poison tx

7/30/2019 poison tx

1/28

SYMPTOMS AND TREATMENT OF SPECIFIC POISONS

MERCK MANUALSONLINE MEDICAL LIBRARY

FOR HEALTHCARE

PROFESSIONALS

SECTION

SUBJECT

TOPIC

Injuries; Poisoning

Poisoning

General Principles

THE

POISON* SYMPTOMS TREATMENT

ACE inhibitors Angioedema, hypotension

Acephate See Organophosphates

Acetaminophen See Acetaminophen Poisoning

Acetic acid Low concentration: Mild mucosalirritation

High concentration: See CausticIngestion

Supportive care with irrigationand dilution

Acetone

Ketones

Model airplane

glues or cements

Nail polishremover

Ingestion: As for inhalation,except for direct pulmonaryeffect

Inhalation: Bronchial irritation,pneumonia (pulmonary conges-tion and edema, decreasedrespiration, dyspnea), drunken-ness, stupor, ketosis, cardiacarrhythmias

Removal from source

Respiratory support, O2 andfluids, correction of metabolic

acidosis

Acetonitrile

Cosmetic nailadhesive

Converted to cyanide, with usualsymptoms and signs

See Cyanides

Acetophenetidin See Acetanilid

Acetylsalicylic acid See Salicylates

Acids and alkalis See specific acids and alkalis(eg, Boric acid, Fluorides) andsee Caustic Ingestion

Eye contact: See Burns in EyeInjuries

Skin contact: See Burns

Airplane glues orcements (model-building)

See Acetone, Benzene (toluene),and Petroleum distillates

Alcohol, ethyl(ethanol)

Brandy

Whiskey

Other liquors

Emotional lability, impairedcoordination, flushing, nausea,vomiting, stupor to coma,respiratory depression

Supportive care, IV glucose toprevent hypoglycemia

Charcoal, supportive care

For angioedema, epinephrine,antihistamines, or cortico-steroids possibly effective

For hypotension, consideration ofnaloxone

Acetanilid

Aniline dyes and oil

Chloroaniline

Phenacetin(acetophenetidin,phenylacetamide)

Cyanosis due to formation ofmethemoglobin and sulfhemo-globin, dyspnea, weakness,

vertigo, angina, rashes andurticaria, vomiting, delirium,depression, respiratory andcirculatory failure

Ingestion: Charcoal; then as forinhalation

Skin contact: Clothing removed

and area washed with copioussoap and water; then as forinhalation

Inhalation: O2, respiratorysupport, blood transfusion

For severe cyanosis, methyleneblue 12 mg/kg IV

7/30/2019 poison tx

2/28

Alcohol, methyl(methanol, woodalcohol)

Antifreeze

Paint solvent

Solid canned fuel

Varnish

Severe toxicity with 60250 mL(28 oz) in adults or 810 mL(2 tsp) in children

Latency period 1218 h

Headache, weakness, leg cramps,vertigo, seizures, retinal injury,dimmed vision, acidosis,decreased respiration

Fomepizole (15 mg/kg, then10 mg/kg q 12 h); alternatively,10% ethanol/5% D/W IV withan initial loading dose of10 mL/kg over 1 h, then 12mL/kg/h to maintain a bloodethanol level of 100 mg/dL(22 mmol/L)

Hemodialysis (which is definitivetreatment)


FOR HEALTHCARE

PROFESSIONALS

SECTION

SUBJECT

TOPIC

Injuries; Poisoning

Poisoning

General Principles

THE

SYMPTOMS AND TREATMENT OF SPECIFIC POISONSCONTINUED


Alcohol, isopropyl

Rubbing alcohol

Dizziness, incoordination, stuporto coma, gastroenteritis, hemor-rhagic gastritis, hypotension

No retinal injury or acidosis

Supportive care, IV glucose,correction of dehydration andelectrolyte abnormalities

For gastritis, IV H2 blockers orproton pump inhibitors

Aldrin See Chlorinated hydrocarbons

Alkalis See Acids and alkalis

Alphaprodine See Opioids

Amitriptyline See Tricyclic antidepressants

Ammonia gas(anhydrousammonia [NH3])

Irritation of eyes and respiratorytract, cough, choking, abdomi-nal pain

Flushing of eyes for 15 min withtap water or saline

If severe toxicity, positive pres-sure O2 to manage pulmonaryedema, respiratory support

Ammonia water(ammoniumhydroxide[NH4OH])

See Caustic Ingestion

Ammoniated mercury(NH2HgCl)

See Mercury

Ammonium carbonate([NH4]2CO3)


Ammonium fluoride(NH4F)

See Fluorides

Amobarbital See Barbiturates

Aminophylline

Caffeine

Theophylline

Wakefulness, restlessness, anorex-ia, vomiting, dehydration,seizures, tachycardia

In adults, greater toxicity afteracute overdose added to chronicintake

Ingestion: Charcoal, discontinua-tion of drug, measurement ofblood theophylline level, pheno-barbital or diazepam forseizures, parenteral fluids, main-tenance of BP

For serum level > 50100 mg/L(> 278555 mmol/L), acidosis,seizures, or coma, possiblydialysis

For patients without asthma,possibly -blocker (eg, esmolol)

7/30/2019 poison tx

3/28



FOR HEALTHCARE

PROFESSIONALS

SECTION

SUBJECT

TOPIC

Injuries; Poisoning

Poisoning

General Principles

THE


Amphetamines

Amphetaminesulfate orphosphate

Dextroamphet-amine

Methamphetamine

Phenmetrazine

Increased activity, exhilaration,talkativeness, insomnia, irritabil-ity, exaggerated reflexes,anorexia, diaphoresis, tachy-arrhythmia, anginal chest pain,psychotic-like states, inability toconcentrate or sit still, paranoia

Charcoal possibly effective longafter ingestion because ofrecycling via enterohepaticcirculation, benzodiazepines forsedation and seizures, reductionof external stimuli, externalcooling, prevention of cerebraledema

For patients without asthma,-blockers possibly helpful butrarely necessary

Amyl nitrite See Nitrites

Aniline See Acetanilid Anticoagulants

Dicumarol

Superwarfarins

Warfarin

Increased PT/INR after repeatedingestions

Observation for single ingestion

For repeated chronic ingestions,measurement of PT/INR todetermine whether vitamin Ktherapy is needed

Antidepressants See Bupropion, Mirtazapine,SSRIs, Trazodone, Tricyclicantidepressants, andVenlafaxine

Antifreeze See Alcohol, methyl and Ethyleneglycol

Antihistamines Anticholinergic symptoms(eg, tachycardia, hyperthermia,

mydriasis, warm and dry skin,urinary retention, ileus,delirium)

For diagnostic testing or for treat-ment of severe symptoms

refractory to sedation(CAUTION: Seizuressee Physostigmine), considera-tion of physostigmine 0.52.0mg in adults or 0.02 mg/kg inchildren IV (slowly)

Antihyperglycemicdrugs, oral

See Hypoglycemic drugs, oral

Antimony

Stibophen

Tartar emetic

Throat constriction, dysphagia,burning GI pain, vomiting,diarrhea, GI hemorrhage,dehydration, pulmonary edema,renal failure, lactic acidosis,liver failure, shock

Chelation with penicillamine,dimercaprol for patients whocannot take oral drugs, hydra-tion, treatment of shock andpain

Antineoplastic drugs

Methotrexate

Mercaptopurine

Vincristine

> 50 Others

Effects on hematopoiesis, nausea,

vomiting, specific acute vschronic effects depending ondrug

Supportive care, leucovorin

rescue, observation for posta-cute problems (> 2448 h)

7/30/2019 poison tx

4/28



FOR HEALTHCARE

PROFESSIONALS

SECTION

SUBJECT

TOPIC

Injuries; Poisoning

Poisoning

General Principles

THE


Antipsychotic drugs(conventional)

Chlorpromazine

Fluphenazine

Haloperidol

Loxapine

Mesoridazine

Molindone

Perphenazine

Pimozide

Prochlorperazine

ThioridazineThiothixene

Trifluoperazine

Triflupromazine

A wide range of symptoms(eg, sedation, seizures, excite-ment, coma, dystonia, hypoten-sion, tachycardia, ventriculararrhythmias or torsades depointes, anticholinergic effects,hyperthermia or hypothermia)

For dystonia, diphenhydramine orbenztropine

For hypotension refractory tofluids, norepinephrine

For ventricular arrhythmias,consideration of alkalinization

Antipsychotic drugs(2nd-generation)

Clozapine

Olanzapine

Quetiapine

Risperidone

Ziprasidone

CNS depression (particularly witholanzapine), miosis, anticholin-ergic effects, hypotension, dys-tonia, QT prolongation (occa-sionally), fatal bone marrowsuppression (rare)

For dystonia, diphenhydramineor benztropine

For hypotension refractory tofluids, norepinephrine

For ventricular arrhythmias,consideration of alkalinization

Ant poison See Arsenic (sodium arsenate)and Borates

Arsenic

Donovanssolution

Fowlers solution

Herbicides

Paris green

Pesticides

Selenium

Sodium arsenate

Same as for Antimony Same as for Antimony

Arsine gas Acute hemolytic anemia Transfusions, diuresis

Artificial bitteralmond oil

See Cyanide

Asphalt See Petroleum distillates

Aspirin See Aspirin and Other SalicylatePoisoning

Atropine See Belladonna

Automobile exhaust See Carbon monoxide

7/30/2019 poison tx

5/28


Barbiturates

Amobarbital

Meprobamate

Pentobarbital

Phenobarbital

Secobarbital

Bradycardia, hypothermia, confu-sion, delirium, loss of cornealreflex, respiratory failure,drowsiness, ataxia, coma

Charcoal up to 24 h after inges-tion, supportive care, forcedalkaline diuresis for phenobarbi-tal (to aid in elimination)

For severe cases, hemodialysis

Barium compounds(soluble)

Barium acetate

Barium carbonate

Barium chloride

Barium hydroxide

Barium nitrate

Barium sulfide

Depilatories

Explosives

Fireworks

Rat poisons

Vomiting, abdominal pain,diarrhea, tremors, seizures,colic, hypertension, cardiacarrest, dyspnea and cyanosis,ventricular fibrillation, severehypokalemia, skeletal muscle

weakness

KCl 1015 mEq/h IV; Na orMg sulfate 60 g po to precipitatebarium in stomach, then possi-bly gastric lavage

Diazepam to control seizures

For dyspnea and cyanosis, O2

Belladonna

Atropine

Hyoscyamine

Hyoscyamus

Scopolamine(hyoscine)

Stramonium

Anticholinergic symptoms (eg,tachycardia, hyperthermia,mydriasis, warm and dry skin,urinary retention, ileus, deliri-um)

For diagnostic testing or for treat-ment of severe symptomsrefractory to sedation, which israrely needed (CAUTION:Seizuressee Physostigmine),consideration of physostigmine0.52.0 mg in adults or 0.02

mg/kg in children IV (slowly)

Benzene

Benzol

Hydrocarbons

Model airplaneglue

Toluene

Toluol

Xylene

Dizziness, weakness, headache,euphoria, nausea, vomiting, ven-tricular arrhythmia, paralysis,seizures

With chronic poisoning, aplasticanemia, hypokalemia, leukemia,CNS depression

Decontamination with water,avoiding vomiting and aspira-tion; O2; respiratory support;ECG monitoring (ventricularfibrillation can occur early)


For severe anemia, blood transfu-sions

Replacement of K as necessary

Epinephrine contraindicated

-Benzenehexachloride

Benzene hexachloride

Hexachloro-cyclohexane

Lindane

Irritability, CNS excitation, mus-cle spasms, atonia, tonic-clonic

seizures, respiratory failure, pul-monary edema, nausea, vomit-ing, obtundation, coma

Supportive care, activated char-coal after airway control



FOR HEALTHCARE

PROFESSIONALS

SECTION

SUBJECT

TOPIC

Injuries; Poisoning

Poisoning

General Principles

THE


Benzine (benzin) See Petroleum distillates

7/30/2019 poison tx

6/28



FOR HEALTHCARE

PROFESSIONALS

SECTION

SUBJECT

TOPIC

Injuries; Poisoning

Poisoning

General Principles

THE


Benzodiazepines

Chlordiazepoxide

Diazepam

Flurazepam

Sedation to coma, particularlyif drugs are accompanied byalcohol

Hypotension

Airway control

For hypotension, IV fluids andvasopressors

Avoidance of flumazenil(CAUTION:If tricyclic anti-depressants are involved,

flumazenil may precipitateseizures; in patients who dependon benzodiazepines, flumazenilmay precipitate withdrawal.)

Benzol See Benzene

Beta-blockers Hypotension, bradycardia,

seizures, cardiac arrhythmias,hypoglycemia, altered mentalstatus

Close monitoring and attention to

airway maintenanceFor symptomatic patients, consid-

eration of dopamine, epineph-rine, other vasopressors,glucagon 35 mg IV followedby infusion, CaCl2, IV insulinand glucose, cardiac pacing, andintra-aortic balloon pump

Bichloride of mercury See Mercury

Bichromates See Chromic acid

Bidrin (dicrotophos) See Organophosphates

Bifenthrin See Pyrethroids

Bishydroxycoumarin See Warfarin

Bismuth compounds Acute: Abdominal pain, oliguria,acute renal failure

Chronic: Poor absorption, ulcera-tive stomatitis, anorexia, pro-gressive encephalopathy

Respiratory support, considerationof chelation with dimercaproland succimer (see Table 326-4)

Bitter almond oil See Cyanides

Bleach, chlorine See Hypochlorites

-Blockers See Beta-blockers

Boric acid Nausea, vomiting, diarrhea, hem-orrhagic gastroenteritis, weak-ness, lethargy, CNS depression,seizures, boiled lobster rash,shock

Removal from skin, preventionor treatment of electrolyteabnormalities and shock, controlof seizures

For severe poisoning (rare),

dialysis

Brandy See Alcohol, ethyl

Bromates Vomiting, diarrhea, epigastricpain, acidosis, deafness

Supportive care, thiosulfate toreduce bromate to less toxicbromide

For renal failure, hemodialysis forrenal failure

7/30/2019 poison tx

7/28


Bromides Nausea, vomiting, rash (may beacneiform), slurred speech, atax-ia, confusion, psychotic behav-ior, coma, paralysis, negativeanion gap

Discontinuation of drug,hydration and NaCl IV topromote diuresis, furosemide10 mg q 6 h

For severe poisoning, hemo-dialysis

Bromine Highly corrosive

With exposure to liquid or vapor,skin and mucous membraneburns

Aggressive decontamination, sup-portive care

Bupropion HCl Respiratory depression, ataxia,seizures

Charcoal, benzodiazepines, sup-portive care

Cadmium

Cadmium oxidefumes (eg, fromwelding)

Ingestion: Severe gastric cramps,vomiting, diarrhea, dry throat,cough, dyspnea, headache,shock, coma, brown urine, renalfailure

Inhalation: Pneumonitis withdyspnea and bilateral pulmonaryinfiltrates, hypoxia, death

Dilution with milk or albumin,respiratory support, hydration,possibly chelation with succimeror dimercaptopropane sulfonate(see Table 326-4)

Dimercaprol contraindicated

For inhalation, O2, sometimesbronchodilators, corticosteroids

Ca channel blockers

Diltiazem

Nifedipine

VerapamilOthers

Nausea, vomiting, confusion,bradycardia, hypotension, totalcardiovascular collapse

Toxicity sometimes occurring

after hyperglycemia

For sustained-release prepara-tions, consideration of whole-bowel irrigation

For hypotension or severe

arrhythmias, consideration ofCaCl2 (eg, 1 g10 mL of a 10%solution) or 3 times as much Cagluconate IV with additionalamounts as needed, pacemaker,or intra-aortic balloon pump

Possible consideration of regularinsulin 10100 units IV and50100 mL 50% dextrose plus50100 mL/h 10% dextrose IVinfusion

Possible consideration ofglucagon 510 mg IV

Camphor

Camphorated oils

Camphor odor on breath,

headache, confusion, delirium,hallucinations, seizures, coma

Diazepam to prevent and treat

seizures, respiratory support

Cantharides

Cantharidin

Spanish fly

Irritated skin and mucousmembranes, skin vesicles,nausea, vomiting, bloodydiarrhea, burning pain in backand urethra, respiratorydepression, seizures, coma,abortion, menorrhagia

Avoidance of all oils, respiratorysupport, treatment of seizures,maintenance of fluid balance

No specific antidote


FOR HEALTHCARE

PROFESSIONALS

SECTION

SUBJECT

TOPIC

Injuries; Poisoning

Poisoning

General Principles

THE


Butyl nitrate See Nitrites

Caffeine See Aminophylline

Calomel See Mercury

Canned fuel, solid See Alcohol, methyl

7/30/2019 poison tx

8/28



FOR HEALTHCARE

PROFESSIONALS

SECTION

SUBJECT

TOPIC

Injuries; Poisoning

Poisoning

General Principles

THE


Carbamates

Aldicarb

Bendiocarb

Benomyl

Carbaryl

Carbofuran

Fenothiocarb

Methiocarb

Methomyl

Oxamyl

Propoxur

Slightly to highly toxic effects;similar to those of organophos-phates except cholinesteraseinhibition is not permanent

See Organophosphates

Carbamazepine Progressive CNS depression,seizures (occasional), cardiacarrhythmia (rare)

Supportive care after decontami-nation, heart rate monitoring

For arrhythmias, consideration ofIV Na bicarbonate

Carbolic acid See Phenols

Carbonates(ammonium,potassium, sodium)


Carbon bisulfide See Carbon disulfide

Carbon disulfide

Carbon bisulfide

Garlic-breath odor, irritability,

weakness, mania, narcosis,delirium, mydriasis, blindness,parkinsonism, seizures, coma,paralysis, respiratory failure

Washing of skin, O2, diazepam

sedation, respiratory andcirculatory support

Carbon dioxide Dyspnea, weakness, tinnitus,palpitations, asphyxia

Respiratory support, O2

Carbon monoxide

Acetylene gas

Automobileexhaust

Coal gas

Furnace gas

Illuminating gas

Marsh gas

Variable toxicity depending onlength of exposure, concentra-tion inhaled, and respiratory andcirculatory rates

Various symptoms depending on% carboxyhemoglobin in blood

Headache, vertigo, vomiting,dyspnea, confusion, dilatedpupils, seizures, coma

100% O2 by mask, respiratorysupport if needed, immediatemeasurement of carboxyhemo-globin level; if carboxyhemo-globin is > about 25%, hyper-baric O2 (see Carbon MonoxidePoisoning) possibly effective

Carbon tetrachloride

(sometimes used inchemical manufac-turing)

Cleaning fluids(nonflammable)

Nausea, vomiting, abdominal

pain, headache, confusion, visu-al disturbances, CNS depres-sion, ventricular fibrillation, kid-ney injury, liver injury, cirrhosis

Washing of skin, O2, respiratory

support, monitoring of kidneyand liver function and appropri-ate treatment

Carbonyl iron See Iron

Caustic soda (sodiumhydroxide)


7/30/2019 poison tx

9/28


Chloral hydrate

Chloral amide

Drowsiness, confusion, shock,coma, respiratory depression,kidney injury, liver injury

For ventricular arrhythmias,respiratory support, assessmentof concomitant ingestions,-blockers

Chlorinated and otherhalogenated hydro-carbons

Aldrin

Benzene hexa-chloride

Chlordane

Chlorothalonil

DDD(2-dichlorethane)

DDT (chloro-phenothane)

Dicofol

Dieldrin

Dienochlor

Dilan

Endosulfan

Endrin

Heptachlor

Lindane

Methoxychlor

Perchlordecone

Prolan

Toxaphene

Other chlorinatedorganic insecti-cides and indus-trial compounds

Slightly toxic effects (eg, withmethoxychlor) to highly toxiceffects (eg, with dieldrin)

Vomiting (early or delayed),paresthesias, malaise, coarsetremors, seizures, pulmonaryedema, ventricular fibrillation,respiratory failure

Diazepam or phenobarbital toprevent and control tremors andseizures, cautious use ofepinephrine, avoidance ofsudden stimuli, parenteral fluids

For renal and liver failure,monitoring

Chlorine (see alsoHypochlorites)

Chlorinated lime

Chlorine water

Tear gas

Ingestion: Irritation, corrosion ofmouth and GI tract, possibleulceration or perforation,abdominal pain, tachycardia,prostration, circulatory collapse

Inhalation: Severe respiratory andocular irritation, glottal spasm,cough, choking, vomiting, pul-monary edema, cyanosis

Ingestion: Dilution with water ormilk, treatment of shock

Inhalation: O2, respiratory sup-port, observation for and treat-ment of pulmonary edema

Chlorates and nitrates

Herbicides

Manufacture ofexplosives andmatches

Vomiting, nausea, diarrhea,cyanosis (methemoglobin), toxicnephritis, shock, seizures, CNSdepression, coma, jaundice

Methylene blue for methemoglo-binemia, 10% thiosulfate toreduce chlorate to the less toxicchloride, transfusion for severecyanosis, ascorbic acid, treat-ment of shock, O2

For complex cases, possiblydialysis


FOR HEALTHCARE

PROFESSIONALS

SECTION

SUBJECT

TOPIC

Injuries; Poisoning

Poisoning

General Principles

THE


Chlordane See Chlorinated hydrocarbons Chlorethoxyfos See Organophosphates

Chlorinated lime See Chlorine

7/30/2019 poison tx

10/28



FOR HEALTHCARE

PROFESSIONALS

SECTION

SUBJECT

TOPIC

Injuries; Poisoning

Poisoning

General Principles

THE


Chloroaniline See Acetanilid

Chlorothalonil See Chlorinated hydrocarbons

Chlorothion See Organophosphates

Chlorpromazine See Phenothiazines

Chlorpyrifos See Organophosphates

Chromates See Chromic acid

Chromic acid

Bichromates

Chromates

Chromiumtrioxide

Corrosive effects due to oxida-tion, ulcerated and perforatednasal septum, severe gastroen-teritis, shock, vertigo, coma,nephritis

Dilution with milk or water,cautious use of fluids andelectrolytes to support kidneyfunction, consideration of

N-acetylcysteine and ascorbicacid to convert hexavalent to theless toxic trivalent compound

Chromium Irritation of skin and mucousmembranes

Thorough washing with water and10% ascorbic acid solution for15 min

Chromium trioxide See Chromic acid

Cimetidine

Ranitidine

Slight dryness and drowsiness,possible altered metabolism ofconcomitant drugs

No specific antidote available

Monitoring for effect on metabo-lism of other drugs being taken

Clonidine Bradycardia, sedation, periodicapnea, hypotension, hypother-mia

Supportive care; vasopressors;naloxone 5 g/kg up to 220mg, repeated prn, to possiblyreduce sedation

Coal gas See Carbon monoxide

Cobalt Tachycardia, tachypnea andhypoxia after inhalation, skinand mucous membrane irrita-tion, glomerulonephritis,hypothyroidism (rare)

Supportive care, decontaminationwith water and soap

Cobaltous chloride See Cobalt

Cocaine

Stimulation then depression,nausea, vomiting, loss ofself-control, anxiety, hallucina-tions, sweating, hyperthermia,seizures, MI (rare)

Diazepam for excitation (primarytreatment), O2, respiratory andcirculatory support if needed,IV NaHCO3

For arrhythmias, extremelycautious use of IV esmolol

Observation for myocardial orpulmonary disorder (usuallybefore emergency departmentarrival)

For hyperthermia, externalcooling

Chloroform

Ether

Nitrous oxide

Trichloromethane

Drowsiness, coma

With nitrous oxide, delirium

Ingestion: Observation for kidneyand liver damage; respiratory,cardiac, and circulatory support

Inhalation: Respiratory, cardiac,and circulatory support

7/30/2019 poison tx

11/28


Cyanides

Bitter almond oil

Hydrocyanic acid

Nitroprusside

Potassium cyanide

Prussic acid

Sodium cyanide

Wild cherry syrup

Tachycardia, headache, drowsi-ness, hypotension, coma, rapidsevere acidosis, seizures, death,possibly bitter almond odor onbreath, bright red venous blood

Very rapidly lethal (in 115 min)

Speed essential

For inhalation, removal fromsource

For both inhalation and ingestion,100% O2; respiratory support

Standard treatment for inhalationand ingestion: Inhalation ofamyl nitrite 0.2 mL (1 ampule)for 30 sec of each min; 3% Nanitrite 10 mL at 2.55 mL/minIV (in children, 10 mg/kg), then25% Na thiosulfate 2550 mL at2.55 mL/min IV (Lilly cyanidekit); treatment repeated if symp-toms recur

Hydroxocobalamin 5 g IV (willprobably become preferredtreatment)

Copper salts

Cupric sulfate,acetate, orsubacetate

Cuprous chlorideor oxide

Zinc salts

Vomiting, burning sensation,metallic taste, diarrhea, pain,shock, jaundice, anuria, seizures

Penicillamine or dimercaprol(see Table 326-4 ), maintenanceof electrolyte and fluid balance,respiratory support, monitoringof GI tract, treatment of shock,control of seizures, monitoringfor liver and renal failure


FOR HEALTHCARE

PROFESSIONALS

SECTION

SUBJECT

TOPIC

Injuries; Poisoning

Poisoning

General Principles

THE


Codeine See Opioids

Corrosive sublimate(mercuric chloride)

See Mercury

Coumaphos See Organophosphates

Creosote, cresols See Phenols

Cyfluthrin See Pyrethroids

Cypermethrin See Pyrethroids

DDD(2-dichlorethane)

See Chlorinated hydrocarbons

DDT (chlorophen-othane)


Demeton See Organophosphates

Deodorizers,household

See Naphthalene andParadichlorobenzene

Depilatories See Barium compounds

Desipramine See Tricyclic antidepressants

Detergent powders See Caustic Ingestion

Copper See Copper salts

Dicofol See Chlorinated hydrocarbons

Dextroamphetamine See Amphetamines

Diazinon See Organophosphates

Dichlorvos See Organophosphates

7/30/2019 poison tx

12/28



FOR HEALTHCARE

PROFESSIONALS

SECTION

SUBJECT

TOPIC

Injuries; Poisoning

Poisoning

General Principles

THE


Dicumarol See Warfarin

Digitalis

Digitoxin

Digoxin

See discussion of digitalis prepa-rations

Dilan See Chlorinated hydrocarbons

Dimethoate See Organophosphates

Dinitrobenzene See Nitrobenzene

Dinitro-o-cresol

Herbicides

Pesticides

Fatigue, thirst, flushing, nausea,vomiting, abdominal pain,hyperpyrexia, tachycardia, lossof consciousness, dyspnea,respiratory arrest, skinabsorption

Fluid therapy, O2, anticipation ofkidney and liver toxicity, nospecific antidote, detergents torinse skin

Diphenoxylate withatropine

Lethargy, nystagmus, pinpointpupils, tachycardia, coma, respi-ratory depression(NOTE: Toxicity may bedelayed up to 12 h.)

Activated charcoal, naloxone,careful monitoring of all chil-dren for 1218 h if ingestion isverified, supportive care

Diquat See Paraquat

Dishwasherdetergents


Disulfoton See Organophosphates

Diuretics, mercurial See Mercury

Donovans solution See Arsenic

Doxepin See Tricyclic antidepressants

Drain cleaners See Caustic Ingestion

Endosulfan See Chlorinated hydrocarbons

Esfenvalerate See Pyrethroids

Dieldrin See Chlorinated hydrocarbons

Dienochlor See Chlorinated hydrocarbons

Diethylene glycol See Ethylene glycol

Ergot derivatives Thirst, diarrhea, vomiting, light-headedness, burning feet,increased heart rate and BP,cardiovascular collapse,seizures, hypotension, coma,abortion, gangrene of feet,cataracts

Benzodiazepine or a short-actingbarbiturate for seizures

For peripheral ischemia, heparinplus phentolamine 510 mg in10 mL normal saline IV orintra-arterially or nitroprusside12 g/kg/min IV

For coronary vasospasm, IVnitroglycerin and nifedipine

Ethanol See Alcohol, ethyl

Ether See Chloroform

Ethion See Organophosphates

Endrin See Chlorinated hydrocarbons

Eserine See Physostigmine

7/30/2019 poison tx

13/28


Ferrous salts(eg, gluconate,sulfate)

See Iron

FluoridesAmmonium

fluoride

Fluorine

Hydrofluoric acid

Rat poisons

Roach poisons

Sodium fluoride

Soluble fluoridesgenerally

Ingestion: Salty or soapy tasteWith large doses: tremors,

seizures, CNS depression,shock, renal failure

Skin and mucosal contact: Painfulsuperficial or deep burns

Inhalation: Intense eye and nasalirritation, headache, dyspnea,sense of suffocation, glottaledema, pulmonary edema, bron-chitis, pneumonia, mediastinaland subcutaneous emphysemadue to bleb rupture

Ingestion: Dilution with milk orwater, IV glucose and saline,10% Ca gluconate 30 mL IV(for children, 0.6 mL/kg) or10% CaCl2 10 mL IV (in chil-dren, 0.10.2 mL/kg), monitor-ing for cardiac irritability, treat-ment of shock and dehydration

Skin and mucosal contact:Copious flushing with water,debridement of white tissue,sometimes injection of 10% Cagluconate locally but may begiven intra-arterially, applica-tion of Ca gluconate or Ca car-bonate paste

Inhalation: O2, respiratory sup-port, prednisone for chemicalpneumonitis (in adults, 1540mg bid), management of pul-monary edema

Ethylene glycol

Diethylene glycol

Permanentantifreeze

Ingestion: Inebriation but no alco-hol odor on breath, nausea,vomiting

Later, carpopedal spasm, lumbarpain, oxalate crystalluria, olig-uria progressing to anuria andacute renal failure, respiratorydistress, seizures, coma

Eye contact: Iridocyclitis

Ingestion: Respiratory support,correction of electrolyte imbal-ance (anion gap), considerationof correcting acidemia, ethanol(see treatment of methyl alco-hol) or fomepizole 15 mg/kg IV(loading dose) followed by 10mg/kg IV q 12 h

Hemodialysis, which is definitivetreatment

Eye contact: Flushing of eyes


FOR HEALTHCARE

PROFESSIONALS

SECTION

SUBJECT

TOPIC

Injuries; Poisoning

Poisoning

General Principles

THE


Ethyl alcohol See Alcohol, ethyl

Explosives See Barium compounds (fire-works) and Nitrogen oxides

Famphur See Organophosphates

Fava bean (favism) See Table 326-5

Fenthion See Organophosphates

Ferric salts See Iron

Fireworks See Barium compounds

Fluvalinate See Pyrethroids

Ethyl biscoumacetate See Warfarin

7/30/2019 poison tx

14/28



FOR HEALTHCARE

PROFESSIONALS

SECTION

SUBJECT

TOPIC

Injuries; Poisoning

Poisoning

General Principles

THE


Formaldehyde

Formalin

(NOTE: Maycontain methylalcohol.)

Ingestion: Oral and gastric pain,nausea, vomiting, hematemesis,shock, hematuria, anuria, coma,respiratory failure

Skin contact: Irritation,coagulation necrosis (with highconcentrations), dermatitis,hypersensitivity

Inhalation: Eye, nose, andrespiratory tract irritation;laryngeal spasm and edema;dysphagia; bronchitis;pneumonia

Ingestion: Dilution with water ormilk, treatment of shock,NaHCO3 to correct acidosis,respiratory support, observationfor perforations

Skin contact: Washing with copi-ous soap and water

Inhalation: Flushing of eyes withsaline, O2, respiratory support

Fowlers solution See Arsenic

Fuel, canned See Alcohol, methyl

Fuel oil See Petroleum distillates

Furnace gas See Carbon monoxide

Gas See Ammonia gas, Carbonmonoxide (acetylene gas,automobile exhaust, coal gas,furnace gas, illuminating gas,marsh gas), Chlorine (tear gas),Hydrogen sulfide (sewer gas,volatile hydrides), andOrganophosphates (nerve gas)

Gasoline See Petroleum distillates

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

Glutethimide Drowsiness, areflexia, mydriasis,hypotension, respiratory depres-sion, coma

Activated charcoal, respiratorysupport, maintenance of fluidand electrolyte balance,hemodialysis possibly helpful,treatment of shock

Gold salts See gold in Table 326-4 and goldcompounds under JointDisorders: RheumatoidArthritis: Treatment

Guaiacol See Phenols

H2 blockers

(eg, cimetidine,ranitidine)

Minor GI problems, possibly

altered levels of other drugs

Nonspecific supportive measures

Heptachlor See Chlorinated hydrocarbons

Herbicides See specific ingredient (eg,Arsenic, Dinitro-o-cresol, andChlorates)

Heroin See Opioids

Hexachlorocyclo-hexane

See -Benzene hexachloride

Hexaethyltetra-phosphate

http://www.merck.com/mmpe/sec04/ch034/ch034b.htmlhttp://www.merck.com/mmpe/sec04/ch034/ch034b.htmlhttp://www.merck.com/mmpe/sec04/ch034/ch034b.htmlhttp://www.merck.com/mmpe/sec04/ch034/ch034b.htmlhttp://www.merck.com/mmpe/sec04/ch034/ch034b.html

7/30/2019 poison tx

15/28


Hydrogen sulfide

Alkali sulfides

Phosphine

Sewer gas

Volatile hydrides

Gas eye (subacute keratoconjunc-tivitis), lacrimation and burning,cough, dyspnea, pulmonaryedema, caustic skin burns,erythema, pain, profuse saliva-tion, nausea, vomiting, diarrhea,confusion, vertigo, suddencollapse, unconsciousness

O2, respiratory support

Hyoscine(scopolamine)

HyoscyamineHyoscyamus

See Belladonna

Hypochlorites

Bleach, chlorine

Javelle water

Usually mild pain and inflamma-tion of oral and GI mucosa

Cough, dyspnea, vomiting, skinvesicles

Dilution with milk for usual 6%household preparations (littleelse required); treatment ofshock

If concentrated forms have beeningested, esophagoscopy

Hypoglycemic drugs,oral

Chlorpropamide

Glipizide

Hypoglycemia, diaphoresis,lethargy, confusion

Admission to the hospital, IVdextrose as needed, frequentfeeding (not just sugar) pluscareful observation of behaviorand periodic measurement ofplasma glucose

For persistent hypoglycemia, con-sideration of octreotide 5075g sc q 8 h

Imipramine See Tricyclic antidepressants

Insecticides See Chlorinated hydrocarbons,Organophosphates,Paradichlorobenzene, andPyrethroids


FOR HEALTHCARE

PROFESSIONALS

SECTION

SUBJECT

TOPIC

Injuries; Poisoning

Poisoning

General Principles

THE


Histamine-2 blockers See H2 blockers

Hydrocarbons,halogenated


Hydrochloric acid See Caustic Ingestion

Hydrocodone See Opioids

Hydrocyanic acid See Cyanides

Hydrofluoric acid See Fluorides

Hydrogen chloride orfluoride

See Nitrogen oxides

Illuminating gas See Carbon monoxide

Hydrides, volatile See Hydrogen sulfide

Hydrocarbons See Benzene

Hydrocarbons,chlorinated


7/30/2019 poison tx

16/28



FOR HEALTHCARE

PROFESSIONALS

SECTION

SUBJECT

TOPIC

Injuries; Poisoning

Poisoning

General Principles

THE


Iodine Burning pain in mouth andesophagus, brown-stainedmucous membranes, laryngealedema, vomiting, abdominalpain, diarrhea, shock, nephritis,circulatory collapse

Milk, starch, or flour po; earlyairway support; fluid and elec-trolytes; treatment of shock;early, aggressive airwaymanagement

Iodoform

Triiodomethane

Dermatitis, vomiting, cerebraldepression, excitation, coma,respiratory difficulty

Ingestion: Dilution with milk orwater, respiratory support

Skin contact: Washing withNaHCO3 or alcohol

Iron

Carbonyl iron

(see Carbonmonoxide)

Ferric salts

Ferrous salts

Ferrous gluconate

Ferrous sulfate

Vitamins with iron

(NOTE:Childrenschewables withiron are remark-ably safe.)

Vomiting, upper abdominal pain,pallor, cyanosis, diarrhea,

drowsiness, shock; possible tox-icity if > 20 mg/kg of elementaliron is ingested

For serum iron > 400500 g/dL(> 7290 mmol/L) at 36 h plus

GI symptoms, deferoxamine IVinfusion starting at 15 mg/kg/hand titrated to BP

Isofenphos See Organophosphates

Isoniazid CNS stimulation, seizures, obtun-dation, coma

Pyridoxine IV for seizures, mg formg ingested or, if amountingested is unknown, 5 g IV

For acidosis, NaHCO3

Isopropyl alcohol See Alcohol, isopropyl

Javelle water See Hypochlorites

Kerosene See Petroleum distillates

Ketones See Acetone

Lambda-cyhalothrin See Pyrethroids

Lead

Lead salts

Solder

Some paints andpainted surfaces

Acute ingestion: Thirst, burningabdominal pain, vomiting,diarrhea, CNS symptoms(eg, irritability, inattentiveness,

decreased level of conscious-ness, seizures)

Acute inhalation: Insomnia,headache, ataxia, mania,seizures

Chronic exposure: Anemia,peripheral neuropathy, confu-sion, lead encephalopathy

See Lead Poisoning

7/30/2019 poison tx

17/28


Lead, tetraethyl Vapor inhalation, skin absorption,or ingestion, CNS symptoms(eg, insomnia, restlessness, atax-ia, delusions, mania, seizures)

Supportive care, diazepam tocontrol seizures, fluids andelectrolytes, elimination ofsource

Lithium salts Nausea, vomiting, diarrhea,tremors, fasciculations, drowsi-ness, diabetes insipidus, ataxia,

seizures, hypothyroidism

Acute: Hydration, diazepam, pos-sibly dialysis for end-organdamage or serum lithium level >

4 mEq/LChronic: Dialysis if symptoms are

severe

Lysergic acid diethyl-amide (LSD)

Confusion, hallucinations, hyper-excitability, coma, flashbacks

Supportive care, benzodiazepines

For severe agitation, haloperidol210 mg IV or IM in adults(repeated as necessary)

Marsh gas See Carbon monoxide

Meperidine See Opioids

Meprobamate See Barbiturates

Mercury

All mercurycompounds

Ammoniatedmercury

Bichloride ofmercury

Calomel

Corrosivesublimate

Diuretics,mercurial

Mercuric chloride

Mercury vapor(otherwise,not elementalmercury)

Merthiolate

Acute: Severe gastroenteritis,burning mouth pain, salivation,abdominal pain, vomiting,colitis, nephrosis, anuria, uremia

With alkyl and phenyl mercurials,skin burns

Chronic: Gingivitis, mentaldisturbance, neurologic deficits

Mercury vapor: Severepneumonitis

Consideration of gastric lavage,activated charcoal, penicil-lamine (or succimerseeTable 326-4 )

Maintenance of fluid and elec-trolyte balance, hemodialysis forrenal failure, observation forGI perforation

Skin contact: Soap and water forscrubbing

Lungs: Supportive care


FOR HEALTHCARE

PROFESSIONALS

SECTION

SUBJECT

TOPIC

Injuries; Poisoning

Poisoning

General Principles

THE


Lime, chlorinated See Chlorine

Lindane See -Benzene hexachloride andChlorinated hydrocarbons

Liquor See Alcohol, ethyl

Lye (sodiumhydroxide [NaOH])


Malathion See Organophosphates

Manganese See Potassium permanganate

Merthiolate(thimerosal)

See Mercuryusually nontoxic

7/30/2019 poison tx

18/28



FOR HEALTHCARE

PROFESSIONALS

SECTION

SUBJECT

TOPIC

Injuries; Poisoning

Poisoning

General Principles

THE


Metaldehyde

Slug bait

Nausea, vomiting, retching,abdominal pain, muscular rigidi-ty, hyperventilation, seizures,coma

Supportive care, diazepam

Methadone See Opioids

Methamphetamine See Amphetamines

Methanol See Alcohol, methyl

Methidathion See Organophosphates

Methoxychlor See Chlorinated hydrocarbons

Methyl alcohol See Alcohol, methyl

Methyl parathion See Organophosphates

Methyl salicylate

Mineral spirits See Petroleum distillates

Mirtazapine Usually benign

Most commonly, sedation,confusion, tachycardia

Observation for 8 h

Model airplane glues,solvents

See Acetone, Benzene, Petroleumdistillates, and Toluene

Monoamine oxidase(MAO) inhibitors

Isocarboxazid

Phenelzine

Selegiline

Tranylcypromine

Nonspecific and highly variablesymptoms, which are oftendelayed 624 h

Sympathomimetic toxidromes,headache, nausea, dystonia, hal-lucinations, nystagmus, fascicu-lations, diarrhea, seizures, agita-tion, muscle rigidity

Hypotension and bradycardia(which may be ominous)

Consideration of gastricdecontamination, supportivecare

Monosodiumglutamate

Burning sensations throughout thebody, facial pressure, anxiety,chest pain (Chinese restaurantsyndrome)

Supportive care

Morphine See Opioids

Moth balls, crystals,or repellent cakes

See Naphthalene, Camphor,Paradichlorobenzene

Mushrooms,poisonous

See Chemical Food Poisoning

Nail polish remover See Acetone

Naled See Organophosphates

Naphtha See Petroleum distillates

Metals See specific metals See Table 326-4

Metformin See Hypoglycemic agents, oral

See Aspirin and Other SalicylatePoisoning

7/30/2019 poison tx

19/28


Naphthalene

Deodorizer cakes

Moth balls,crystals, orrepellent cakes(see also Paradi-chlorobenzene)

Ingestion: Abdominal cramps,nausea, vomiting, headache,confusion, dysuria, intravascularhemolysis, seizures, hemolyticanemia in people with G6PDdeficiency

Skin contact: Dermatitis, cornealulceration

Inhalation: Headache, confusion,vomiting, dyspnea

Ingestion: Blood transfusion forsevere hemolysis, urine alkalin-ization for hemoglobinuria, ben-zodiazepines to control seizures

Skin contact: Clothing removed ifformerly stored with naphtha-lene moth balls, flushing of skinand eyes

Nickel Hypersensitivity dermatitis

Chronic inhalation: Pulmonaryinflammation

Removal from source of nickel,irrigation with water

Nickel carbonyl Pneumonitis, cyanosis, delirium,seizures (see also Nickel)

Removal from source, decontami-nation, consideration of Nadiethyldithiocarbamate po (mildexposure) or IV (severe expo-sure) or disulfiram if Nadiethyldithiocarbamate isunavailable

Nitrites

Amyl nitrite

Butyl nitrite

Nitroglycerin

Potassium nitrite

Sodium nitrite

Methemoglobinemia, cyanosis,anoxia, GI disturbance, vomit-ing, headache, dizziness,hypotension, respiratory failure,coma

O2

For methemoglobinemia, 1%methylene blue 12 mg/kgslowly IV

Nitrobenzene

Artificial bitter

almond oilDinitrobenzene

Bitter almond odor (suggestscyanides), drowsiness,headache, vomiting, ataxia, nys-

tagmus, brown urine, convulsivemovements, delirium, cyanosis,coma, respiratory arrest

See Acetanilid


FOR HEALTHCARE

PROFESSIONALS

SECTION

SUBJECT

TOPIC

Injuries; Poisoning

Poisoning

General Principles

THE


Naphthols See Phenols

Narcotics See Opioids

Nefazodone See Trazodone

Neostigmine See Physostigmine

Nerve gas agents See Organophosphates

Nicotine See Tobacco

Nitrates See Chlorates and Nitrates

Nitric acid See Caustic Ingestion

7/30/2019 poison tx

20/28



FOR HEALTHCARE

PROFESSIONALS

SECTION

SUBJECT

TOPIC

Injuries; Poisoning

Poisoning

General Principles

THE


Delayed onset of symptoms withnitrogen oxides unless heavyconcentration

Fatigue, cough, dyspnea,pulmonary edema

Later, bronchitis, pneumonia

Bed rest, O2 as soon as symptomsdevelop

For excessive pulmonary edema:suction, postural drainage,mechanical ventilation, pred-nisone 3080 mg/day in adultsand dexamethasone 1 mg/m2

BSA in children to possiblyprevent pulmonary fibrosis

Nitroglycerin See Nitrites

Nitroprusside See Cyanides

Nitrous oxide See Chloroform

NSAIDs

Ibuprofen

Nausea, vomiting, CNS toxicity(eg, seizures with massiveoverdoses)

Clinical observation, supportivecare

Nortriptyline See Tricyclic antidepressants

Octamethyl pyrophos-phoramide


Oil of wintergreen See Aspirin and Other SalicylatePoisoning

Oils See Acetanilid (aniline oil) andPetroleum distillates (fuel oil,lubricating oils)

Opioids (see Opioids)

Alphaprodine

Codeine

Fentanyl

Heroin

Hydrocodone

Meperidine

Methadone

Morphine

Opium

Oxycodone

Propoxyphene

Pinpoint pupils, drowsiness, shal-low respirations, spasticity, res-piratory failure

Charcoal, respiratory support,naloxone IV as required toawaken patients and improverespiration, IV fluids to supportcirculation

Opium See Opioids

Nitrogen oxides(see also Chlorine,Fluorides, Hydrogensulfide, Sulfurdioxide, andEnvironmentalPulmonaryDiseases)

Air contaminantsthat form atmos-pheric oxidantsand that havebeen liberatedfrom missile

fuels, explo-sives, or agricul-tural wastes

Cobaltous chloride

Hydrogen chloride

Hydrogen fluoride

7/30/2019 poison tx

21/28



FOR HEALTHCARE

PROFESSIONALS

SECTION

SUBJECT

TOPIC

Injuries; Poisoning

Poisoning

General Principles

THE


Organophosphates

Acephate

Bidrin

Chlorethoxyfos

Chlorothion

Chlorpyrifos

Coumaphos

Demeton

Diazinon

Dichlorvos

Dimethoate

Disulfoton

Ethion

Famphur

Fenthion

Hexaethyltetra-phosphate

Isofenphos

Leptophos

Malathion

Merphos

Methidathion

Methyl parathion

Mipafox

Naled

Nerve gas agents

Octamethylpyrophospho-ramide

Oxydemeton-methyl

Parathion

Phorate

Phosdrin

Phosmet

Pirimiphos-methyl

Temefos

TerbufosTetrachlorvinphos

Trichlorfon

Triorthocresylphosphate

Absorption via skin, inhalation, oringestion: Nausea, vomiting,abdominal cramping, excessivesalivation, increased pulmonarysecretion, headache, rhinorrhea,blurred vision, miosis, slurredspeech, mental confusion, diffi-culty breathing, frothing at themouth, coma

Removal of clothing, flushing andwashing of skin

For increased secretions, atropine25 mg in adults or 0.05 mg/kgin children IV or IM q 1560min, repeated and increased prn(massive amounts may benecessary) as often as q 35min; pralidoxime chloride 12 gin adults or 2040 mg/kg inchildren IV over 1530 min,repeated in 1 h if needed; O2;respiratory support; correctionof dehydration

For attendants, avoidance of self-contamination

Oxycodone See Opioids

Oxydemeton-methyl See Organophosphates

Oxalic acid

Oxalates

Burning pain in throat, vomiting,intense pain, hypotension,tetany, shock, glottal and kidneydamage, oxaluria

Milk or Ca lactate, 10% Ca glu-conate 1020 mL IV, pain con-trol, saline IV for shock, obser-vation for glottal edema andstricture

7/30/2019 poison tx

22/28



FOR HEALTHCARE

PROFESSIONALS

SECTION

SUBJECT

TOPIC

Injuries; Poisoning

Poisoning

General Principles

THE


Paints See Lead

Paraldehyde Acetic acid odor on breath, inco-herence, miosis, depressed res-piration, coma

O2, respiratory support

Paraquat (a strongcorrosive)

Diquat

Immediate: GI pain and vomiting

Within 24 h: Respiratory failure(but no pulmonary problemswith diquat)

Activated charcoal, fullers earth,limited O2, consultation withpoison control center ormanufacturer

Parathion See Organophosphates

Paris green See Arsenic

Pentobarbital See Barbiturates

Perchlordecone See Chlorinated hydrocarbons

Permanent waveneutralizers

See Bromates

Permethrin See Pyrethroids

Pesticides See Organophosphates

Petroleum distillates(see alsoHydrocarbonPoisoning)

Asphalt

Benzine (benzin)

Fuel oil

Gasoline

Kerosene

Lubricating oils

Mineral spiritsModel airplane

glue

Naphtha

Petroleum ether

Tar

Ingestion: Burning throat andstomach, vomiting, diarrhea,pneumonia only if aspiration hasoccurred

Vapor inhalation: Euphoria, burn-ing in chest, headache, nausea,weakness, CNS depression, con-fusion, dyspnea, tachypnea,rales, possibly myocardial sensi-tization to catecholamines(which can result in cardiacarrhythmias)

Aspiration: Early acute pulmonarychanges

Because major problems resultfrom aspiration (not GI absorp-tion), gastric evacuation usuallynot warranted

Supportive care for pulmonaryedema, O2, respiratory support

Phenacetin See Acetanilid

Phencyclidine (PCP) Inattentiveness with eyes open,agitation, violent behavior,unconsciousness, tachycardia,hypertension

Quiet environment

Benzodiazepines if needed toprovide sedation

Paint solvents See Alcohol, methyl; Petroleumdistillates (mineral spirits); andTurpentine

Paradichlorobenzene

Insecticides

Moth repellents

Pesticides

Toilet bowldeodorizers

Abdominal pain, nausea, vomit-ing, diarrhea, seizures, tetany(rare)

Fluid replacement, diazepam tocontrol seizures

7/30/2019 poison tx

23/28



FOR HEALTHCARE

PROFESSIONALS

SECTION

SUBJECT

TOPIC

Injuries; Poisoning

Poisoning

General Principles

THE


Phenmetrazine See Amphetamines

Phenothiazines

Chlorpromazine

Prochlorperazine

Promazine

Trifluoperazine

Extrapyramidal symptoms (eg,ataxia, muscular and carpopedal

spasms, torticollis), usually idio-syncratic; if overdose, drymouth, drowsiness, seizures,coma, respiratory depression

Diphenhydramine 23 mg/kg IVor IM for extrapyramidal symp-

toms, diazepam to controlseizures

Phenylpropanolamine Nervousness, irritability, brady-cardia, hypertension plus othersympathomimetic effects

Supportive care, diazepam

For hypertension, phentolamine 5mg IV over about 1 min ornitroprusside IV

Phorate See Organophosphates

Phosdrin See Organophosphates

Phosmet See Organophosphates

Phosphine See Hydrogen sulfide

Phosphoric acid See Caustic Ingestion

Phosphorus (yellowor white)

Rat poisons

Roach powders(NOTE: Redphosphorus isunabsorbableand nontoxic.)

Stage 1: Garlicky taste, garlic-breath odor, local irritation, skinand throat burns, nausea, vomit-ing, diarrhea, corrosion ofmucous membranes

Stage 2: Symptom-free 8 h toseveral days

Stage 3: Nausea, vomiting, diar-rhea, liver enlargement, jaun-dice, hemorrhages, kidney dam-age, seizures, coma

Toxicity enhanced by alcohol,fats, or digestible oils

Protection of patient and attendantfrom vomitus and feces

GI lavage with dilute K perman-ganate (1:5000) or hydrogenperoxide (eg, 12%), which maychange phosphorus to nontoxicoxides

If phosphorus is embedded in skin:

Submersion of the patientsbody in water

Irrigation with dilute K per-manganate or cupric sulfate(250 mg in 250 mL ofwater), recommended by

some experts Mineral oil 100 mL (applied

topically to prevent absorp-tion), repeated in 2 h

Prevention of shock

Meticulous surgicaldebridement

5% NaHCO3 plus 3% cupricsulfate plus 1% hydroxy-ethyl cellulose as a pasteapplied to exposed skin,which is thoroughly washedoff after 30 min (prolongedcontact with cupric sulfatemay result in copperpoisoning)

Phenobarbital See Barbiturates

Phenols

Carbolic acid

Creosote

Cresols

Guaiacol

Naphthols

Corrosive effects, mucous mem-brane burns, pallor, weakness,shock, seizures in children, pul-monary edema, smoky urine,esophageal stricture (rare)

Respiratory, cardiac, and circula-tory failure

Removal of clothing, washing ofexternal burns with water, acti-vated charcoal, pain relief, O2,respiratory support, correctionof fluid imbalance, observationfor esophageal stricture

7/30/2019 poison tx

24/28



FOR HEALTHCARE

PROFESSIONALS

SECTION

SUBJECT

TOPIC

Injuries; Poisoning

Poisoning

General Principles

THE


Physostigmine

Eserine

Neostigmine

Pilocarpine

Pilocarpus genus

Dizziness, weakness, vomiting,cramping pain, bradycardia,possibly seizures, agitation

Atropine sulfate 0.61 mg inadults or 0.01 mg/kg in childrensc or IV, repeated prn

Benzodiazepine prn to providesedation

Pilocarpus genus See Physostigmine

Pirimiphos-methyl See Organophosphates

Potash (potassiumhydroxide or potas-

sium carbonate)

See Acids and alkalis

Potassium cyanide See Cyanides

Potassium nitrite See Nitrites

Potassiumpermanganate

Brown discoloration and burns oforal mucosa, glottal edema,hypotension, kidney involve-ment

Dilution with water or milk, con-sideration of early endoscopy,maintenance of fluid balance

Prochlorperazine See Phenothiazines

Prolan See Chlorinated hydrocarbons

Promazine See Phenothiazines

Propoxyphene See Opioids

Protriptyline See Tricyclic antidepressants

Prussic acid See Cyanides

Pyrethrin See Pyrethroids

Allergic response (including ana-phylactic reactions and skin sen-sitivity) in sensitive people; oth-erwise, low toxicity unless vehi-cle is a petroleum distillate

Thorough washing of skin, symp-tomatic and supportive care

Ranitidine See Cimetidine

Rat poisons See specific components (eg,Barium compounds, Fluorides,Phosphorus, Thallium salts, andWarfarin)

Resmethrin See Pyrethroids

Pilocarpine See Physostigmine

Pyrethroids

Bifenthrin

Cyfluthrin

Cypermethrin

Esfenvalerate

Fluvalinate

Lambda-cyhalothrin

Permethrin

Pyrethrin

Resmethrin

Sumithrin

Tefluthrin

Tetramethrin

7/30/2019 poison tx

25/28


Resorcinol (resorcin) Vomiting, dizziness, tinnitus,chills, tremor, delirium,seizures, respiratory depression,coma, methemoglobinemia

Respiratory support, methyleneblue for methemoglobinemia

Silver salts

Silver nitrate

Stained lips (white, brown, thenblack), gastroenteritis, shock,vertigo, seizures

Control of pain, diazepam to con-trol seizures


FOR HEALTHCARE

PROFESSIONALS

SECTION

SUBJECT

TOPIC

Injuries; Poisoning

Poisoning

General Principles

THE


Salicylates See Aspirin and Other SalicylatePoisoning

Salicylic acid See Aspirin and Other SalicylatePoisoning

Scopolamine(hyoscine)

See Belladonna

Secobarbital See Barbiturates

Selenium See Arsenic and Thallium salts

Sewer gas See Hydrogen sulfide

Smog See Sulfur dioxide

Soda, caustic(Na hydroxide)


Sodium carbonate See Acids and alkalis

Sodium cyanide See Cyanides

Sodium fluoride See Fluorides

Sodium hydroxide See Caustic Ingestion

Sodium nitrite See Nitrites

Sodium salicylate

Solder See Cadmium and Lead

SSRIs

Citalopram

Escitalopram

FluoxetineFluvoxamine

Paroxetine

Sertraline

Commonly, sedation, vomiting,tremor, tachycardia

Possibly, seizures, hallucinations,hypotension, serotonin syn-

dromeRarely, death

With citalopram, QRS prolonga-tion possible

Airway protection, considerationof alkalinization for QRSprolongation, admission ofpatients who have symptoms

> 6 h after ingestion

Stibophen See Arsenic

Stramonium See Belladonna

Roach poisons See Fluorides, Phosphorus, andThallium salts

Rubbing alcohol See Alcohol, isopropyl

See Aspirin and Other SalicylatePoisoning

7/30/2019 poison tx

26/28



FOR HEALTHCARE

PROFESSIONALS

SECTION

SUBJECT

TOPIC

Injuries; Poisoning

Poisoning

General Principles

THE


Sulfur dioxide

Smog

Respiratory tract irritation, sneez-ing, cough, dyspnea, pulmonaryedema

Removal from contaminated area,O2, positive pressure breathing,respiratory support

Syrup of wild cherry See Cyanides

Tar See Petroleum distillates

Tartar emetic See Arsenic

Tear gas See Chlorine

Tefluthrin See Pyrethroids

Temefos See Organophosphates

Terbufos See Organophosphates

Tetrachlorvinphos See Organophosphates

Tetraethyl lead See Lead, tetraethyl

Tetramethrin See Pyrethroids

Thallium salts (for-merly used in ant,rat, and roachpoisons)

Selenium

Abdominal pain (colic), vomiting(may be bloody), diarrhea (maybe bloody), stomatitis, excessivesalivation, tremors, leg pains,paresthesias, polyneuritis, ocularand facial palsy, delirium,seizures, respiratory failure,loss of hair about 3 wk afterpoisoning

Treatment of shock, supportivecare, diazepam to controlseizures, activated charcoal(which effectively binds thalli-um and interrupts enterohepaticcirculation), Prussian blue 60mg/kg qid via NGT (same pur-pose as charcoal), chelationtherapy with dimercaprol (usedwith varying success)

Avoidance of penicillamine anddiethyldithiocarbamate (whichmay redistribute thallium into

the CNS)Consultation with poison control

center for latest informationadvisable

Theophylline See Aminophylline

Thyroxine Usually asymptomatic

Rarely, increasing irritabilityprogressing to thyroid storm in57 days

Emesis, observation at home,diazepam, possibly antithyroidpreparations and propranolol butonly if symptoms occur

Sulfuric acid See Caustic Ingestion

Sumithrin See Pyrethroids

Strychnine Restlessness; hyperacuity of hear-ing, vision, and tactile sensation

Violent myoclonus that simulatesgeneralized seizures but withintact mental status, caused byminor stimuli; complete musclerelaxation between apparentseizures; perspiration;respiratory arrest

Isolation and restricted stimula-tion to prevent seizures, activat-ed charcoal po, IV diazepam,respiratory support

For severe seizures, neuromuscu-lar blockade and mechanicalventilatory support

7/30/2019 poison tx

27/28


Turpentine

Paint solvent

Varnish

Turpentine odor, burning oral andabdominal pain, coughing,choking, respiratory failure,nephritis

Respiratory support, O2, controlof pain, monitoring of kidneyfunction

Venlafaxine Possibly sedation, seizures, QRSprolongation, sympathomimeticsymptoms (eg, tremor, mydria-sis, tachycardia, hypertension,diaphoresis), hypotension

Rarely, death

Observation for 6 h

For QRS prolongation, considera-tion of alkalinization

TrazodoneNefazodone

CNS depression, orthostatichypotension, seizures, QRSprolongation (but torsades depointes is rare), hypotension(rare)

Airway protectionFor hypotension refractory to

fluids, norepinephrine


FOR HEALTHCARE

PROFESSIONALS

SECTION

SUBJECT

TOPIC

Injuries; Poisoning

Poisoning

General Principles

THE


Toxaphene See Chlorinated hydrocarbons

Trichlorfon See Organophosphates

Trichloromethane See Chloroform

Tricyclic anti-depressants

Amitriptyline

Desipramine

Doxepin

Imipramine

NortriptylineProtriptyline

Anticholinergic effects (eg,blurred vision, urinary hesita-tion), CNS effects (eg, drowsi-ness, stupor, coma, ataxia, rest-lessness, agitation, hyperactivereflexes, muscle rigidity,seizures), cardiovascular effects(eg, tachycardia, other arrhyth-

mias, bundle branch block, QRSwidening, impaired conduction,heart failure), respiratorydepression, hypotension, shock,vomiting, hyperpyrexia, mydria-sis, diaphoresis

Symptomatic treatment and sup-portive care, charcoal, monitor-ing of vital signs and ECG,maintenance of airway

NaHCO3 as a rapid IV injection(0.52 mEq/kg), repeated peri-odically to narrow the QRS,prevent arrhythmias, and main-tain blood pH > 7.45 (constantinfusion may be needed)


Vasopressors (eg, norepinephrine)to maintain BP

Trifluoperazine See Phenothiazines

Triiodomethane See Iodoform

Tungsten See Table 326-4

Valproate Progressive CNS and respiratorydepression Respiratory and cardiovascularsupportive measures, monitoringof liver function

Varnish See Alcohol, methyl andTurpentine

Vitamins with iron See Iron

Tobacco

Nicotine

Excitement, confusion, musculartwitching, weakness, abdominalcramps, generalized myoclonus,CNS depression, rapid respira-tions, palpitations, cardiovascu-lar collapse, coma, respiratoryfailure

Activated charcoal, respiratorysupport, O2, diazepam forseizures, thorough washing ofskin if contaminated

Toilet bowl cleaners,deodorizers

See Caustic Ingestion andParadichlorobenzene

Toluene, toluol See Benzene

7/30/2019 poison tx

28/28



FOR HEALTHCARE

PROFESSIONALS

SECTION

SUBJECT

TOPIC

Injuries; Poisoning

Poisoning

General Principles

THE


Warfarin (sometimesused in pesticides)

Bishydroxycou-marin

Dicumarol

Ethyl biscoumac-etate

Superwarfarins(sometimes usedin pesticides)

Single ingestion not serious

With multiple overdoses, coagu-lopathy

For hemorrhagic manifestations,vitamin K1 (phytonadione) untilINR is normal, transfusion withfresh blood if necessary

Wild cherry syrup See Cyanides

Wintergreen oil See Salicylates

Wood alcohol See Alcohol, methyl

Xylene See Benzene

Zinc See Table 326-4

Zinc salts 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 ingredi-

ent 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 (so-

called stuffers).

Documents

poison tx