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Specific Poisons

by Gerald F. O’Malley, DO, Rika O’Malley, MD

Symptoms and treatment of specific poisons vary ( Symptoms and Treatment of Specific Poisons); including all the specific complexities and details is impossible. Consultation with a poison control center is recommended for any poisonings except the mildest and most routine.

Symptoms and Treatment of Specific Poisons

Poison*

Symptoms

Treatment

ACE inhibitors

Angioedema, hypotension

Charcoal, supportive care, a bradykinin inhibitor (ecallantide or icatibant)

For angioedema, epinephrine, antihistamines, or corticosteroids unlikely to be effective

For hypotension, consideration of naloxone

Acephate

See Organophosphates

see Poisoning

Acetaminophen

Acetanilide

Aniline dyes and oil

Chloroaniline

Phenacetin (acetophenetidin, phenylacetamide)

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

Ingestion: Charcoal; then as for inhalation

Skin contact: Clothing removed and area washed with copious soap and water; then as for inhalation

Inhalation: O 2 , respiratory support, blood transfusion

For severe cyanosis, methylene blue 1–2 mg/kg IV

Acetic acid

Low concentration: Mild mucosal irritation

High concentration: see Caustic Ingestion

Supportive care with irrigation and dilution

Acetone

Ketones

  • Model airplane glues or cements

  • Nail polish remover

Ingestion: As for inhalation, except for direct pulmonary effect

Inhalation: Bronchial irritation, pneumonia (pulmonary congestion and edema, decreased respiration, dyspnea), drunkenness, stupor, ketosis, cardiac arrhythmias

Removal from source

Respiratory support, O 2 and fluids, correction of metabolic acidosis

Acetonitrile

Cosmetic nail adhesive

Converted to cyanide, with usual symptoms and signs

see Poisoning

See Cyanides

Acetophenetidin

See see Poisoning

See Acetanilide

Acetylsalicylic acid

Acids and alkalis

See specific acids and alkalis (eg, Boric acid, Fluorides) and see Caustic IngestionSee specific acids and alkalis (eg, see Poisoning, see Poisoning) and see Caustic Ingestion

Eye contact: see Eye Trauma

Skin contact: see Burns

Airplane glues or cements (model-building)

See Acetone, Benzene (toluene), and Petroleum distillates

See see Poisoning, see Poisoning (toluene), and see Poisoning

Alcohol, ethyl (ethanol)

  • Brandy

  • Whiskey

  • Other liquors

Emotional lability, impaired coordination, flushing, nausea, vomiting, stupor to coma, respiratory depression

Supportive care, IV glucose to prevent hypoglycemia

Alcohol, isopropyl

  • Rubbing alcohol

Dizziness, incoordination, stupor to coma, gastroenteritis, hemorrhagic gastritis, hypotension

Ketosis without acidosis

No retinal injury or acidosis

Supportive care, IV glucose, correction of dehydration and electrolyte abnormalities

For gastritis, IV H 2 blockers or proton pump inhibitors

Alcohol, methyl (methanol, wood alcohol)

  • Antifreeze

  • Paint solvent

  • Solid canned fuel

  • Varnish

Severe toxicity with 60–250 mL (2–8 oz) in adults or 8–10 mL (2 tsp) in children

Latency period 12–18 h

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

Fomepizole (15 mg/kg, then 10 mg/kg q 12 h); alternatively, 10% ethanol/5% D/W IV with an initial loading dose of 10 mL/kg over 1 h, then 1–2 mL/kg/h to maintain a blood ethanol level of 100 mg/dL (22 mmol/L)

Hemodialysis (which is definitive treatment)

Aldrin

See Chlorinated and other halogenated hydrocarbons

See see Poisoning

Alkalis

See Acids and alkalis

See see Poisoning

Alphaprodine

See Opioids

See see Poisoning

Aminophylline

Caffeine

Theophylline

Wakefulness, restlessness, anorexia, vomiting, dehydration, seizures, tachycardia

In adults, greater toxicity after acute overdose added to chronic intake

Charcoal (for ingestion), discontinuation of drug, measurement of blood theophylline level, phenobarbital or diazepam for seizures, parenteral fluids, maintenance of BP

For serum level > 50–100 mg/L (> 278–555 μmol/L), acidosis, seizures, or coma, possibly dialysis

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

Amitriptyline

See Tricyclic antidepressants

See see Poisoning

Ammonia gas (anhydrous ammonia [NH 3 ])

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 O 2 to manage pulmonary edema, respiratory support

Ammonia water (ammonium hydroxide [NH 4 OH])

Ammoniated mercury (NH 2 HgCl)

See Mercury

See see Poisoning

Ammonium carbonate ([NH 4 ] 2 CO 3 )

Ammonium fluoride (NH 4 F)

See Fluorides

See see Poisoning

Amobarbital

See Barbiturates

See see Poisoning

Amphetamines

  • Amphetamine sulfate or phosphate

  • Dextroamphetamine

  • Methamphetamine

  • Phenmetrazine

Increased activity, exhilaration, talkativeness, insomnia, irritability, exaggerated reflexes, anorexia, diaphoresis, tachyarrhythmia, anginal chest pain, psychotic-like states, inability to concentrate or sit still, paranoia

Charcoal possibly effective long after ingestion because of recycling via enterohepatic circulation, benzodiazepines for sedation and seizures, reduction of external stimuli, external cooling, prevention of cerebral edema

For patients without asthma, β-blockers possibly helpful but rarely necessary

Amyl nitrite

See Nitrites

See see Poisoning

Aniline

See Acetanilide

See see Poisoning

Anticoagulants, direct thrombin inhibitors

  • Argatroban

  • Bivalirudin

  • Dabigatran etexilate

  • Desirudin

Bleeding secondary to thrombin inhibition

Supportive care (eg, whole blood transfusion, consideration of prothrombin complex concentrates or hemodialysis)

Anticoagulants, factor Xa inhibitors

  • Fondaparinux

  • Apixaban

  • Rivaroxaban

Bleeding secondary to factor Xa inhibition

For control of bleeding complications, supportive care (eg, whole blood transfusion) and/or prothrombin complex concentrate

Oral activated charcoal and supportive care

Anticoagulants, heparin and low mol wt heparins

  • Heparin (unfractionated)

  • Dalteparin

  • Enoxaparin

  • Tinzaparin

Bleeding secondary to decreased thrombin and fibrin clot formation

Supportive care (eg, whole blood transfusion)

Protamine sulfate (to reverse unfractionated heparin, but only partially neutralizes low mol wt heparins)

Anticoagulants, warfarins

  • Dicumarol

  • Superwarfarins

  • Warfarin

See Warfarin

See see Poisoning

Antidepressants

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

Seesee Poisoning, see Poisoning, see Poisoning, see Poisoning, see Poisoning, and see Poisoning

Antifreeze

See Alcohol, methyl and Ethylene glycol

See see Poisoningand see see Poisoning)

Antihistamines

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

For diagnostic or therapeutic trial or for treatment of severe symptoms refractory to sedation (C aution : Seizures—see Physostigmine )(C aution : Seizures— see Poisoning), consideration of physostigmine 0.5–2.0 mg in adults or 0.02 mg/kg in children IV (slowly)

Antihyperglycemic drugs, oral

See Hypoglycemic drugs, oral

See see Poisoning

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 who cannot take oral drugs, hydration, treatment of shock and pain

Antineoplastic drugs

  • Mercaptopurine

  • Methotrexate

  • Vincristine

  • > 50 others

Effects on hematopoiesis, nausea, vomiting, specific acute vs chronic effects depending on drug

Supportive care, leucovorin rescue, observation for postacute problems (> 24–48 h)

Antipsychotic drugs (conventional)

  • Chlorpromazine

  • Fluphenazine

  • Haloperidol

  • Loxapine

  • Mesoridazine

  • Molindone

  • Perphenazine

  • Pimozide

  • Prochlorperazine

  • Thioridazine

  • Thiothixene

  • Trifluoperazine

  • Triflupromazine

A wide range of effects (eg, sedation, seizures, excitement, coma, dystonia, hypotension, tachycardia, ventricular arrhythmias or torsades de pointes, anticholinergic effects, hyperthermia, agranulocytosis, or hypothermia)

For dystonia, diphenhydramine or benztropine

For hypotension refractory to fluids, norepinephrine

For ventricular arrhythmias, consideration of alkalinization

Antipsychotic drugs (2nd-generation)

  • Clozapine

  • Olanzapine

  • Quetiapine

  • Risperidone

  • Ziprasidone

CNS depression (particularly with olanzapine), miosis, anticholinergic effects, hypotension, dystonia, QT prolongation (occasionally), fatal bone marrow suppression (rare)

For dystonia, diphenhydramine or benztropine

For hypotension refractory to fluids, norepinephrine

For ventricular arrhythmias, consideration of alkalinization

Ant poison

See Arsenic (sodium arsenate) and Boric acid

See see Poisoning (sodium arsenate) and see Poisoning

Arsenic

  • Donovan solution

  • Fowler solution

  • Herbicides

  • Paris green

  • Pesticides

  • Selenium

  • Sodium arsenate

Same as for Antimony

See see Poisoning

Same as for Antimony

See see Poisoning

Arsine gas

Acute hemolytic anemia

Transfusions, diuresis

Artificial bitter almond oil

See Cyanides

See Cyanides

Asphalt

See Petroleum distillates

See see Poisoning

Aspirin

Atropine

See Belladonna

See see Poisoning

Automobile exhaust

See Carbon monoxide

See see Poisoning

Barbiturates

  • Amobarbital

  • Meprobamate

  • Pentobarbital

  • Phenobarbital

  • Secobarbital

Bradycardia, hypothermia, confusion, delirium, loss of corneal reflex, respiratory failure, drowsiness, ataxia, coma

Charcoal up to 24 h after ingestion, supportive care, forced alkaline diuresis for phenobarbital (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, cardiac arrest, dyspnea and cyanosis, ventricular fibrillation, severe hypokalemia, skeletal muscle weakness

KCl 10–15 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, O 2

Belladonna

  • Atropine

  • Hyoscyamine

  • Hyoscyamus

  • Scopolamine (hyoscine)

  • Stramonium

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

For diagnostic or therapeutic trial or for treatment of severe symptoms refractory to sedation, which is rarely needed (C aution : Seizures—see Physostigmine )(C aution : Seizures—see see Poisoning), consideration of physostigmine 0.5–2.0 mg in adults or 0.02 mg/kg in children IV (slowly)

Benzene

  • Benzol

  • Hydrocarbons

  • Model airplane glue

  • Toluene

  • Toluol

  • Xylene

Dizziness, weakness, headache, euphoria, nausea, vomiting, ventricular arrhythmia, paralysis, seizures

With chronic poisoning, aplastic anemia, hypokalemia, leukemia, CNS depression

Decontamination with water, avoidance of vomiting and aspiration, O 2 , respiratory support, ECG monitoring (ventricular fibrillation can occur early)

Diazepam to control seizures

For severe anemia, blood transfusions

Replacement of K as necessary

Epinephrine contraindicated

γ-Benzene hexachloride

Benzene hexachloride

Hexachlorocyclohexane

Lindane

Irritability, CNS excitation, muscle spasms, atonia, tonic-clonic seizures, respiratory failure, pulmonary edema, nausea, vomiting, obtundation, coma

Supportive care, activated charcoal after airway control

Diazepam to control seizures

Benzine (benzin)

See Petroleum distillates

See see Poisoning

Benzodiazepines

  • Alprazolam

  • Chlordiazepoxide

  • Diazepam

  • Flurazepam

Sedation to coma, particularly if drugs are accompanied by alcohol

Hypotension

Airway control

For hypotension, IV fluids and vasopressors

Avoidance of flumazenil (C aution : If tricyclic antidepressants are involved, flumazenil may precipitate seizures; in patients who depend on benzodiazepines, flumazenil may precipitate withdrawal. )

Benzol

See Benzene

See see Poisoning

Beta-blockers

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

Close monitoring and attention to airway maintenance

For symptomatic patients, consideration of dopamine, epinephrine, other vasopressors, glucagon 3–5 mg IV followed by infusion, CaCl 2 , IV insulin and glucose, cardiac pacing, intra-aortic balloon pump, and IV lipid emulsion

Bichloride of mercury

See Mercury

See see Poisoning

Bichromates

See Chromic acid

See see Poisoning

Bidrin (dicrotophos)

See Organophosphates

See see Poisoning

Bifenthrin

See Pyrethroids

See see Poisoning

Bishydroxycoumarin

See Warfarin

See see Poisoning

Bismuth compounds

Acute: Abdominal pain, oliguria, acute renal failure

Chronic: Poor absorption, ulcerative stomatitis, anorexia, progressive encephalopathy

Respiratory support, consideration of chelation with dimercaprol and succimer (see Guidelines for Chelation Therapy)

Bitter almond oil

See see Poisoning

See Cyanides

Bleach, chlorine

See Hypochlorites

See see Poisoning

β-Blockers

See Beta-blockers

See see Poisoning

Boric acid

Nausea, vomiting, diarrhea, hemorrhagic gastroenteritis, weakness, lethargy, CNS depression, seizures, “boiled lobster” rash, shock

Removal from skin, prevention or treatment of electrolyte abnormalities and shock, control of seizures

For severe poisoning (rare), dialysis

Brandy

See Alcohol, ethyl

See see Poisoning

Bromates

Vomiting, diarrhea, epigastric pain, acidosis, deafness

Supportive care, thiosulfate to reduce bromate to less toxic bromide

For renal failure, hemodialysis

Bromides

Nausea, vomiting, rash (may be acneiform), slurred speech, ataxia, confusion, psychotic behavior, coma, paralysis, negative anion gap

Discontinuation of drug, hydration and NaCl IV to promote diuresis, furosemide 10 mg IV q 6 h

For severe poisoning, hemodialysis

Bromine

Highly corrosive

With exposure to liquid or vapor, skin and mucous membrane burns

Aggressive decontamination, supportive care

Bupropion HCl

Respiratory depression, ataxia, seizures

Charcoal, benzodiazepines, supportive care

Butyl nitrate

See Nitrites

See see Poisoning

Cadmium

  • Cadmium oxide fumes (eg, from welding)

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

Inhalation: Pneumonitis with dyspnea and bilateral pulmonary infiltrates, hypoxia, death

Dilution with milk or albumin, respiratory support, hydration, possibly chelation with succimer or dimercaptopropane sulfonate

Dimercaprol contraindicated

For inhalation, O 2 , sometimes bronchodilators and corticosteroids

Caffeine

See Aminophylline

See see Poisoning

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 whole-bowel irrigation

Glucagon 5–10 mg IV

For hypotension or severe arrhythmias, consideration of CaCl 2 (eg, 1 g–10 mL of a 10% solution) or 3 times as much Ca gluconate IV with additional amounts as needed, pacemaker, or intra-aortic balloon pump

Consideration of regular insulin 10–100 units IV and 50–100 mL 50% dextrose plus 50–100 mL/h 10% dextrose IV infusion

Consideration of IV lipid emulsion

Calomel

See Mercury

See see Poisoning

Camphor

  • Camphorated oils

Camphor odor on breath, headache, confusion, delirium, hallucinations, seizures, coma

Diazepam to prevent and treat seizures, respiratory support

Canned fuel, solid

See Alcohol, methyl

See see Poisoning

Cantharides

  • Cantharidin

  • Spanish fly

Irritated skin and mucous membranes, skin vesicles, nausea, vomiting, bloody diarrhea, burning pain in back and urethra, respiratory depression, seizures, coma, abortion, menorrhagia

Avoidance of all oils, respiratory support, treatment of seizures, maintenance of fluid balance

No specific antidote

Carbamates

  • Aldicarb

  • Bendiocarb

  • Benomyl

  • Carbaryl

  • Carbofuran

  • Fenothiocarb

  • Methiocarb

  • Methomyl

  • Oxamyl

  • Propoxur

Slightly to highly toxic effects; similar to those of organophosphates except cholinesterase inhibition is not permanent

See Organophosphates

See see Poisoning

Carbamazepine

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

Supportive care after decontamination, heart rate monitoring

For arrhythmias, consideration of IV Na bicarbonate

Carbolic acid

See Phenols

See see Poisoning

Carbonates (ammonium, potassium, sodium)

Carbon bisulfide

See Carbon disulfide

See see Poisoning

Carbon dioxide

Dyspnea, weakness, tinnitus, palpitations, asphyxia

Respiratory support, O 2

Carbon disulfide

  • Carbon bisulfide

Garlic odor on breath, irritability, weakness, mania, narcosis, delirium, mydriasis, blindness, parkinsonism, seizures, coma, paralysis, respiratory failure

Washing of skin, O 2 , diazepam sedation, respiratory and circulatory support

Carbon monoxide

  • Acetylene gas

  • Automobile exhaust

  • Coal gas

  • Furnace gas

  • Illuminating gas

  • Marsh gas

Variable toxicity depending on length of exposure, concentration inhaled, and respiratory and circulatory rates

Various symptoms depending on % carboxyhemoglobin in blood

Headache, vertigo, vomiting, dyspnea, confusion, dilated pupils, seizures, coma

100% O 2 by mask, respiratory support if needed, immediate measurement of carboxyhemoglobin level; if carboxyhemoglobin is more than about 25%, consideration of hyperbaric O 2 in consultation with poison control center (see Carbon Monoxide Poisoning)

Carbon tetrachloride (sometimes used in chemical manufacturing)

  • Cleaning fluids (nonflammable)

Nausea, vomiting, abdominal pain, headache, confusion, visual disturbances, CNS depression, ventricular fibrillation, kidney injury, liver injury, cirrhosis

Washing of skin, O 2 , respiratory support, monitoring of kidney and liver function and appropriate treatment

Carbonyl iron

See Iron

See see Poisoning

Caustic soda (sodium hydroxide)

Chloral hydrate

Chloral amide

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

For ventricular arrhythmias, respiratory support, assessment of concomitant ingestions, β-blockers

Chlorates and nitrates

  • Herbicides

  • Manufacture of explosives and matches

Vomiting, nausea, diarrhea, cyanosis (methemoglobin), toxic nephritis, shock, seizures, CNS depression, coma, jaundice

Methylene blue for methemoglobinemia, 10% thiosulfate to reduce chlorate to the less toxic chloride, transfusion for severe cyanosis, ascorbic acid, treatment of shock, O 2

For complex cases, possibly dialysis

Chlordane

See Chlorinated and other halogenated hydrocarbons

See see Poisoning

Chlorethoxyfos

See Organophosphates

See see Poisoning

Chlorinated and other halogenated hydrocarbons

  • Aldrin

  • Benzene hexachloride

  • Chlordane

  • 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

Slightly toxic effects (eg, with methoxychlor) to highly toxic effects (eg, with dieldrin)

Vomiting (early or delayed), paresthesias, malaise, coarse tremors, seizures, pulmonary edema, ventricular fibrillation, respiratory failure

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 lime

See Chlorine

See see Poisoning

Chlorine (see also Hypochlorites)(see also see Poisoning)

  • Chlorinated lime

  • Chlorine water

  • Tear gas

Ingestion: Irritation, corrosion of mouth and GI tract, possible ulceration or perforation, abdominal pain, tachycardia, prostration, circulatory collapse

Inhalation: Severe respiratory and ocular irritation, glottal spasm, cough, choking, vomiting, pulmonary edema, cyanosis

Ingestion: Dilution with water or milk, treatment of shock

Inhalation: O 2 , respiratory support, observation for and treatment of pulmonary edema

Chloroaniline

See Acetanilide

See see Poisoning

Chloroform

  • Ether

  • Nitrous oxide

  • Trichloromethane

Drowsiness, coma

With nitrous oxide, delirium

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

Inhalation: Respiratory, cardiac, and circulatory support

Chlorothalonil

See Chlorinated and other halogenated hydrocarbons

See see Poisoning

Chlorothion

See Organophosphates

See see Poisoning

Chlorpromazine

See Phenothiazines

See see Poisoning

Chlorpyrifos

See Organophosphates

See see Poisoning

Chromates

See Chromic acid

See see Poisoning

Chromic acid

  • Bichromates

  • Chromates

  • Chromium trioxide

Corrosive effects due to oxidation, ulcerated and perforated nasal septum, severe gastroenteritis, shock, vertigo, coma, nephritis

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

Chromium

Irritation of skin and mucous membranes

Thorough washing with water and 10% ascorbic acid solution for 15 min

Chromium trioxide

See Chromic acid

See see Poisoning

Cimetidine

Ranitidine

Slight dryness and drowsiness, possible altered metabolism of concomitant drugs

No specific antidote available

Monitoring for effect on metabolism of other drugs being taken

Clonidine

Bradycardia, sedation, periodic apnea, hypotension, hypothermia

Supportive care; vasopressors; naloxone 5 mcg/kg up to 2–20 mg, repeated prn, to possibly reduce sedation

Coal gas

See Carbon monoxide

See see Poisoning

Cobalt

Tachycardia, tachypnea and hypoxia after inhalation, skin and mucous membrane irritation, glomerulonephritis, hypothyroidism (rare)

Supportive care, decontamination with water and soap

Cobaltous chloride

See Nitrogen oxides

See see Poisoning

Cocaine

Stimulation then depression, nausea, vomiting, loss of self-control, anxiety, hallucinations, sweating, hyperthermia, seizures, MI (rare)

Diazepam for excitation (primary treatment), O 2 , respiratory and circulatory support if needed, IV NaHCO 3

For arrhythmias, extremely cautious use of IV esmolol

Observation for myocardial or pulmonary disorder (usually before emergency department arrival)

For hyperthermia, external cooling

Codeine

See Opioids

See see Poisoning

Colchicine

Nausea, hemorrhagic gastritis, multiorgan failure, sepsis

Multiple-dose activated charcoal, IV fluids, supportive care, granulocyte colony-stimulating factor

Copper

See Copper salts

See see Poisoning

Copper salts

  • Cupric sulfate, acetate, or subacetate

  • Cuprous chloride or oxide

  • Zinc salts

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

Penicillamine or dimercaprol (see Guidelines for Chelation Therapy), electrolyte and fluid balance, respiratory support, monitoring of GI tract, treatment of shock, control of seizures, monitoring for liver and renal failure

Corrosive sublimate (mercuric chloride)

See Mercury

See see Poisoning

Coumaphos

See Organophosphates

See see Poisoning

Creosote, cresols

See Phenols

See see Poisoning

Cyanides

  • Bitter almond oil

  • Hydrocyanic acid

  • Nitroprusside

  • Potassium cyanide

  • Prussic acid

  • Sodium cyanide

  • Wild cherry syrup

Tachycardia, headache, drowsiness, hypotension, coma, rapid severe acidosis, seizures, death, possibly bitter almond odor on breath, bright red venous blood

Very rapidly lethal (in 1–15 min)

Speed essential

Inhalation: Removal from source

Inhalation or ingestion: 100% O 2 , respiratory support

Inhalation of amyl nitrite 0.2 mL (1 ampule) for 30 sec of each min; 3% Na nitrite 10 mL at 2.5–5 mL/min IV (in children, 10 mg/kg), then 25% Na thiosulfate 25–50 mL at 2.5–5 mL/min IV (Lilly cyanide kit); treatment repeated if symptoms recur

Hydroxocobalamin 5 g IV (becoming the preferred treatment)

Cyfluthrin

See Pyrethroids

See see Poisoning

Cypermethrin

See Pyrethroids

See see Poisoning

DDD (2-dichlorethane)

See Chlorinated and other halogenated hydrocarbons

See see Poisoning

DDT (chlorophenothane)

See Chlorinated and other halogenated hydrocarbons

See see Poisoning

Demeton

See Organophosphates

See see Poisoning

Deodorizers, household

See Naphthalene and Paradichlorobenzene

See see Poisoning and see Poisoning

Depilatories

See Barium compounds

See see Poisoning

Desipramine

See Tricyclic antidepressants

See see Poisoning

Detergent powders

Dextroamphetamine

See Amphetamines

See see Poisoning

Diazinon

See Organophosphates

See see Poisoning

Dichlorvos

See Organophosphates

See see Poisoning

Dicofol

See Chlorinated and other halogenated hydrocarbons

See see Poisoning

Dicumarol

See Warfarin

See see Poisoning

Dieldrin

See Chlorinated and other halogenated hydrocarbons

See see Poisoning

Dienochlor

See Chlorinated and other halogenated hydrocarbons

See see Poisoning

Diethylene glycol

See Ethylene glycol

See see Poisoning

Digitalis

Digitoxin

Digoxin

Dilan

See Chlorinated and other halogenated hydrocarbons

See see Poisoning

Dimethoate

See Organophosphates

See see Poisoning

Dinitrobenzene

See Nitrobenzene

See see Poisoning

Dinitro- o -cresol

  • Herbicides

  • Pesticides

Fatigue, thirst, flushing, nausea, vomiting, abdominal pain, hyperpyrexia, tachycardia, loss of consciousness, dyspnea, respiratory arrest, skin absorption

Fluid therapy, O 2 , anticipation of kidney and liver toxicity, no specific antidote, detergents to rinse skin

Diphenoxylate with atropine

Lethargy, nystagmus, pinpoint pupils, tachycardia, coma, respiratory depression (N ote : Toxicity may be delayed up to 12 h.)

Activated charcoal, naloxone, careful monitoring of all children for 12–18 h if ingestion is verified, supportive care

Diquat

See Paraquat

See see Poisoning

Dishwasher detergents

Disulfoton

See Organophosphates

See see Poisoning

Diuretics, mercurial

See Mercury

See see Poisoning

Donovan solution

See Arsenic

See see Poisoning

Doxepin

See Tricyclic antidepressants

See see Poisoning

Drain cleaners

Endosulfan

See Chlorinated and other halogenated hydrocarbons

See see Poisoning

Endrin

See Chlorinated and other halogenated hydrocarbons

See see Poisoning

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-acting barbiturate for seizures

For peripheral ischemia, heparin plus phentolamine 5–10 mg in 10 mL normal saline IV or intra-arterially or nitroprusside 1–2 mcg/kg/min IV

For coronary vasospasm, IV nitroglycerin and nifedipine

Eserine

See Physostigmine

See see Poisoning

Esfenvalerate

See Pyrethroids

See see Poisoning

Ethanol

See Alcohol, ethyl

See see Poisoning

Ether

See Chloroform

See see Poisoning

Ethion

See Organophosphates

See see Poisoning

Ethyl alcohol

See Alcohol, ethyl

See see Poisoning

Ethyl biscoumacetate

See Warfarin

See see Poisoning

Ethylene glycol

Diethylene glycol

  • Most automotive antifreeze

Ingestion: Inebriation but no alcohol odor on breath, nausea, vomiting

Later, carpopedal spasm, lumbar pain, oxalate crystalluria, oliguria progressing to anuria and acute renal failure, respiratory distress, seizures, coma

Eye contact: Iridocyclitis

Ingestion: Respiratory support, correction of electrolyte imbalance (anion gap), consideration of correcting acidemia, ethanol (see treatment of methyl alcohol) or fomepizole 15 mg/kg IV (loading dose) followed by 10 mg/kg IV q 12 h

Hemodialysis, which is definitive treatment

Eye contact: Flushing of eyes

Explosives

See Barium compounds (fireworks) and Nitrogen oxides

See see Poisoning (fireworks) and see Poisoning

Famphur

See Organophosphates

See see Poisoning

Fava bean (favism)

Fenthion

See Organophosphates

See see Poisoning

Ferric salts

See Iron

See see Poisoning

Ferrous salts (eg, gluconate, sulfate)

See Iron

See see Poisoning

Fireworks

See Barium compounds

See see Poisoning

Fluorides

  • Ammonium fluoride

  • Fluorine

  • Hydrofluoric acid

  • Rat poisons

  • Roach poisons

  • Sodium fluoride

  • Soluble fluorides generally

Ingestion: Salty or soapy taste

With large doses: Tremors, seizures, CNS depression, shock, renal failure

Skin and mucosal contact: Painful superficial or deep burns

Inhalation: Intense eye and nasal irritation, headache, dyspnea, sense of suffocation, glottal edema, pulmonary edema, bronchitis, pneumonia, mediastinal and subcutaneous emphysema due to bleb rupture

Ingestion: Dilution with milk or water, IV glucose and saline, 10% Ca gluconate 30 mL IV (in children, 0.6 mL/kg) or 10% CaCl 2 10 mL IV (in children, 0.1–0.2 mL/kg), monitoring for cardiac irritability, treatment of shock and dehydration

Skin and mucosal contact: Copious flushing with water, debridement of white tissue, sometimes injection of 10% Ca gluconate locally but may be given intra-arterially, application of Ca gluconate or Ca carbonate paste or gel

Inhalation: O 2 , respiratory support, prednisone for chemical pneumonitis (in adults, 15–40 mg po bid), management of pulmonary edema

Fluvalinate

See Pyrethroids

See see Poisoning

Formaldehyde

  • Formalin (may contain methyl alcohol)

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

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

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

Ingestion: Dilution with water or milk; treatment of shock, NaHCO 3 to correct acidosis, respiratory support, observation for perforations

Skin contact: Washing with copious soap and water

Inhalation: Flushing of eyes with saline, O 2 , respiratory support

Fowler solution

See Arsenic

See see Poisoning

Fuel, canned

See Alcohol, methyl

See see Poisoning

Fuel oil

See Petroleum distillates

See see Poisoning

Furnace gas

See Carbon monoxide

See see Poisoning

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 see Poisoning, see Poisoning (acetylene gas, automobile exhaust, coal gas, furnace gas, illuminating gas, marsh gas), see Poisoning (tear gas), see Poisoning (sewer gas, volatile hydrides), and see Poisoning (nerve gas)

Gasoline

See Petroleum distillates

See see Poisoning

Glues, model airplane

See Acetone, Benzene (toluene), and Petroleum distillates

See see Poisoning, see Poisoning (toluene), and see Poisoning

Glutethimide

Drowsiness, areflexia, mydriasis, hypotension, respiratory depression, coma

Activated charcoal, respiratory support, maintenance of fluid and electrolyte balance, hemodialysis possibly helpful, treatment of shock

Gold salts

Guaiacol

See Phenols

See see Poisoning

H 2 blockers (eg, cimetidine, ranitidine)

Minor GI problems, possibly altered levels of other drugs

Nonspecific supportive measures

Heptachlor

See Chlorinated and other halogenated hydrocarbons

See see Poisoning

Herbicides

See specific ingredient (eg, Arsenic, Dinitro- o -cresol, Chlorates and nitrates)

See specific ingredient (eg, see Poisoning, see Poisoning, see Poisoning)

Heroin

See Opioids

See see Poisoning

Hexachlorocyclohexane

See γ-Benzene hexachloride

See see Poisoning

Hexaethyltetraphosphate

See Organophosphates

See see Poisoning

Histamine-2 blockers

See H 2 blockers

See see Poisoning

Hydrides, volatile

See Hydrogen sulfide

See see Poisoning

Hydrocarbons

See Benzene

See see Poisoning

Hydrocarbons, chlorinated

See Chlorinated and other halogenated hydrocarbons

See see Poisoning

Hydrocarbons, halogenated

See Chlorinated and other halogenated hydrocarbons

See see Poisoning

Hydrochloric acid

Hydrocodone

See Opioids

See see Poisoning

Hydrocyanic acid

See Cyanides

See see Poisoning

Hydrofluoric acid

See Fluorides

See see Poisoning

Hydrogen chloride or fluoride

See Nitrogen oxides

See see Poisoning

Hydrogen sulfide

  • Alkali sulfides

  • Phosphine

  • Sewer or manure gas

  • Volatile hydrides

Gas eye (subacute keratoconjunctivitis), lacrimation and burning, cough, dyspnea, pulmonary edema, caustic skin burns, erythema, pain, profuse salivation, nausea, vomiting, diarrhea, confusion, vertigo, sudden collapse, unconsciousness

O 2 , respiratory support

Hyoscine (scopolamine)

Hyoscyamine

Hyoscyamus

See Belladonna

See see Poisoning

Hypochlorites

  • Bleach, chlorine

  • Javelle water

Usually mild pain and inflammation of oral and GI mucosa

Cough, dyspnea, vomiting, skin vesicles

If usual 6% household preparations have been ingested, dilution with milk (little else required); treatment of shock

If concentrated forms have been ingested, esophagoscopy

Hypoglycemic drugs, oral

  • Chlorpropamide

  • Glipizide

Hypoglycemia, diaphoresis, lethargy, confusion

Admission to the hospital, IV dextrose as needed, frequent feeding (not just sugar) plus careful observation of behavior and periodic measurement of blood glucose

For persistent hypoglycemia, consideration of octreotide 50–100 mcg IV or sc bid or tid

Illuminating gas

See Carbon monoxide

See see Poisoning

Imipramine

See Tricyclic antidepressants

See see Poisoning

Insecticides

See Chlorinated and other halogenated hydrocarbons, Organophosphates, Paradichlorobenzene, and Pyrethroids

See see Poisoning, see Poisoning, see Poisoning, and see Poisoning

Iodine

Burning pain in mouth and esophagus, brown-stained mucous membranes, laryngeal edema, vomiting, abdominal pain, diarrhea, shock, nephritis, circulatory collapse

Milk, starch, or flour po; early airway support; fluid and electrolytes; treatment of shock; early, aggressive airway management

Iodoform (triiodomethane)

Dermatitis, vomiting, cerebral depression, excitation, coma, respiratory difficulty

Ingestion: Dilution with milk or water, respiratory support

Skin contact: Washing with NaHCO 3 or alcohol

Iron

  • Carbonyl iron (see Carbon monoxide)(see see Poisoning)

  • Ferric salts

  • Ferrous salts

  • Ferrous gluconate

  • Ferrous sulfate

  • Vitamins with iron

(N ote : Children’s chewables with iron are remarkably safe.)

Vomiting, upper abdominal pain, pallor, cyanosis, diarrhea, drowsiness, shock; possible toxicity if > 20 mg/kg of elemental iron is ingested

For serum iron > 400–500 μg/dL (> 72–90 μmol/L) at 3–6 h plus GI symptoms, deferoxamine IV infusion starting at 15 mg/kg/h and titrated to BP

Isofenphos

See Organophosphates

See see Poisoning

Isoniazid

CNS stimulation, seizures, obtundation, coma

For seizures, pyridoxine given IV mg for mg ingested or, if amount ingested is unknown, 5 mg IV

For acidosis, NaHCO 3

Isopropyl alcohol

See Alcohol, isopropyl

See see Poisoning

Javelle water

See Hypochlorites

See see Poisoning

Kerosene

See Petroleum distillates

See see Poisoning

Ketones

See Acetone

See see Poisoning

Lambda-cyhalothrin

See Pyrethroids

See see Poisoning

Lead

  • Lead salts

  • Solder

  • Some paints and painted surfaces

Acute ingestion: Thirst, burning abdominal pain, vomiting, diarrhea; CNS symptoms (eg, irritability, inattentiveness, decreased level of consciousness, seizures)

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

Chronic exposure: Anemia, peripheral neuropathy, confusion, lead encephalopathy

Lead, tetraethyl

Vapor inhalation, skin absorption, or ingestion: CNS symptoms (eg, insomnia, restlessness, ataxia, delusions, mania, seizures)

Supportive care, diazepam to control seizures, fluid and electrolytes, elimination of source

Lime, chlorinated

See Chlorine

See see Poisoning

Lindane

See γ-Benzene hexachloride and Chlorinated and other halogenated hydrocarbons

See see Poisoning and see Poisoning

Liquor

See Alcohol, ethyl

See see Poisoning

Lithium salts

Nausea, vomiting, diarrhea, tremors, fasciculations, drowsiness, diabetes insipidus, ataxia, seizures, hypothyroidism

Acute: Hydration, diazepam, possibly dialysis for end-organ damage or serum lithium level > 4 mEq/L

Chronic: If symptoms are severe, dialysis

Lye (sodium hydroxide [NaOH])

Lysergic acid diethylamide (LSD)

Confusion, hallucinations, hyperexcitability, coma, flashbacks

Supportive care, benzodiazepines

For severe agitation, haloperidol 2–10 mg IV or IM in adults (repeated as necessary)

Malathion

See Organophosphates

See see Poisoning

Manganese

See Potassium permanganate

See see Poisoning

Marsh gas

See Carbon monoxide

See see Poisoning

Meperidine

See Opioids

See see Poisoning

Meprobamate

See Barbiturates

See see Poisoning

Mercury, compounds of

  • Ammoniated mercury

  • Bichloride of mercury

  • Calomel

  • Corrosive sublimate

  • Diuretics, mercurial

  • Mercuric chloride

  • Merthiolate

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

With alkyl and phenyl mercurials, skin burns

Chronic: Gingivitis, mental disturbance, neurologic deficits

Consideration of gastric lavage, activated charcoal, penicillamine (or succimer—see Guidelines for Chelation Therapy)

Maintenance of fluid and electrolyte balance, hemodialysis for renal failure, observation for GI perforation

Skin contact: Soap and water for scrubbing

Mercury, elemental

  • Liquid (skin contact, ingestion)

  • Vapor

Liquid: If ingested, no symptoms

If injected IV, pulmonary emboli

Mercury vapor: Severe pneumonitis

Liquid: If ingested, no treatment needed

If injected IV, supportive care

Mercury vapor: Supportive care

Merthiolate (thimerosal)

See Mercury—usually nontoxic

See see Poisoning—usually nontoxic

Metaldehyde

  • Slug bait

Nausea, vomiting, retching, abdominal pain, muscular rigidity, hyperventilation, seizures, coma

Supportive care, diazepam

Metals

See specific metals

Metformin

See Hypoglycemic drugs, oral

See see Poisoning

Methadone

See Opioids

See see Poisoning

Methamphetamine

See Amphetamines

See see Poisoning

Methanol

See Alcohol, methyl

See see Poisoning

Methidathion

See Organophosphates

See see Poisoning

Methotrexate

Nausea, vomiting, diarrhea, stomatitis, bone marrow suppression, thrombocytopenia, cirrhosis

IV fluids, urinary alkalinization, folinic acid (leucovorin rescue), glucarpidase to deactivate methotrexate

Methoxychlor

See Chlorinated and other halogenated hydrocarbons

See see Poisoning

Methyl alcohol

See Alcohol, methyl

See see Poisoning

Methyl parathion

See Organophosphates

See see Poisoning

Methyl salicylate

Mineral spirits

See Petroleum distillates

See see Poisoning

Mirtazapine

Usually benign

Most commonly, sedation, confusion, tachycardia

Observation for 8 h

Model airplane glues, solvents

See Acetone, Benzene, Petroleum distillates, and Toluene

See see Poisoning, see Poisoning, see Poisoning, and see Poisoning

Monoamine oxidase (MAO) inhibitors

  • Isocarboxazid

  • Phenelzine

  • Selegiline

  • Tranylcypromine

Nonspecific and highly variable symptoms, which are often delayed 6–24 h

Sympathomimetic toxidromes, headache, nausea, dystonia, hallucinations, nystagmus, fasciculations, diarrhea, seizures, agitation, muscle rigidity

Hypotension and bradycardia (which may be ominous)

Consideration of gastric decontamination, supportive care

Monosodium glutamate

Burning sensations throughout the body, facial pressure, anxiety, chest pain (Chinese restaurant syndrome)

Supportive care

Morphine

See Opioids

See see Poisoning

Moth balls, crystals, or repellent cakes

See Naphthalene, Camphor, and Paradichlorobenzene

See see Poisoning, see Poisoning, and see Poisoning

Mushrooms, poisonous

Nail polish remover

See Acetone

See see Poisoning

Naled

See Organophosphates

See see Poisoning

Naphtha

See Petroleum distillates

See see Poisoning

Naphthalene

  • Deodorizer cakes

  • Moth balls, crystals, or repellent cakes (see also Paradichlorobenzene)(see also see Poisoning)

Ingestion: Abdominal cramps, nausea, vomiting, headache, confusion, dysuria, intravascular hemolysis, seizures, hemolytic anemia in people with G6PD deficiency

Skin contact: Dermatitis, corneal ulceration

Inhalation: Headache, confusion, vomiting, dyspnea

Ingestion: Blood transfusion for severe hemolysis, urine alkalinization for hemoglobinuria, benzodiazepines to control seizures

Skin contact: Clothing removed if formerly stored with naphthalene moth balls, flushing of skin and eyes

Naphthols

See Phenols

See see Poisoning

Narcotics

See Opioids

See see Poisoning

Nefazodone

See Trazodone

See see Poisoning

Neostigmine

See Physostigmine

See see Poisoning

Nerve gas agents

See Organophosphates

See see Poisoning

Nickel

Hypersensitivity dermatitis

Chronic inhalation: Pulmonary inflammation

Removal from the source, irrigation with water

Nickel carbonyl

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

Pneumonitis, cyanosis, delirium, seizures (see also see Poisoning)

Removal from source, decontamination, consideration of Na diethyldithiocarbamate po (mild exposure) or IV (severe exposure) or disulfiram if Na diethyldithiocarbamate is unavailable

Nicotine

See Tobacco

See see Poisoning

Nitrates

See Chlorates and nitrates

See see Poisoning

Nitric acid

Nitrites

  • Amyl nitrite

  • Butyl nitrite

  • Nitroglycerin

  • Potassium nitrite

  • Sodium nitrite

Methemoglobinemia, cyanosis, anoxia, GI disturbance, vomiting, headache, dizziness, hypotension, respiratory failure, coma

O 2

For methemoglobinemia, 1% methylene blue 1–2 mg/kg IV slowly

Nitrobenzene

  • Artificial bitter almond oil

  • Dinitrobenzene

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

See Acetanilide

See see Poisoning

Nitrogen oxides (see also Chlorine, Fluorides, Hydrogen sulfide, Sulfur dioxide, and see Environmental Pulmonary Diseases)(see also see Poisoning, see Poisoning, see Poisoning, see Poisoning, and see Environmental 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

Delayed onset of symptoms with nitrogen oxides unless heavy concentration

Fatigue, cough, dyspnea, pulmonary edema

Later, bronchitis, pneumonia

Bed rest, O 2 as soon as symptoms develop

For excessive pulmonary edema, suction, postural drainage, mechanical ventilation, prednisone 30–80 mg/day in adults and dexamethasone 1 mg/m 2 BSA in children to possibly prevent pulmonary fibrosis

Nitroglycerin

See Nitrites

See see Poisoning

Nitroprusside

See Cyanides

See see Poisoning

Nitrous oxide

See Chloroform

See see Poisoning

NSAIDs

  • Ibuprofen

Nausea, vomiting, CNS toxicity (eg, seizures with massive overdoses)

Clinical observation, supportive care

Nortriptyline

See Tricyclic antidepressants

See see Poisoning

Octamethyl pyrophosphoramide

See Organophosphates

See see Poisoning

Oil of wintergreen

Oils

See Acetanilide (aniline oil) and Petroleum distillates (fuel oil, lubricating oils)

See see Poisoning (aniline oil) and see Poisoning (fuel oil, lubricating oils)

Opioids (see Opioids)

  • Alphaprodine

  • Codeine

  • Fentanyl

  • Heroin

  • Hydrocodone

  • Meperidine

  • Methadone

  • Morphine

  • Opium

  • Oxycodone

  • Propoxyphene

Pinpoint pupils, drowsiness, shallow respirations, spasticity, respiratory failure

Charcoal, respiratory support, naloxone IV as required to awaken patients and improve respiration, IV fluids to support circulation

Opium

See Opioids

See see Poisoning

Organophosphates

  • Acephate

  • Bidrin

  • Chlorethoxyfos

  • Chlorothion

  • Chlorpyrifos

  • Coumaphos

  • Demeton

  • Diazinon

  • Dichlorvos

  • Dimethoate

  • Disulfoton

  • Ethion

  • Famphur

  • Fenthion

  • Hexaethyltetraphosphate

  • Isofenphos

  • Leptophos

  • Malathion

  • Merphos

  • Methidathion

  • Methyl parathion

  • Mipafox

  • Naled

  • Nerve gas agents

  • Octamethyl pyrophosphoramide

  • Oxydemeton-methyl

  • Parathion

  • Phorate

  • Phosdrin

  • Phosmet

  • Pirimiphos-methyl

  • Temefos

  • Terbufos

  • Tetrachlorvinphos

  • Trichlorfon

  • Triorthocresyl phosphate

Absorption via skin, inhalation, or ingestion: Nausea, vomiting, abdominal cramping, excessive salivation, increased pulmonary secretion, headache, rhinorrhea, blurred vision, miosis, slurred speech, mental confusion, difficulty breathing, frothing at the mouth, coma

Removal of clothing, flushing and washing of skin

For increased secretions, atropine 2–5 mg in adults or 0.05 mg/kg in children IV or IM q 15–60 min, repeated and increased prn (massive amounts may be necessary) as often as q 3–5 min; pralidoxime chloride 1–2 g in adults or 20–40 mg/kg in children IV over 15–30 min, repeated in 1 h if needed; O 2 ; respiratory support; correction of dehydration

For attendants, avoidance of self-contamination

Oxalic acid

Oxalates

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

Milk or Ca lactate, 10% Ca gluconate 10–20 mL IV, pain control, saline IV for shock, observation for glottal edema and stricture

Oxycodone

See Opioids

See see Poisoning

Oxydemeton-methyl

See Organophosphates

see Poisoning

Paints

See Lead

See see Poisoning

Paint solvents

See Alcohol, methyl; Petroleum distillates (mineral spirits); and Turpentine

See see Poisoning, see Poisoning (mineral spirits), and see Poisoning

Paradichlorobenzene

  • Insecticides

  • Moth repellents

  • Pesticides

  • Toilet bowl deodorizers

Abdominal pain, nausea, vomiting, diarrhea, seizures, tetany (rare)

Fluid replacement, diazepam to control seizures

Paraldehyde

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

O 2 , respiratory support

Paraquat (a strong corrosive)

Diquat

Immediate: GI pain and vomiting

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

Activated charcoal, fuller’s earth, limited O 2 , consultation with poison control center or manufacturer

Parathion

See Organophosphates

see Poisoning

Paris green

See Arsenic

See see Poisoning

Pentobarbital

See Barbiturates

See see Poisoning

Perchlordecone

See Chlorinated and other halogenated hydrocarbons

See see Poisoning

Permanent wave neutralizers

See Bromates

See see Poisoning

Permethrin

See Pyrethroids

See see Poisoning

Pesticides

See specific compounds

Petroleum distillates (see Hydrocarbon Poisoning)

  • Asphalt

  • Benzine (benzin)

  • Fuel oil

  • Gasoline

  • Kerosene

  • Lubricating oils

  • Mineral spirits

  • Model airplane glue

  • Naphtha

  • Petroleum ether

  • Tar

Ingestion: Burning throat and stomach, vomiting, diarrhea, pneumonia only if aspiration has occurred

Vapor inhalation: Euphoria, burning 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

Because major problems result from aspiration and not GI absorption, gastric evacuation usually not warranted

Supportive care for pulmonary edema, O 2 , respiratory support

Phenacetin

See see Poisoning

See Acetanilide

Phencyclidine (PCP)

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

Quiet environment

Benzodiazepines if needed to provide sedation

Phenmetrazine

See Amphetamines

See see Poisoning

Phenobarbital

See Barbiturates

See see Poisoning

Phenols

  • Carbolic acid

  • Creosote

  • Cresols

  • Guaiacol

  • Naphthols

Corrosive effects, mucous membrane burns, pallor, weakness, shock, seizures in children, pulmonary edema, smoky urine, esophageal stricture (rare)

Respiratory, cardiac, and circulatory failure

Removal of clothing, washing of external burns with water, activated charcoal, pain relief, O 2 , respiratory support, correction of fluid imbalance, observation for esophageal stricture

Phenothiazines

  • Chlorpromazine

  • Prochlorperazine

  • Promazine

  • Trifluoperazine

Extrapyramidal symptoms (eg, ataxia, muscular and carpopedal spasms, torticollis), usually idiosyncratic

With overdose, dry mouth, drowsiness, seizures, coma, respiratory depression

Diphenhydramine 2–3 mg/kg IV or IM for extrapyramidal symptoms, diazepam to control seizures

Phenylpropanolamine

Nervousness, irritability, bradycardia, hypertension plus other sympathomimetic effects

Supportive care, diazepam

For hypertension, phentolamine 5 mg IV over about 1 min or nitroprusside IV

Phorate

See Organophosphates

see Poisoning

Phosdrin

See Organophosphates

see Poisoning

Phosmet

See Organophosphates

see Poisoning

Phosphine

See Hydrogen sulfide

See see Poisoning

Phosphodiesterase (PDE) 5 inhibitors

  • Avanafil

  • Sildenafil

  • Tadalafil

  • Vardenafil

Hypotension, tachycardia, chest pain, arrhythmias, vision loss, priapism

Supportive care, IV fluids and vasopressors, urologic consultation to treat priapism, avoidance of nitrates

Phosphoric acid

Phosphorus (yellow or white)

  • Rat poisons

  • Roach powders (N ote : Red phosphorus is unabsorbable and nontoxic.)

Stage 1: Garlicky taste, garlic odor on the breath, local irritation, skin and throat burns, nausea, vomiting, diarrhea, corrosion of mucous membranes

Stage 2: Symptom-free 8 h to several days

Stage 3: Nausea, vomiting, diarrhea, liver enlargement, jaundice, hemorrhages, kidney damage, seizures, coma

Toxicity enhanced by alcohol, fats, or digestible oils

Protection of patient and attendant from vomitus and feces

GI lavage with dilute K permanganate (1:5000) or hydrogen peroxide (eg, 1–2%), which may change phosphorus to nontoxic oxides

For phosphorus embedded in skin:

  • Submersion of the patient’s body in water

  • Irrigation with dilute K permanganate or cupric sulfate (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% NaHCO 3 plus 3% cupric sulfate plus 1% hydroxyethyl cellulose as a paste, which is applied to exposed skin and is thoroughly washed off after 30 min (prolonged contact with cupric sulfate may result in copper poisoning)

Physostigmine

  • Eserine

  • Neostigmine

  • Pilocarpine

  • Pilocarpus genus

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

Atropine sulfate 0.6–1 mg in adults or 0.01 mg/kg in children sc or IV, repeated prn

Benzodiazepine prn to provide sedation

Pilocarpine

See Physostigmine

See see Poisoning

Pilocarpus genus

See Physostigmine

See see Poisoning

Pirimiphos-methyl

See Organophosphates

see Poisoning

Potash (potassium hydroxide or potassium carbonate)

See Acids and alkalis

See see Poisoning

Potassium cyanide

See see Poisoning

See Cyanides

Potassium nitrite

See Nitrites

See see Poisoning

Potassium permanganate

Brown discoloration and burns of oral mucosa, glottal edema, hypotension, kidney involvement

Dilution with water or milk, consideration of early endoscopy, maintenance of fluid balance

Pregabalin

Agitation, sinus tachycardia, seizures, coma

Withdrawal syndrome similar to withdrawal symptoms after stopping gamma-hydroxybutyrate (GHB)

Supportive care, benzodiazepines for seizures and agitation

Prochlorperazine

See Phenothiazines

See see Poisoning

Prolan

See Chlorinated and other halogenated hydrocarbons

See see Poisoning

Promazine

See Phenothiazines

See see Poisoning

Propoxyphene

See Opioids

See see Poisoning

Protriptyline

See Tricyclic antidepressants

See see Poisoning

Prussic acid

See see Poisoning

See Cyanides

Pyrethrin

See Pyrethroids

See see Poisoning

Pyrethroids

  • Bifenthrin

  • Cyfluthrin

  • Cypermethrin

  • Esfenvalerate

  • Fluvalinate

  • Lambda-cyhalothrin

  • Permethrin

  • Pyrethrin

  • Resmethrin

  • Sumithrin

  • Tefluthrin

  • Tetramethrin

Allergic response (including anaphylactic reactions and skin sensitivity) in sensitive people; otherwise, low toxicity unless vehicle is a petroleum distillate

Thorough washing of skin, symptomatic and supportive care

Ranitidine

See Cimetidine

See see Poisoning

Rat poisons

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

See specific components (eg, see Poisoning, see Poisoning, see Poisoning, see Poisoning, see Poisoning)

Resmethrin

See Pyrethroids

See see Poisoning

Resorcinol (resorcin)

Vomiting, dizziness, tinnitus, chills, tremor, delirium, seizures, respiratory depression, coma, methemoglobinemia

Respiratory support, methylene blue for methemoglobinemia

Roach poisons

See Fluorides, Phosphorus, and Thallium salts

See see Poisoning, see Poisoning, and see Poisoning

Rubbing alcohol

See Alcohol, isopropyl

See see Poisoning

Salicylates

Salicylic acid

Scopolamine (hyoscine)

See Belladonna

See see Poisoning

Secobarbital

See Barbiturates

See see Poisoning

Selenium

See Arsenic and Thallium salts

See see Poisoning and see Poisoning

Sewer gas

See Hydrogen sulfide

See see Poisoning

Silver salts

Silver nitrate

Stained lips (white, brown, then black), gastroenteritis, shock, vertigo, seizures

Control of pain, diazepam to control seizures

Smog

See Sulfur dioxide

See see Poisoning

Soda, caustic (Na hydroxide)

Sodium carbonate

See Acids and alkalis

See see Poisoning

Sodium cyanide

See see Poisoning

See Cyanides

Sodium fluoride

See Fluorides

See see Poisoning

Sodium hydroxide

Sodium nitrite

See Nitrites

See see Poisoning

Sodium salicylate

Solder

See Cadmium and Lead

See see Poisoning and see Poisoning

SSRIs

  • Citalopram

  • Escitalopram

  • Fluoxetine

  • Fluvoxamine

  • Paroxetine

  • Sertraline

Commonly, sedation, vomiting, tremor, tachycardia

Possibly, seizures, hallucinations, hypotension, serotonin syndrome

Rarely, death

With citalopram, QRS prolongation possible

Airway protection, consideration of alkalinization for QRS widening, admission of patients who have symptoms > 6 h after ingestion

For severe symptoms, consideration of IV lipid emulsion

Stibophen

See Arsenic

See see Poisoning

Stramonium

See Belladonna

See see Poisoning

Strychnine

Restlessness; hyperacuity of hearing, vision, and tactile sensation

Violent myoclonus that simulates generalized seizures but with intact mental status, caused by minor stimuli; complete muscle relaxation between apparent seizures; perspiration; respiratory arrest

Isolation and restricted stimulation to prevent seizures, activated charcoal po, IV diazepam, respiratory support

For severe seizures, neuromuscular blockade and mechanical ventilatory support

Sulfur dioxide

  • Smog

Respiratory tract irritation, sneezing, cough, dyspnea, pulmonary edema

Removal from contaminated area, O 2 , positive pressure breathing, respiratory support

Sulfuric acid

Sumithrin

See Pyrethroids

See see Poisoning

Syrup of wild cherry

See see Poisoning

See Cyanides

Tar

See Petroleum distillates

See see Poisoning

Tartar emetic

See Arsenic

See see Poisoning

Tear gas

See Chlorine

See see Poisoning

Tefluthrin

See Pyrethroids

See see Poisoning

Temefos

See Organophosphates

see Poisoning

Terbufos

See Organophosphates

see Poisoning

Tetrachlorvinphos

See Organophosphates

see Poisoning

Tetraethyl lead

See Lead, tetraethyl

See see Poisoning

Tetramethrin

See Pyrethroids

See see Poisoning

Thallium salts (formerly used in ant, rat, and roach poisons)

Abdominal pain (colic), vomiting (may be bloody), diarrhea (may be bloody), stomatitis, excessive salivation, tremors, leg pains, paresthesias, polyneuritis, ocular and facial palsy, delirium, seizures, respiratory failure, loss of hair about 3 wk after poisoning

Treatment of shock, supportive care, diazepam to control seizures, activated charcoal (which effectively binds thallium and interrupts enterohepatic circulation), Prussian blue 60 mg/kg qid via NGT (same purpose as charcoal), chelation therapy with dimercaprol (used with varying success)

Avoidance of penicillamine and diethyldithiocarbamate (which may redistribute thallium into the CNS)

Consultation with poison control center for latest information advisable

Theophylline

See Aminophylline

See see Poisoning

Thyroxine

Usually asymptomatic

Rarely, increasing irritability progressing to thyroid storm in 5–7 days

Emesis, observation at home, diazepam, possibly antithyroid preparations and propranolol but only if symptoms occur

Tobacco

  • Nicotine

Excitement, confusion, muscular twitching, weakness, abdominal cramps, generalized myoclonus, CNS depression, rapid respirations, palpitations, cardiovascular collapse, coma, respiratory failure

Activated charcoal, respiratory support, O 2 , diazepam for seizures, thorough washing of skin if contaminated

Toilet bowl cleaners, deodorizers

see Caustic Ingestion and see Paradichlorobenzene

See see Poisoning

Toluene, toluol

See Benzene

See see Poisoning

Toxaphene

See Chlorinated and other halogenated hydrocarbons

See Poisoning

Trazodone

CNS depression, orthostatic hypotension, seizures, QRS prolongation (but torsades de pointes is rare), hypotension (rare)

Airway protection

For hypotension refractory to fluids, norepinephrine

Trichlorfon

See Organophosphates

see Poisoning

Trichloromethane

See Chloroform

See see Poisoning

Tricyclic antidepressants

  • Amitriptyline

  • Desipramine

  • Doxepin

  • Imipramine

  • Nortriptyline

  • Protriptyline

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

Symptomatic treatment and supportive care, charcoal, monitoring of vital signs and ECG, maintenance of airway

NaHCO 3 as a rapid IV injection (0.5–2 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

For severe poisoning, consideration of IV lipid emulsion

Trifluoperazine

See Phenothiazines

See see Poisoning

Triiodomethane

See Iodoform

See see Poisoning

Tungsten

Turpentine

  • Some paint solvents

  • Some varnishes

Turpentine odor, burning oral and abdominal pain, coughing, choking, respiratory failure, nephritis

Respiratory support, O 2 , control of pain, monitoring of kidney function

Valproate

Progressive CNS and respiratory depression

Respiratory and cardiovascular supportive measures, monitoring of liver function

Varnish

See Alcohol, methyl and Turpentine

See see Poisoning and see Poisoning

Venlafaxine

Possibly sedation, seizures, QRS prolongation, sympathomimetic symptoms (eg, tremor, mydriasis, tachycardia, hypertension, diaphoresis), hypotension

Rarely death

Observation for 6 h

For QRS prolongation, consideration of alkalinization

Vitamins with iron

See Iron

See see Poisoning

Warfarin (sometimes used in pesticides)

  • Bishydroxycoumarin

  • Dicumarol

  • Ethyl biscoumacetate

  • Superwarfarins (sometimes used in pesticides)

Single ingestion not serious

With multiple ingestions, coagulopathy with increased PT/INR

For single ingestion, observation

For hemorrhagic manifestations, vitamin K 1 (phytonadione—see Vitamin K Deficiency : Etiology) until INR is normal, transfusion with fresh frozen plasma if necessary

To achieve rapid reversal, prothrombin complex concentrate

Wild cherry syrup (natural, not artificially flavored)

See see Poisoning

See Cyanides

Wintergreen oil

Wood alcohol

See Alcohol, methyl

See see Poisoning

Xylene

See Benzene

See see Poisoning

Zinc

Zinc salts

See Copper salts

See see Poisoning

*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. Lists of substances containing the poison are examples and are not all-inclusive.

Physicians should be aware of people who smuggle plastic bags of cocaine in the GI tract (inserted 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).

Resources In This Article

Drugs Mentioned In This Article

  • Drug Name
    Select Trade
  • VORAXAZE
  • ELIQUIS
  • NAVANE
  • DOLOPHINE
  • CYANOKIT
  • No US brand name
  • DESOXYN
  • OXYCONTIN
  • No US brand names
  • LEVOPHED
  • CIALIS
  • STENDRA
  • XANAX
  • DIABINESE
  • LASIX
  • ZOLOFT
  • ADVIL, MOTRIN IB
  • ATROPEN
  • SEROQUEL
  • PROTOPAM CHLORIDE
  • DEXEDRINE
  • LANOXIN
  • MEPHYTON
  • PROZAC, SARAFEM
  • COMPRO
  • BAL
  • ANTIZOL
  • LOVENOX
  • IPRIVASK
  • OLEPTRO
  • NARDIL
  • ADASUVE
  • MARQIBO KIT
  • LEXAPRO
  • COMMIT, NICORETTE, NICOTROL
  • VIAGRA
  • EFFEXOR XR
  • SECONAL
  • PURINETHOL
  • LIBRIUM
  • AVENTYL
  • RISPERDAL
  • CARDIZEM, CARTIA XT, DILACOR XR
  • COGENTIN
  • HALDOL
  • DEMEROL
  • ORAP
  • LANIAZID
  • GEODON
  • DESFERAL
  • CALAN
  • ACETADOTE
  • TOFRANIL
  • VALIUM
  • ZYPREXA
  • TRANSDERM SCOP
  • ANTABUSE
  • PANHEPRIN
  • ISOPTO CARPINE, PILOPINE HS, SALAGEN
  • CHEMET
  • GLUCOTROL
  • COLCRYS
  • PARNATE
  • VIVACTIL
  • ADALAT CC, PROCARDIA
  • GLUCOPHAGE
  • ADRENALIN
  • KALBITOR
  • INDERAL
  • ELDEPRYL
  • ZONALON
  • CATAPRES
  • ARIXTRA
  • BLOXIVERZ
  • COUMADIN
  • LEVITRA
  • OZURDEX
  • CLOZARIL
  • No US trade name
  • MARPLAN
  • LYRICA
  • DURAMORPH PF, MS CONTIN
  • TAGAMET
  • TYLENOL
  • ACTIQ, DURAGESIC, SUBLIMAZE
  • ANGIOMAX
  • ELIMITE, NIX
  • PAXIL
  • OTREXUP
  • FRAGMIN
  • WELLBUTRIN, ZYBAN
  • LUVOX
  • NEMBUTAL SODIUM
  • CELEXA
  • CUPRIMINE
  • BREVIBLOC
  • NORPRAMIN
  • SANDOSTATIN
  • ELIXOPHYLLIN
  • XARELTO
  • REMERON
  • EVZIO
  • FIRAZYR
  • RAYOS
  • LITHOBID
  • NITROPRESS
  • NITRO-DUR
  • ZANTAC
  • TEGRETOL

* This is a professional Version *