collapse Toxicity sometimes occurring after hyperglycemia For sustained-release preparations, consideration of wholebowel irrigation For hypotension or severe arrhythmias, consideration of CaCl2 (eg, 1 g10 mL of a 10% solution) or 3 times as much Ca gluconate IV with additional amounts as needed, pacemaker, or intra-aortic balloon pump Possible consideration of regular insulin 10100 units IV and 50100 mL 50% dextrose plus 50100 mL/h 10% dextrose IV infusion Possible consideration of glucagon 510 mg IV Diazepam to prevent and treat seizures, respiratory support Avoidance of all oils, respiratory support, treatment of seizures, maintenance of fluid balance No specific antidote

Calomel Camphor Camphorated oils Canned fuel, solid Cantharides Cantharidin Spanish fly

See Mercury Camphor odor on breath, headache, confusion, delirium, hallucinations, seizures, coma See Alcohol, methyl Irritated skin and mucous membranes, skin vesicles, nausea, vomiting, bloody diarrhea, burning pain in back and urethra, respiratory depression, seizures, coma, abortion, menorrhagia

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SYMPTOMS AND TREATMENT OF SPECIFIC POISONSCONTINUED POISON* Carbamates Aldicarb Bendiocarb Benomyl Carbaryl Carbofuran Fenothiocarb Methiocarb Methomyl Oxamyl Propoxur Carbamazepine SYMPTOMS Slightly to highly toxic effects; similar to those of organophosphates except cholinesterase inhibition is not permanent TREATMENT See Organophosphates

Progressive CNS depression, seizures (occasional), cardiac arrhythmia (rare) See Phenols

Supportive care after decontamination, heart rate monitoring For arrhythmias, consideration of IV Na bicarbonate

Carbolic acid

See Caustic Ingestion Carbonates (ammonium, potassium, sodium) Carbon bisulfide Carbon dioxide Carbon disulfide Carbon bisulfide See Carbon disulfide Dyspnea, weakness, tinnitus, palpitations, asphyxia Garlic-breath odor, irritability, weakness, mania, narcosis, delirium, mydriasis, blindness, parkinsonism, seizures, coma, paralysis, respiratory failure

Respiratory support, O2 Washing of skin, O2, diazepam sedation, respiratory and circulatory support

Carbon monoxide Acetylene gas Automobile exhaust Coal gas Furnace gas Illuminating gas Marsh gas

100% O2 by mask, respiratory Variable toxicity depending on length of exposure, concentrasupport if needed, immediate tion inhaled, and respiratory and measurement of carboxyhemocirculatory rates globin level; if carboxyhemoglobin is > about 25%, hyperVarious symptoms depending on baric O2 (see Carbon Monoxide % carboxyhemoglobin in blood Poisoning) possibly effective Headache, vertigo, vomiting, dyspnea, confusion, dilated pupils, seizures, coma

Washing of skin, O2, respiratory Carbon tetrachloride Nausea, vomiting, abdominal pain, headache, confusion, visu- support, monitoring of kidney (sometimes used in al disturbances, CNS depreschemical manufacand liver function and approprision, ventricular fibrillation, kid- ate treatment turing) ney injury, liver injury, cirrhosis Cleaning fluids (nonflammable) Carbonyl iron See Iron

Caustic soda (sodium See Caustic Ingestion hydroxide)

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SYMPTOMS AND TREATMENT OF SPECIFIC POISONSCONTINUED POISON* Chloral hydrate Chloral amide SYMPTOMS Drowsiness, confusion, shock, coma, respiratory depression, kidney injury, liver injury TREATMENT For ventricular arrhythmias, respiratory support, assessment of concomitant ingestions, -blockers

Methylene blue for methemogloChlorates and nitrates Vomiting, nausea, diarrhea, cyanosis (methemoglobin), toxic binemia, 10% thiosulfate to Herbicides reduce chlorate to the less toxic nephritis, shock, seizures, CNS Manufacture of chloride, transfusion for severe depression, coma, jaundice explosives and cyanosis, ascorbic acid, treatmatches ment of shock, O2 For complex cases, possibly dialysis Chlordane Chlorethoxyfos See Chlorinated hydrocarbons See Organophosphates Diazepam or phenobarbital to prevent and control tremors and seizures, cautious use of epinephrine, avoidance of sudden stimuli, parenteral fluids For renal and liver failure, monitoring

Chlorinated and other Slightly toxic effects (eg, with methoxychlor) to highly toxic halogenated hydroeffects (eg, with dieldrin) carbons Vomiting (early or delayed), Aldrin paresthesias, malaise, coarse Benzene hexatremors, seizures, pulmonary chloride edema, ventricular fibrillation, Chlordane respiratory failure Chlorothalonil DDD (2-dichlorethane) DDT (chlorophenothane) Dicofol Dieldrin Dienochlor Dilan Endosulfan Endrin Heptachlor Lindane Methoxychlor Perchlordecone Prolan Toxaphene Other chlorinated organic insecticides and industrial compounds Chlorinated lime Chlorine (see also Hypochlorites) Chlorinated lime Chlorine water Tear gas See Chlorine

Ingestion: Irritation, corrosion of Ingestion: Dilution with water or milk, treatment of shock mouth and GI tract, possible ulceration or perforation, Inhalation: O2, respiratory supabdominal pain, tachycardia, port, observation for and treatprostration, circulatory collapse ment of pulmonary edema Inhalation: Severe respiratory and ocular irritation, glottal spasm, cough, choking, vomiting, pulmonary edema, cyanosis

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SYMPTOMS AND TREATMENT OF SPECIFIC POISONSCONTINUED POISON* Chloroaniline SYMPTOMS See Acetanilid Ingestion: Observation for kidney and liver damage; respiratory, cardiac, and circulatory support Inhalation: Respiratory, cardiac, and circulatory support Dilution with milk or water, cautious use of fluids and electrolytes to support kidney function, consideration of N-acetylcysteine and ascorbic acid to convert hexavalent to the less toxic trivalent compound Thorough washing with water and 10% ascorbic acid solution for 15 min No specific antidote available Monitoring for effect on metabolism of other drugs being taken Supportive care; vasopressors; naloxone 5 g/kg up to 220 mg, repeated prn, to possibly reduce sedation Supportive care, decontamination with water and soap TREATMENT

Drowsiness, coma Chloroform With nitrous oxide, delirium Ether Nitrous oxide Trichloromethane Chlorothalonil Chlorothion Chlorpromazine Chlorpyrifos Chromates Chromic acid Bichromates Chromates Chromium trioxide Chromium See Chlorinated hydrocarbons See Organophosphates See Phenothiazines See Organophosphates See Chromic acid Corrosive effects due to oxidation, ulcerated and perforated nasal septum, severe gastroenteritis, shock, vertigo, coma, nephritis

Irritation of skin and mucous membranes See Chromic acid Slight dryness and drowsiness, possible altered metabolism of concomitant drugs Bradycardia, sedation, periodic apnea, hypotension, hypothermia See Carbon monoxide Tachycardia, tachypnea and hypoxia after inhalation, skin and mucous membrane irritation, glomerulonephritis, hypothyroidism (rare) See Cobalt Stimulation then depression, nausea, vomiting, loss of self-control, anxiety, hallucinations, sweating, hyperthermia, seizures, MI (rare)

Chromium trioxide Cimetidine Ranitidine Clonidine

Coal gas Cobalt

Cobaltous chloride Cocaine

Diazepam for excitation (primary treatment), O2, respiratory and circulatory support if needed, IV NaHCO3 For arrhythmias, extremely cautious use of IV esmolol Observation for myocardial or pulmonary disorder (usually before emergency department arrival) For hyperthermia, external cooling

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SYMPTOMS AND TREATMENT OF SPECIFIC POISONSCONTINUED POISON* Codeine Copper Copper salts Cupric sulfate, acetate, or subacetate Cuprous chloride or oxide Zinc salts SYMPTOMS See Opioids See Copper salts TREATMENT

Vomiting, burning sensation, Penicillamine or dimercaprol metallic taste, diarrhea, pain, (see Table 326-4 ), maintenance shock, jaundice, anuria, seizures of electrolyte and fluid balance, respiratory support, monitoring of GI tract, treatment of shock, control of seizures, monitoring for liver and renal failure

Corrosive sublimate See Mercury (mercuric chloride) Coumaphos Creosote, cresols Cyanides Bitter almond oil Hydrocyanic acid Nitroprusside Potassium cyanide Prussic acid Sodium cyanide Wild cherry syrup See Organophosphates See Phenols

Tachycardia, headache, drowsiSpeed essential ness, hypotension, coma, rapid For inhalation, removal from severe acidosis, seizures, death, source possibly bitter almond odor on breath, bright red venous blood For both inhalation and ingestion, 100% O2; respiratory support Very rapidly lethal (in 115 min) Standard treatment for inhalation and ingestion: Inhalation of amyl nitrite 0.2 mL (1 ampule) for 30 sec of each min; 3% Na nitrite 10 mL at 2.55 mL/min IV (in children, 10 mg/kg), then 25% Na thiosulfate 2550 mL at 2.55 mL/min IV (Lilly cyanide kit); treatment repeated if symptoms recur Hydroxocobalamin 5 g IV (will probably become preferred treatment) See Pyrethroids See Pyrethroids See Chlorinated hydrocarbons See Chlorinated hydrocarbons See Organophosphates See Naphthalene and Paradichlorobenzene See Barium compounds See Tricyclic antidepressants See Caustic Ingestion See Amphetamines See Organophosphates See Organophosphates See Chlorinated hydrocarbons

Cyfluthrin Cypermethrin DDD (2-dichlorethane) DDT (chlorophenothane) Demeton Deodorizers, household Depilatories Desipramine Detergent powders Dextroamphetamine Diazinon Dichlorvos Dicofol

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SYMPTOMS AND TREATMENT OF SPECIFIC POISONSCONTINUED POISON* Dicumarol Dieldrin Dienochlor Diethylene glycol Digitalis Digitoxin Digoxin Dilan Dimethoate Dinitrobenzene Dinitro-o-cresol Herbicides Pesticides SYMPTOMS See Warfarin See Chlorinated hydrocarbons See Chlorinated hydrocarbons See Ethylene glycol See discussion of digitalis preparations TREATMENT

See Chlorinated hydrocarbons See Organophosphates See Nitrobenzene Fatigue, thirst, flushing, nausea, vomiting, abdominal pain, hyperpyrexia, tachycardia, loss of consciousness, dyspnea, respiratory arrest, skin absorption

Fluid therapy, O2, anticipation of kidney and liver toxicity, no specific antidote, detergents to rinse skin

Diphenoxylate with atropine

Lethargy, nystagmus, pinpoint Activated charcoal, naloxone, pupils, tachycardia, coma, respi- careful monitoring of all chilratory depression dren for 1218 h if ingestion is (NOTE: Toxicity may be verified, supportive care delayed up to 12 h.) See Paraquat See Caustic Ingestion See Organophosphates See Mercury See Arsenic See Tricyclic antidepressants See Caustic Ingestion See Chlorinated hydrocarbons See Chlorinated hydrocarbons Thirst, diarrhea, vomiting, lightheadedness, burning feet, increased heart rate and BP, cardiovascular collapse, seizures, hypotension, coma, abortion, gangrene of feet, cataracts Benzodiazepine or a short-acting barbiturate for seizures For peripheral ischemia, heparin plus phentolamine 510 mg in 10 mL normal saline IV or intra-arterially or nitroprusside 12 g/kg/min IV For coronary vasospasm, IV nitroglycerin and nifedipine

Diquat Dishwasher detergents Disulfoton Diuretics, mercurial Donovans solution Doxepin Drain cleaners Endosulfan Endrin Ergot derivatives

Eserine Esfenvalerate Ethanol Ether Ethion

See Physostigmine See Pyrethroids See Alcohol, ethyl See Chloroform See Organophosphates

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SYMPTOMS AND TREATMENT OF SPECIFIC POISONSCONTINUED POISON* Ethyl alcohol SYMPTOMS See Alcohol, ethyl TREATMENT

Ethyl biscoumacetate See Warfarin Ethylene glycol Diethylene glycol Permanent antifreeze

Ingestion: Inebriation but no alco- Ingestion: Respiratory support, correction of electrolyte imbalhol odor on breath, nausea, ance (anion gap), consideration vomiting of correcting acidemia, ethanol Later, carpopedal spasm, lumbar (see treatment of methyl alcopain, oxalate crystalluria, olighol) or fomepizole 15 mg/kg IV uria progressing to anuria and (loading dose) followed by 10 acute renal failure, respiratory mg/kg IV q 12 h distress, seizures, coma Hemodialysis, which is definitive Eye contact: Iridocyclitis treatment Eye contact: Flushing of eyes See Barium compounds (fireworks) and Nitrogen oxides See Organophosphates See Table 326-5 See Organophosphates See Iron See Iron

Explosives Famphur Fava bean (favism) Fenthion Ferric salts Ferrous salts (eg, gluconate, sulfate) Fireworks Fluorides Ammonium fluoride Fluorine Hydrofluoric acid Rat poisons Roach poisons Sodium fluoride Soluble fluorides generally

See Barium compounds

Ingestion: Dilution with milk or Ingestion: Salty or soapy taste water, IV glucose and saline, With large doses: tremors, 10% Ca gluconate 30 mL IV seizures, CNS depression, (for children, 0.6 mL/kg) or shock, renal failure 10% CaCl2 10 mL IV (in chilSkin and mucosal contact: Painful dren, 0.10.2 mL/kg), monitorsuperficial or deep burns ing for cardiac irritability, treatInhalation: Intense eye and nasal ment of shock and dehydration irritation, headache, dyspnea, Skin and mucosal contact: sense of suffocation, glottal Copious flushing with water, edema, pulmonary edema, bron- debridement of white tissue, chitis, pneumonia, mediastinal sometimes injection of 10% Ca and subcutaneous emphysema gluconate locally but may be due to bleb rupture given intra-arterially, application of Ca gluconate or Ca carbonate paste Inhalation: O2, respiratory support, prednisone for chemical pneumonitis (in adults, 1540 mg bid), management of pulmonary edema See Pyrethroids

Fluvalinate

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SYMPTOMS AND TREATMENT OF SPECIFIC POISONSCONTINUED POISON* Formaldehyde Formalin (NOTE: May contain methyl alcohol.) SYMPTOMS TREATMENT

Ingestion: Oral and gastric pain, Ingestion: Dilution with water or milk, treatment of shock, nausea, vomiting, hematemesis, NaHCO3 to correct acidosis, shock, hematuria, anuria, coma, respiratory failure respiratory support, observation for perforations Skin contact: Irritation, coagulation necrosis (with high Skin contact: Washing with copiconcentrations), dermatitis, ous soap and water hypersensitivity Inhalation: Flushing of eyes with Inhalation: Eye, nose, and saline, O2, respiratory support respiratory tract irritation; laryngeal spasm and edema; dysphagia; bronchitis; pneumonia See Arsenic See Alcohol, methyl See Petroleum distillates See Carbon monoxide

Fowlers solution Fuel, canned Fuel oil Furnace gas Gas

See Ammonia gas, Carbon monoxide (acetylene gas, automobile exhaust, coal gas, furnace gas, illuminating gas, marsh gas), Chlorine (tear gas), Hydrogen sulfide (sewer gas, volatile hydrides), and Organophosphates (nerve gas) See Petroleum distillates

Gasoline

Glues, model airplane See Acetone, Benzene (toluene), Petroleum distillates Glutethimide

Drowsiness, areflexia, mydriasis, Activated charcoal, respiratory hypotension, respiratory depres- support, maintenance of fluid and electrolyte balance, sion, coma hemodialysis possibly helpful, treatment of shock See gold in Table 326-4 and gold compounds under Joint Disorders: Rheumatoid Arthritis: Treatment See Phenols Minor GI problems, possibly altered levels of other drugs See Chlorinated hydrocarbons See specific ingredient (eg, Arsenic, Dinitro-o-cresol, and Chlorates) See Opioids See -Benzene hexachloride See Organophosphates Nonspecific supportive measures

Gold salts

Guaiacol H2 blockers (eg, cimetidine, ranitidine) Heptachlor Herbicides

Heroin Hexachlorocyclohexane Hexaethyltetraphosphate

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SYMPTOMS AND TREATMENT OF SPECIFIC POISONSCONTINUED POISON* SYMPTOMS TREATMENT

Histamine-2 blockers See H2 blockers Hydrides, volatile Hydrocarbons Hydrocarbons, chlorinated Hydrocarbons, halogenated Hydrochloric acid Hydrocodone Hydrocyanic acid Hydrofluoric acid See Hydrogen sulfide See Benzene See Chlorinated hydrocarbons See Chlorinated hydrocarbons See Caustic Ingestion See Opioids See Cyanides See Fluorides

Hydrogen chloride or See Nitrogen oxides fluoride Hydrogen sulfide Alkali sulfides Phosphine Sewer gas Volatile hydrides

Gas eye (subacute keratoconjunc- O2, respiratory support tivitis), lacrimation and burning, cough, dyspnea, pulmonary edema, caustic skin burns, erythema, pain, profuse salivation, nausea, vomiting, diarrhea, confusion, vertigo, sudden collapse, unconsciousness See Belladonna

Hyoscine (scopolamine) Hyoscyamine Hyoscyamus Hypochlorites Bleach, chlorine Javelle water

Usually mild pain and inflamma- Dilution with milk for usual 6% tion of oral and GI mucosa household preparations (little else required); treatment of Cough, dyspnea, vomiting, skin shock vesicles If concentrated forms have been ingested, esophagoscopy Admission to the hospital, IV dextrose as needed, frequent feeding (not just sugar) plus careful observation of behavior and periodic measurement of plasma glucose For persistent hypoglycemia, consideration of octreotide 5075 g sc q 8 h

Hypoglycemic drugs, Hypoglycemia, diaphoresis, lethargy, confusion oral Chlorpropamide Glipizide

Illuminating gas Imipramine Insecticides

See Carbon monoxide See Tricyclic antidepressants See Chlorinated hydrocarbons, Organophosphates, Paradichlorobenzene, and Pyrethroids

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SYMPTOMS AND TREATMENT OF SPECIFIC POISONSCONTINUED POISON* Iodine SYMPTOMS TREATMENT

Milk, starch, or flour po; early Burning pain in mouth and airway support; fluid and elecesophagus, brown-stained trolytes; treatment of shock; mucous membranes, laryngeal early, aggressive airway edema, vomiting, abdominal management pain, diarrhea, shock, nephritis, circulatory collapse Dermatitis, vomiting, cerebral depression, excitation, coma, respiratory difficulty Ingestion: Dilution with milk or water, respiratory support Skin contact: Washing with NaHCO3 or alcohol

Iodoform Triiodomethane

Vomiting, upper abdominal pain, For serum iron > 400500 g/dL Iron pallor, cyanosis, diarrhea, (> 7290 mmol/L) at 36 h plus Carbonyl iron drowsiness, shock; possible tox- GI symptoms, deferoxamine IV (see Carbon icity if > 20 mg/kg of elemental infusion starting at 15 mg/kg/h monoxide) iron is ingested and titrated to BP Ferric salts Ferrous salts Ferrous gluconate Ferrous sulfate Vitamins with iron (NOTE: Childrens chewables with iron are remarkably safe.) Isofenphos Isoniazid See Organophosphates

CNS stimulation, seizures, obtun- Pyridoxine IV for seizures, mg for mg ingested or, if amount dation, coma ingested is unknown, 5 g IV For acidosis, NaHCO3 See Alcohol, isopropyl See Hypochlorites See Petroleum distillates See Acetone See Pyrethroids See Lead Poisoning

Isopropyl alcohol Javelle water Kerosene Ketones Lambda-cyhalothrin

Acute ingestion: Thirst, burning Lead abdominal pain, vomiting, Lead salts diarrhea, CNS symptoms Solder (eg, irritability, inattentiveness, decreased level of consciousSome paints and ness, seizures) painted surfaces Acute inhalation: Insomnia, headache, ataxia, mania, seizures Chronic exposure: Anemia, peripheral neuropathy, confusion, lead encephalopathy

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SYMPTOMS AND TREATMENT OF SPECIFIC POISONSCONTINUED POISON* Lead, tetraethyl SYMPTOMS TREATMENT

Vapor inhalation, skin absorption, Supportive care, diazepam to or ingestion, CNS symptoms control seizures, fluids and (eg, insomnia, restlessness, atax- electrolytes, elimination of ia, delusions, mania, seizures) source See Chlorine See -Benzene hexachloride and Chlorinated hydrocarbons See Alcohol, ethyl

Lime, chlorinated Lindane Liquor Lithium salts

Acute: Hydration, diazepam, posNausea, vomiting, diarrhea, sibly dialysis for end-organ tremors, fasciculations, drowsidamage or serum lithium level > ness, diabetes insipidus, ataxia, 4 mEq/L seizures, hypothyroidism Chronic: Dialysis if symptoms are severe See Caustic Ingestion

Lye (sodium hydroxide [NaOH])

Lysergic acid diethyl- Confusion, hallucinations, hyper- Supportive care, benzodiazepines amide (LSD) excitability, coma, flashbacks For severe agitation, haloperidol 210 mg IV or IM in adults (repeated as necessary) Malathion Manganese Marsh gas Meperidine Meprobamate Mercury All mercury compounds Ammoniated mercury Bichloride of mercury Calomel Corrosive sublimate Diuretics, mercurial Mercuric chloride Mercury vapor (otherwise, not elemental mercury) Merthiolate Merthiolate (thimerosal) See Organophosphates See Potassium permanganate See Carbon monoxide See Opioids See Barbiturates

Consideration of gastric lavage, Acute: Severe gastroenteritis, activated charcoal, penicilburning mouth pain, salivation, lamine (or succimersee abdominal pain, vomiting, colitis, nephrosis, anuria, uremia Table 326-4 ) With alkyl and phenyl mercurials, Maintenance of fluid and electrolyte balance, hemodialysis for skin burns renal failure, observation for Chronic: Gingivitis, mental GI perforation disturbance, neurologic deficits Skin contact: Soap and water for Mercury vapor: Severe scrubbing pneumonitis Lungs: Supportive care

See Mercuryusually nontoxic

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SYMPTOMS AND TREATMENT OF SPECIFIC POISONSCONTINUED POISON* Metaldehyde Slug bait SYMPTOMS TREATMENT

Nausea, vomiting, retching, Supportive care, diazepam abdominal pain, muscular rigidity, hyperventilation, seizures, coma See specific metals See Hypoglycemic agents, oral See Opioids See Amphetamines See Alcohol, methyl See Organophosphates See Chlorinated hydrocarbons See Alcohol, methyl See Organophosphates See Aspirin and Other Salicylate Poisoning See Petroleum distillates Usually benign Most commonly, sedation, confusion, tachycardia See Table 326-4 Observation for 8 h

Metals Metformin Methadone Methamphetamine Methanol Methidathion Methoxychlor Methyl alcohol Methyl parathion Methyl salicylate Mineral spirits Mirtazapine

Model airplane glues, See Acetone, Benzene, Petroleum solvents distillates, and Toluene Monoamine oxidase (MAO) inhibitors Isocarboxazid Phenelzine Selegiline Tranylcypromine Nonspecific and highly variable Consideration of gastric decontamination, supportive symptoms, which are often care delayed 624 h Sympathomimetic toxidromes, headache, nausea, dystonia, hallucinations, nystagmus, fasciculations, diarrhea, seizures, agitation, muscle rigidity Hypotension and bradycardia (which may be ominous) Burning sensations throughout the Supportive care body, facial pressure, anxiety, chest pain (Chinese restaurant syndrome) See Opioids See Naphthalene, Camphor, Paradichlorobenzene See Chemical Food Poisoning See Acetone See Organophosphates See Petroleum distillates

Monosodium glutamate

Morphine Moth balls, crystals, or repellent cakes Mushrooms, poisonous Nail polish remover Naled Naphtha

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SYMPTOMS AND TREATMENT OF SPECIFIC POISONSCONTINUED POISON* SYMPTOMS TREATMENT

Ingestion: Blood transfusion for Ingestion: Abdominal cramps, Naphthalene severe hemolysis, urine alkalinnausea, vomiting, headache, Deodorizer cakes confusion, dysuria, intravascular ization for hemoglobinuria, benMoth balls, zodiazepines to control seizures hemolysis, seizures, hemolytic crystals, or anemia in people with G6PD Skin contact: Clothing removed if repellent cakes deficiency formerly stored with naphtha(see also Paradilene moth balls, flushing of skin chlorobenzene) Skin contact: Dermatitis, corneal and eyes ulceration Inhalation: Headache, confusion, vomiting, dyspnea Naphthols Narcotics Nefazodone Neostigmine Nerve gas agents Nickel See Phenols See Opioids See Trazodone See Physostigmine See Organophosphates Hypersensitivity dermatitis Chronic inhalation: Pulmonary inflammation Pneumonitis, cyanosis, delirium, seizures (see also Nickel) Removal from source of nickel, irrigation with water Removal from source, decontamination, consideration of Na diethyldithiocarbamate po (mild exposure) or IV (severe exposure) or disulfiram if Na diethyldithiocarbamate is unavailable

Nickel carbonyl

Nicotine Nitrates Nitric acid Nitrites Amyl nitrite Butyl nitrite Nitroglycerin Potassium nitrite Sodium nitrite Nitrobenzene Artificial bitter almond oil Dinitrobenzene

See Tobacco See Chlorates and Nitrates See Caustic Ingestion

O2 Methemoglobinemia, cyanosis, anoxia, GI disturbance, vomit- For methemoglobinemia, 1% ing, headache, dizziness, methylene blue 12 mg/kg hypotension, respiratory failure, slowly IV coma

See Acetanilid Bitter almond odor (suggests cyanides), drowsiness, headache, vomiting, ataxia, nystagmus, brown urine, convulsive movements, delirium, cyanosis, coma, respiratory arrest

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SYMPTOMS AND TREATMENT OF SPECIFIC POISONSCONTINUED POISON* SYMPTOMS TREATMENT Bed rest, O2 as soon as symptoms develop For excessive pulmonary edema: suction, postural drainage, mechanical ventilation, prednisone 3080 mg/day in adults and dexamethasone 1 mg/m2 BSA in children to possibly prevent pulmonary fibrosis

Nitrogen oxides Delayed onset of symptoms with (see also Chlorine, nitrogen oxides unless heavy Fluorides, Hydrogen concentration sulfide, Sulfur Fatigue, cough, dyspnea, dioxide, and pulmonary edema Environmental Later, bronchitis, pneumonia Pulmonary Diseases) Air contaminants that form atmospheric oxidants and that have been liberated from missile fuels, explosives, or agricultural wastes Cobaltous chloride Hydrogen chloride Hydrogen fluoride Nitroglycerin Nitroprusside Nitrous oxide NSAIDs Ibuprofen Nortriptyline See Nitrites See Cyanides See Chloroform Nausea, vomiting, CNS toxicity (eg, seizures with massive overdoses) See Tricyclic antidepressants

Clinical observation, supportive care

Octamethyl pyrophos- See Organophosphates phoramide Oil of wintergreen Oils See Aspirin and Other Salicylate Poisoning See Acetanilid (aniline oil) and Petroleum distillates (fuel oil, lubricating oils)

Opioids (see Opioids) Pinpoint pupils, drowsiness, shal- Charcoal, respiratory support, naloxone IV as required to low respirations, spasticity, resAlphaprodine awaken patients and improve piratory failure Codeine respiration, IV fluids to support circulation Fentanyl Heroin Hydrocodone Meperidine Methadone Morphine Opium Oxycodone Propoxyphene Opium See Opioids

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SYMPTOMS AND TREATMENT OF SPECIFIC POISONSCONTINUED POISON* SYMPTOMS TREATMENT

Absorption via skin, inhalation, or Removal of clothing, flushing and Organophosphates washing of skin ingestion: Nausea, vomiting, Acephate abdominal cramping, excessive For increased secretions, atropine Bidrin salivation, increased pulmonary 25 mg in adults or 0.05 mg/kg secretion, headache, rhinorrhea, Chlorethoxyfos in children IV or IM q 1560 blurred vision, miosis, slurred min, repeated and increased prn Chlorothion speech, mental confusion, diffi(massive amounts may be Chlorpyrifos culty breathing, frothing at the necessary) as often as q 35 mouth, coma Coumaphos min; pralidoxime chloride 12 g in adults or 2040 mg/kg in Demeton children IV over 1530 min, Diazinon repeated in 1 h if needed; O2; Dichlorvos respiratory support; correction Dimethoate of dehydration Disulfoton For attendants, avoidance of selfcontamination Ethion Famphur Fenthion Hexaethyltetraphosphate Isofenphos Leptophos Malathion Merphos Methidathion Methyl parathion Mipafox Naled Nerve gas agents Octamethyl pyrophosphoramide Oxydemetonmethyl Parathion Phorate Phosdrin Phosmet Pirimiphos-methyl Temefos Terbufos Tetrachlorvinphos Trichlorfon Triorthocresyl phosphate Oxalic acid Oxalates Burning pain in throat, vomiting, Milk or Ca lactate, 10% Ca gluconate 1020 mL IV, pain conintense pain, hypotension, tetany, shock, glottal and kidney trol, saline IV for shock, observation for glottal edema and damage, oxaluria stricture See Opioids See Organophosphates

Oxycodone Oxydemeton-methyl

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SYMPTOMS AND TREATMENT OF SPECIFIC POISONSCONTINUED POISON* Paints Paint solvents See Lead See Alcohol, methyl; Petroleum distillates (mineral spirits); and Turpentine Abdominal pain, nausea, vomiting, diarrhea, seizures, tetany (rare) SYMPTOMS TREATMENT

Paradichlorobenzene Insecticides Moth repellents Pesticides Toilet bowl deodorizers Paraldehyde

Fluid replacement, diazepam to control seizures

Acetic acid odor on breath, incoherence, miosis, depressed respiration, coma

O2, respiratory support

Paraquat (a strong corrosive) Diquat Parathion Paris green Pentobarbital Perchlordecone Permanent wave neutralizers Permethrin Pesticides Petroleum distillates (see also Hydrocarbon Poisoning) Asphalt Benzine (benzin) Fuel oil Gasoline Kerosene Lubricating oils Mineral spirits Model airplane glue Naphtha Petroleum ether Tar Phenacetin Phencyclidine (PCP)

Immediate: GI pain and vomiting Activated charcoal, fullers earth, limited O2, consultation with Within 24 h: Respiratory failure poison control center or (but no pulmonary problems manufacturer with diquat) See Organophosphates See Arsenic See Barbiturates See Chlorinated hydrocarbons See Bromates See Pyrethroids See Organophosphates

Because major problems result Ingestion: Burning throat and from aspiration (not GI absorpstomach, vomiting, diarrhea, pneumonia only if aspiration has tion), gastric evacuation usually not warranted occurred Vapor inhalation: Euphoria, burn- Supportive care for pulmonary edema, O2, respiratory support ing in chest, headache, nausea, weakness, CNS depression, confusion, dyspnea, tachypnea, rales, possibly myocardial sensitization to catecholamines (which can result in cardiac arrhythmias) Aspiration: Early acute pulmonary changes

See Acetanilid Inattentiveness with eyes open, agitation, violent behavior, unconsciousness, tachycardia, hypertension

Quiet environment Benzodiazepines if needed to provide sedation

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SYMPTOMS AND TREATMENT OF SPECIFIC POISONSCONTINUED POISON* Phenmetrazine Phenobarbital Phenols Carbolic acid Creosote Cresols Guaiacol Naphthols Phenothiazines Chlorpromazine Prochlorperazine Promazine Trifluoperazine SYMPTOMS See Amphetamines See Barbiturates TREATMENT

Corrosive effects, mucous mem- Removal of clothing, washing of external burns with water, actibrane burns, pallor, weakness, vated charcoal, pain relief, O2, shock, seizures in children, pulmonary edema, smoky urine, respiratory support, correction esophageal stricture (rare) of fluid imbalance, observation for esophageal stricture Respiratory, cardiac, and circulatory failure Diphenhydramine 23 mg/kg IV Extrapyramidal symptoms (eg, ataxia, muscular and carpopedal or IM for extrapyramidal sympspasms, torticollis), usually idio- toms, diazepam to control seizures syncratic; if overdose, dry mouth, drowsiness, seizures, coma, respiratory depression Supportive care, diazepam For hypertension, phentolamine 5 mg IV over about 1 min or nitroprusside IV

Phenylpropanolamine Nervousness, irritability, bradycardia, hypertension plus other sympathomimetic effects Phorate Phosdrin Phosmet Phosphine Phosphoric acid Phosphorus (yellow or white) Rat poisons Roach powders (NOTE: Red phosphorus is unabsorbable and nontoxic.) See Organophosphates See Organophosphates See Organophosphates See Hydrogen sulfide See Caustic Ingestion

Protection of patient and attendant Stage 1: Garlicky taste, garlicbreath odor, local irritation, skin from vomitus and feces and throat burns, nausea, vomit- GI lavage with dilute K permaning, diarrhea, corrosion of ganate (1:5000) or hydrogen mucous membranes peroxide (eg, 12%), which may change phosphorus to nontoxic Stage 2: Symptom-free 8 h to oxides several days Stage 3: Nausea, vomiting, diar- If phosphorus is embedded in skin: rhea, liver enlargement, jaun Submersion of the patients dice, hemorrhages, kidney dambody in water age, seizures, coma Irrigation with dilute K perToxicity enhanced by alcohol, manganate or cupric sulfate fats, or digestible oils (250 mg in 250 mL of water), recommended by some experts Mineral oil 100 mL (applied topically to prevent absorption), repeated in 2 h Prevention of shock Meticulous surgical debridement 5% NaHCO3 plus 3% cupric sulfate plus 1% hydroxyethyl cellulose as a paste applied to exposed skin, which is thoroughly washed off after 30 min (prolonged contact with cupric sulfate may result in copper poisoning)

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SYMPTOMS AND TREATMENT OF SPECIFIC POISONSCONTINUED POISON* Physostigmine Eserine Neostigmine Pilocarpine Pilocarpus genus Pilocarpine Pilocarpus genus Pirimiphos-methyl SYMPTOMS Dizziness, weakness, vomiting, cramping pain, bradycardia, possibly seizures, agitation TREATMENT Atropine sulfate 0.61 mg in adults or 0.01 mg/kg in children sc or IV, repeated prn Benzodiazepine prn to provide sedation

See Physostigmine See Physostigmine See Organophosphates

See Acids and alkalis Potash (potassium hydroxide or potassium carbonate) Potassium cyanide Potassium nitrite Potassium permanganate See Cyanides See Nitrites

Brown discoloration and burns of Dilution with water or milk, consideration of early endoscopy, oral mucosa, glottal edema, maintenance of fluid balance hypotension, kidney involvement See Phenothiazines See Chlorinated hydrocarbons See Phenothiazines See Opioids See Tricyclic antidepressants See Cyanides See Pyrethroids

Prochlorperazine Prolan Promazine Propoxyphene Protriptyline Prussic acid Pyrethrin Pyrethroids Bifenthrin Cyfluthrin Cypermethrin Esfenvalerate Fluvalinate Lambdacyhalothrin Permethrin Pyrethrin Resmethrin Sumithrin Tefluthrin Tetramethrin Ranitidine Rat poisons

Allergic response (including ana- Thorough washing of skin, sympphylactic reactions and skin sen- tomatic and supportive care sitivity) in sensitive people; otherwise, low toxicity unless vehicle is a petroleum distillate

See Cimetidine

See specific components (eg, Barium compounds, Fluorides, Phosphorus, Thallium salts, and Warfarin) See Pyrethroids

Resmethrin

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SYMPTOMS AND TREATMENT OF SPECIFIC POISONSCONTINUED POISON* SYMPTOMS TREATMENT

Resorcinol (resorcin) Vomiting, dizziness, tinnitus, Respiratory support, methylene chills, tremor, delirium, blue for methemoglobinemia seizures, respiratory depression, coma, methemoglobinemia Roach poisons Rubbing alcohol Salicylates Salicylic acid Scopolamine (hyoscine) Secobarbital Selenium Sewer gas Silver salts Silver nitrate Smog Soda, caustic (Na hydroxide) Sodium carbonate Sodium cyanide Sodium fluoride Sodium hydroxide Sodium nitrite Sodium salicylate Solder SSRIs Citalopram Escitalopram Fluoxetine Fluvoxamine Paroxetine Sertraline Stibophen Stramonium See Fluorides, Phosphorus, and Thallium salts See Alcohol, isopropyl See Aspirin and Other Salicylate Poisoning See Aspirin and Other Salicylate Poisoning See Belladonna See Barbiturates See Arsenic and Thallium salts See Hydrogen sulfide Stained lips (white, brown, then black), gastroenteritis, shock, vertigo, seizures See Sulfur dioxide See Caustic Ingestion See Acids and alkalis See Cyanides See Fluorides See Caustic Ingestion See Nitrites See Aspirin and Other Salicylate Poisoning See Cadmium and Lead Control of pain, diazepam to control seizures

Airway protection, consideration Commonly, sedation, vomiting, of alkalinization for QRS tremor, tachycardia prolongation, admission of Possibly, seizures, hallucinations, patients who have symptoms hypotension, serotonin syn> 6 h after ingestion drome Rarely, death With citalopram, QRS prolongation possible See Arsenic See Belladonna

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SYMPTOMS AND TREATMENT OF SPECIFIC POISONSCONTINUED POISON* Strychnine SYMPTOMS TREATMENT

Restlessness; hyperacuity of hear- Isolation and restricted stimulaing, vision, and tactile sensation tion to prevent seizures, activated charcoal po, IV diazepam, Violent myoclonus that simulates respiratory support generalized seizures but with intact mental status, caused by For severe seizures, neuromuscular blockade and mechanical minor stimuli; complete muscle ventilatory support relaxation between apparent seizures; perspiration; respiratory arrest Respiratory tract irritation, sneez- Removal from contaminated area, ing, cough, dyspnea, pulmonary O2, positive pressure breathing, edema respiratory support See Caustic Ingestion See Pyrethroids See Cyanides See Petroleum distillates See Arsenic See Chlorine See Pyrethroids See Organophosphates See Organophosphates See Organophosphates See Lead, tetraethyl See Pyrethroids

Sulfur dioxide Smog Sulfuric acid Sumithrin Syrup of wild cherry Tar Tartar emetic Tear gas Tefluthrin Temefos Terbufos Tetrachlorvinphos Tetraethyl lead Tetramethrin Thallium salts (formerly used in ant, rat, and roach poisons) Selenium

Abdominal pain (colic), vomiting Treatment of shock, supportive care, diazepam to control (may be bloody), diarrhea (may be bloody), stomatitis, excessive seizures, activated charcoal (which effectively binds thallisalivation, tremors, leg pains, paresthesias, polyneuritis, ocular um and interrupts enterohepatic circulation), Prussian blue 60 and facial palsy, delirium, mg/kg qid via NGT (same purseizures, respiratory failure, pose as charcoal), chelation loss of hair about 3 wk after therapy with dimercaprol (used poisoning with varying success) Avoidance of penicillamine and diethyldithiocarbamate (which may redistribute thallium into the CNS) Consultation with poison control center for latest information advisable See Aminophylline Usually asymptomatic Rarely, increasing irritability progressing to thyroid storm in 57 days Emesis, observation at home, diazepam, possibly antithyroid preparations and propranolol but only if symptoms occur

Theophylline Thyroxine

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SYMPTOMS AND TREATMENT OF SPECIFIC POISONSCONTINUED POISON* Tobacco Nicotine SYMPTOMS TREATMENT

Excitement, confusion, muscular Activated charcoal, respiratory twitching, weakness, abdominal support, O2, diazepam for cramps, generalized myoclonus, seizures, thorough washing of CNS depression, rapid respiraskin if contaminated tions, palpitations, cardiovascular collapse, coma, respiratory failure Airway protection For hypotension refractory to fluids, norepinephrine

Toilet bowl cleaners, See Caustic Ingestion and deodorizers Paradichlorobenzene Toluene, toluol Toxaphene Trazodone Nefazodone See Benzene See Chlorinated hydrocarbons CNS depression, orthostatic hypotension, seizures, QRS prolongation (but torsades de pointes is rare), hypotension (rare) See Organophosphates See Chloroform Anticholinergic effects (eg, blurred vision, urinary hesitation), CNS effects (eg, drowsiness, stupor, coma, ataxia, restlessness, agitation, hyperactive reflexes, muscle rigidity, seizures), cardiovascular effects (eg, tachycardia, other arrhythmias, bundle branch block, QRS widening, impaired conduction, heart failure), respiratory depression, hypotension, shock, vomiting, hyperpyrexia, mydriasis, diaphoresis See Phenothiazines See Iodoform See Table 326-4

Trichlorfon Trichloromethane Tricyclic antidepressants Amitriptyline Desipramine Doxepin Imipramine Nortriptyline Protriptyline

Symptomatic treatment and supportive care, charcoal, monitoring of vital signs and ECG, maintenance of airway NaHCO3 as a rapid IV injection (0.52 mEq/kg), repeated periodically to narrow the QRS, prevent arrhythmias, and maintain blood pH > 7.45 (constant infusion may be needed) Diazepam to control seizures Vasopressors (eg, norepinephrine) to maintain BP

Trifluoperazine Triiodomethane Tungsten Turpentine Paint solvent Varnish Valproate

Turpentine odor, burning oral and Respiratory support, O2, control abdominal pain, coughing, of pain, monitoring of kidney choking, respiratory failure, function nephritis Progressive CNS and respiratory depression See Alcohol, methyl and Turpentine Respiratory and cardiovascular supportive measures, monitoring of liver function

Varnish Venlafaxine

Possibly sedation, seizures, QRS Observation for 6 h prolongation, sympathomimetic For QRS prolongation, considerasymptoms (eg, tremor, mydriation of alkalinization sis, tachycardia, hypertension, diaphoresis), hypotension Rarely, death See Iron

Vitamins with iron

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SYMPTOMS AND TREATMENT OF SPECIFIC POISONSCONTINUED POISON* SYMPTOMS TREATMENT For hemorrhagic manifestations, vitamin K1 (phytonadione) until INR is normal, transfusion with fresh blood if necessary

Warfarin (sometimes Single ingestion not serious used in pesticides) With multiple overdoses, coagulopathy Bishydroxycoumarin Dicumarol Ethyl biscoumacetate Superwarfarins (sometimes used in pesticides) Wild cherry syrup Wintergreen oil Wood alcohol Xylene Zinc Zinc salts See Cyanides See Salicylates See Alcohol, methyl See Benzene See Table 326-4 See Copper salts

*Inclusion of one poison with another (eg, toluene with benzene) in a single row indicates that the terms are synonymous, that the poisons are chemically related, or that one poison is an ingredient or impurity of the other.
Physicians should be aware of people who smuggle plastic bags of cocaine in the GI tract (through the mouth or rectum) or the vagina (so-called packers) and people who hurriedly ingest poorly wrapped packs of drugs to avoid criminal consequences when being pursued by police (socalled stuffers).