Specific Poisons: Poisoning: Merck Manual Professional

Injuries; Poisoning

Specific Poisons

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Specific Poisons

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Symptoms and treatment of specific poisons vary (Table 8: Poisoning: 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.

Table 8

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Symptoms and Treatment of Specific Poisons
Poison*	Symptoms	Treatment
ACE inhibitors	Angioedema, hypotension	Charcoal, supportive care, a bradykinin inhibitor (ecallantide or icatibant) For angioedema, epinephrineSome Trade Names ADRENALIN PRIMATENE MIST Click for Drug Monograph , antihistamines, or corticosteroids unlikely to be effective For hypotension, consideration of naloxoneSome Trade Names NARCAN Click for Drug Monograph
Acephate	See Organophosphates	—
AcetaminophenSome Trade Names GENAPAP TYLENOL VALORIN Click for Drug Monograph	see Poisoning: Acetaminophen Poisoning	see Poisoning: Acetaminophen Poisoning
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: O₂, respiratory support, blood transfusion For severe cyanosis, methylene blueSome Trade Names UROLENE BLUE Click for Drug Monograph 1–2 mg/kg IV
Acetic acid	Low concentration: Mild mucosal irritation High concentration: see Poisoning: 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, O₂ and fluids, correction of metabolic acidosis
Acetonitrile Cosmetic nail adhesive	Converted to cyanide, with usual symptoms and signs	See Poisoning:
Acetophenetidin	See Acetanilide	—
Acetylsalicylic acid	see Poisoning: Aspirin and Other Salicylate Poisoning	—
Acids and alkalis	See specific acids and alkalis (eg, Boric acid, Fluorides) and see Poisoning: Caustic Ingestion Eye contact: see Eye Trauma Skin contact: see Burns	—
Airplane glues or cements (model-building)	See Acetone, Benzene (toluene), and Petroleum distillates	—
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 H₂ 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	FomepizoleSome Trade Names ANTIZOL Click for Drug Monograph (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	—
Alkalis	See Acids and alkalis	—
Alphaprodine	See Opioids	—
AminophyllineSome Trade Names No US trade name Click for Drug Monograph Caffeine TheophyllineSome Trade Names ELIXOPHYLLIN THEO-DUR Click for Drug Monograph	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 theophyllineSome Trade Names ELIXOPHYLLIN THEO-DUR Click for Drug Monograph level, phenobarbitalSome Trade Names LUMINAL Click for Drug Monograph or diazepamSome Trade Names VALIUM Click for Drug Monograph 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, esmololSome Trade Names BREVIBLOC Click for Drug Monograph )
AmitriptylineSome Trade Names ELAVIL ENDEP Click for Drug Monograph	See Tricyclic antidepressants	—
Ammonia gas (anhydrous ammonia [NH₃])	Irritation of eyes and respiratory tract, cough, choking, abdominal pain	Flushing of eyes for 15 min with tap water or saline If severe toxicity, positive pressure O₂ to manage pulmonary edema, respiratory support
Ammonia water (ammonium hydroxide [NH₄OH])	see Poisoning: Caustic Ingestion	—
Ammoniated mercury (NH₂HgCl)	See Mercury	—
Ammonium carbonate ([NH₄]₂CO₃)	see Poisoning: Caustic Ingestion	—
Ammonium fluoride (NH₄F)	See Fluorides	—
AmobarbitalSome Trade Names AMYTAL Click for Drug Monograph	See Barbiturates	—
Amphetamines Amphetamine sulfate or phosphate DextroamphetamineSome Trade Names DEXEDRINE DEXTROSTAT Click for Drug Monograph 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	—
Aniline	See Acetanilide	—
Anticoagulants, direct thrombin inhibitors ArgatrobanSome Trade Names No US trade name Click for Drug Monograph BivalirudinSome Trade Names ANGIOMAX Click for Drug Monograph 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 FondaparinuxSome Trade Names ARIXTRA Click for Drug Monograph 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, heparinSome Trade Names HEPFLUSH-10 Click for Drug Monograph and low mol wt heparins HeparinSome Trade Names HEPFLUSH-10 Click for Drug Monograph (unfractionated) DalteparinSome Trade Names FRAGMIN Click for Drug Monograph EnoxaparinSome Trade Names LOVENOX Click for Drug Monograph TinzaparinSome Trade Names INNOHEP Click for Drug Monograph	Bleeding secondary to decreased thrombin and fibrin clot formation	Supportive care (eg, whole blood transfusion) Protamine sulfateSome Trade Names No US trade name (to reverse unfractionated heparinSome Trade Names HEPFLUSH-10 Click for Drug Monograph , but only partially neutralizes low mol wt heparins)
Anticoagulants, warfarins Dicumarol Superwarfarins WarfarinSome Trade Names COUMADIN Click for Drug Monograph	See WarfarinSome Trade Names COUMADIN Click for Drug Monograph	—
Antidepressants	See BupropionSome Trade Names WELLBUTRIN ZYBAN Click for Drug Monograph , MirtazapineSome Trade Names REMERON Click for Drug Monograph , SSRIs, TrazodoneSome Trade Names DESYREL Click for Drug Monograph , Tricyclic antidepressants, and VenlafaxineSome Trade Names EFFEXOR Click for Drug Monograph	—
Antifreeze	See Alcohol, methyl and Ethylene glycol	—
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 (Caution: Seizures—see Physostigmine), consideration of physostigmineSome Trade Names No US trade name Click for Drug Monograph 0.5–2.0 mg in adults or 0.02 mg/kg in children IV (slowly)
Antihyperglycemic drugs, 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 penicillamineSome Trade Names CUPRIMINE Click for Drug Monograph , dimercaprolSome Trade Names BAL IN OIL Click for Drug Monograph for patients who cannot take oral drugs, hydration, treatment of shock and pain
Antineoplastic drugs MercaptopurineSome Trade Names PURINETHOL Click for Drug Monograph MethotrexateSome Trade Names RHEUMATREX Click for Drug Monograph VincristineSome Trade Names ONCOVIN Click for Drug Monograph > 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) ChlorpromazineSome Trade Names THORAZINE Click for Drug Monograph FluphenazineSome Trade Names PROLIXIN DECANOATE PROLIXIN Click for Drug Monograph HaloperidolSome Trade Names HALDOL Click for Drug Monograph LoxapineSome Trade Names LOXITANE Click for Drug Monograph MesoridazineSome Trade Names SERENTIL MolindoneSome Trade Names MOBAN PerphenazineSome Trade Names TRILAFON Click for Drug Monograph PimozideSome Trade Names ORAP Click for Drug Monograph ProchlorperazineSome Trade Names COMPAZINE Click for Drug Monograph ThioridazineSome Trade Names MELLARIL Click for Drug Monograph ThiothixeneSome Trade Names NAVANE Click for Drug Monograph TrifluoperazineSome Trade Names STELAZINE Click for Drug Monograph 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, diphenhydramineSome Trade Names BENADRYL NYTOL Click for Drug Monograph or benztropineSome Trade Names COGENTIN Click for Drug Monograph For hypotension refractory to fluids, norepinephrineSome Trade Names LEVOPHED Click for Drug Monograph For ventricular arrhythmias, consideration of alkalinization
Antipsychotic drugs (2nd-generation) ClozapineSome Trade Names CLOZARIL Click for Drug Monograph OlanzapineSome Trade Names ZYPREXA Click for Drug Monograph QuetiapineSome Trade Names SEROQUEL Click for Drug Monograph RisperidoneSome Trade Names RISPERDAL Click for Drug Monograph ZiprasidoneSome Trade Names GEODON Click for Drug Monograph	CNS depression (particularly with olanzapineSome Trade Names ZYPREXA Click for Drug Monograph ), miosis, anticholinergic effects, hypotension, dystonia, QT prolongation (occasionally), fatal bone marrow suppression (rare)	For dystonia, diphenhydramineSome Trade Names BENADRYL NYTOL Click for Drug Monograph or benztropineSome Trade Names COGENTIN Click for Drug Monograph For hypotension refractory to fluids, norepinephrineSome Trade Names LEVOPHED Click for Drug Monograph For ventricular arrhythmias, consideration of alkalinization
Ant poison	See Arsenic (sodium arsenate) and Boric acid	—
Arsenic Donovan solution Fowler solution Herbicides Paris green Pesticides SeleniumSome Trade Names SELSUN Click for Drug Monograph Sodium arsenate	Same as for Antimony	Same as for Antimony
Arsine gas	Acute hemolytic anemia	Transfusions, diuresis
Artificial bitter almond oil	See Cyanides	—
Asphalt	See Petroleum distillates	—
AspirinSome Trade Names BUFFERIN ECOTRIN GENACOTE Click for Drug Monograph	see Poisoning: Aspirin and Other Salicylate Poisoning	—
AtropineSome Trade Names ATROPEN ATROPINE-CARE SAL-TROPINE Click for Drug Monograph	See Belladonna	—
Automobile exhaust	See Carbon monoxide	—
Barbiturates AmobarbitalSome Trade Names AMYTAL Click for Drug Monograph MeprobamateSome Trade Names EQUANIL MILTOWN Click for Drug Monograph PentobarbitalSome Trade Names NEMBUTAL Click for Drug Monograph PhenobarbitalSome Trade Names LUMINAL Click for Drug Monograph SecobarbitalSome Trade Names SECONAL Click for Drug Monograph	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 phenobarbitalSome Trade Names LUMINAL Click for Drug Monograph (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 DiazepamSome Trade Names VALIUM Click for Drug Monograph to control seizures For dyspnea and cyanosis, O₂
Belladonna AtropineSome Trade Names ATROPEN ATROPINE-CARE SAL-TROPINE Click for Drug Monograph HyoscyamineSome Trade Names HYOSINE LEVSIN Click for Drug Monograph Hyoscyamus ScopolamineSome Trade Names TRANSDERM SCOP Click for Drug Monograph (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 (Caution: Seizures—see Physostigmine), consideration of physostigmineSome Trade Names No US trade name Click for Drug Monograph 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, O₂, respiratory support, ECG monitoring (ventricular fibrillation can occur early) DiazepamSome Trade Names VALIUM Click for Drug Monograph to control seizures For severe anemia, blood transfusions Replacement of K as necessary Epinephrine contraindicated
γ-Benzene hexachloride Benzene hexachloride Hexachlorocyclohexane LindaneSome Trade Names KWELL Click for Drug Monograph	Irritability, CNS excitation, muscle spasms, atonia, tonic-clonic seizures, respiratory failure, pulmonary edema, nausea, vomiting, obtundation, coma	Supportive care, activated charcoal after airway control DiazepamSome Trade Names VALIUM Click for Drug Monograph to control seizures
Benzine (benzin)	See Petroleum distillates	—
Benzodiazepines AlprazolamSome Trade Names XANAX Click for Drug Monograph ChlordiazepoxideSome Trade Names LIBRIUM Click for Drug Monograph DiazepamSome Trade Names VALIUM Click for Drug Monograph FlurazepamSome Trade Names DALMANE Click for Drug Monograph	Sedation to coma, particularly if drugs are accompanied by alcohol Hypotension	Airway control For hypotension, IV fluids and vasopressors Avoidance of flumazenilSome Trade Names ROMAZICON Click for Drug Monograph (Caution: If tricyclic antidepressants are involved, flumazenil may precipitate seizures; in patients who depend on benzodiazepines, flumazenil may precipitate withdrawal.)
Benzol	See Benzene	—
Beta-blockers	Hypotension, bradycardia, seizures, cardiac arrhythmias, hypoglycemia, altered mental status	Close monitoring and attention to airway maintenance For symptomatic patients, consideration of dopamineSome Trade Names INTROPIN Click for Drug Monograph , epinephrineSome Trade Names ADRENALIN PRIMATENE MIST Click for Drug Monograph , other vasopressors, glucagon 3–5 mg IV followed by infusion, CaCl₂, IV insulinSome Trade Names HUMULIN NOVOLIN Click for Drug Monograph and glucose, cardiac pacing, intra-aortic balloon pump, and IV lipid emulsion
Bichloride of mercury	See Mercury	—
Bichromates	See Chromic acid	—
Bidrin (dicrotophos)	See Organophosphates	—
Bifenthrin	See Pyrethroids	—
Bishydroxycoumarin	See WarfarinSome Trade Names COUMADIN Click for Drug Monograph	—
Bismuth compounds	Acute: Abdominal pain, oliguria, acute renal failure Chronic: Poor absorption, ulcerative stomatitis, anorexia, progressive encephalopathy	Respiratory support, consideration of chelation with dimercaprolSome Trade Names BAL IN OIL Click for Drug Monograph and succimerSome Trade Names CHEMET Click for Drug Monograph (see Table 4: Poisoning: Guidelines for Chelation Therapy)
Bitter almond oil	See Cyanides	—
Bleach, chlorine	See Hypochlorites	—
β-Blockers	See Beta-blockers	—
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	—
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, furosemideSome Trade Names LASIX Click for Drug Monograph 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
BupropionSome Trade Names WELLBUTRIN ZYBAN Click for Drug Monograph HCl	Respiratory depression, ataxia, seizures	Charcoal, benzodiazepines, supportive care
Butyl nitrate	See Nitrites	—
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 succimerSome Trade Names CHEMET Click for Drug Monograph or dimercaptopropane sulfonate Dimercaprol contraindicated For inhalation, O₂, sometimes bronchodilators and corticosteroids
Caffeine	See AminophyllineSome Trade Names No US trade name Click for Drug Monograph	—
Ca channel blockers DiltiazemSome Trade Names CARDIZEM CARTIA DILACOR Click for Drug Monograph NifedipineSome Trade Names ADALAT PROCARDIA Click for Drug Monograph VerapamilSome Trade Names CALAN ISOPTIN Click for Drug Monograph 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 CaCl₂ (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 insulinSome Trade Names HUMULIN NOVOLIN Click for Drug Monograph 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	—
Camphor Camphorated oils	Camphor odor on breath, headache, confusion, delirium, hallucinations, seizures, coma	DiazepamSome Trade Names VALIUM Click for Drug Monograph to prevent and treat seizures, respiratory support
Canned fuel, solid	See Alcohol, methyl	—
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
CarbamazepineSome Trade Names TEGRETOL Click for Drug Monograph	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	—
Carbonates (ammonium, potassium, sodium)	see Poisoning: Caustic Ingestion	—
Carbon bisulfide	See Carbon disulfide	—
Carbon dioxide	Dyspnea, weakness, tinnitus, palpitations, asphyxia	Respiratory support, O₂
Carbon disulfide Carbon bisulfide	Garlic odor on breath, irritability, weakness, mania, narcosis, delirium, mydriasis, blindness, parkinsonism, seizures, coma, paralysis, respiratory failure	Washing of skin, O₂, diazepamSome Trade Names VALIUM Click for Drug Monograph 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% O₂ by mask, respiratory support if needed, immediate measurement of carboxyhemoglobin level; if carboxyhemoglobin is more than about 25%, consideration of hyperbaric O₂ in consultation with poison control center (see Poisoning: 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, O₂, respiratory support, monitoring of kidney and liver function and appropriate treatment
Carbonyl iron	See Iron	—
Caustic soda (sodium hydroxide)	see Poisoning: Caustic Ingestion	—
Chloral hydrateSome Trade Names NOCTEC Click for Drug Monograph 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 blueSome Trade Names UROLENE BLUE Click for Drug Monograph for methemoglobinemia, 10% thiosulfate to reduce chlorate to the less toxic chloride, transfusion for severe cyanosis, ascorbic acid, treatment of shock, O₂ For complex cases, possibly dialysis
Chlordane	See Chlorinated and other halogenated hydrocarbons	—
Chlorethoxyfos	See Organophosphates	—
Chlorinated and other halogenated hydrocarbons Aldrin Benzene hexachloride Chlordane Chlorothalonil DDD (2-dichlorethane) DDT (chlorophenothane) Dicofol Dieldrin Dienochlor Dilan Endosulfan Endrin Heptachlor LindaneSome Trade Names KWELL Click for Drug Monograph 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	DiazepamSome Trade Names VALIUM Click for Drug Monograph or phenobarbitalSome Trade Names LUMINAL Click for Drug Monograph to prevent and control tremors and seizures, cautious use of epinephrineSome Trade Names ADRENALIN PRIMATENE MIST Click for Drug Monograph , avoidance of sudden stimuli, parenteral fluids For renal and liver failure, monitoring
Chlorinated lime	See Chlorine	—
Chlorine (see also Hypochlorites) 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: O₂, respiratory support, observation for and treatment of pulmonary edema
Chloroaniline	See Acetanilide	—
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	—
Chlorothion	See Organophosphates	—
ChlorpromazineSome Trade Names THORAZINE Click for Drug Monograph	See Phenothiazines	—
Chlorpyrifos	See Organophosphates	—
Chromates	See Chromic acid	—
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-acetylcysteineSome Trade Names MUCOMYST Click for Drug Monograph 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	—
CimetidineSome Trade Names TAGAMET Click for Drug Monograph RanitidineSome Trade Names ZANTAC Click for Drug Monograph	Slight dryness and drowsiness, possible altered metabolism of concomitant drugs	No specific antidote available Monitoring for effect on metabolism of other drugs being taken
ClonidineSome Trade Names CATAPRES Click for Drug Monograph	Bradycardia, sedation, periodic apnea, hypotension, hypothermia	Supportive care; vasopressors; naloxoneSome Trade Names NARCAN Click for Drug Monograph 5 mcg/kg up to 2–20 mg, repeated prn, to possibly reduce sedation
Coal gas	See Carbon monoxide	—
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	—
Cocaine^†	Stimulation then depression, nausea, vomiting, loss of self-control, anxiety, hallucinations, sweating, hyperthermia, seizures, MI (rare)	DiazepamSome Trade Names VALIUM Click for Drug Monograph for excitation (primary treatment), O₂, respiratory and circulatory support if needed, IV NaHCO₃ For arrhythmias, extremely cautious use of IV esmololSome Trade Names BREVIBLOC Click for Drug Monograph Observation for myocardial or pulmonary disorder (usually before emergency department arrival) For hyperthermia, external cooling
CodeineSome Trade Names No US trade name Click for Drug Monograph	See Opioids	—
ColchicineSome Trade Names No US trade name Click for Drug Monograph	Nausea, hemorrhagic gastritis, multiorgan failure, sepsis	Multiple-dose activated charcoal, IV fluids, supportive care, granulocyte colony-stimulating factor
Copper	See Copper salts	—
Copper salts Cupric sulfate, acetate, or subacetate Cuprous chloride or oxide Zinc salts	Vomiting, burning sensation, metallic taste, diarrhea, pain, shock, jaundice, anuria, seizures	PenicillamineSome Trade Names CUPRIMINE Click for Drug Monograph or dimercaprolSome Trade Names BAL IN OIL Click for Drug Monograph (see Table 4: Poisoning: 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	—
Coumaphos	See Organophosphates	—
Creosote, cresols	See Phenols	—
Cyanides Bitter almond oil Hydrocyanic acid NitroprussideSome Trade Names NIPRIDE Click for Drug Monograph 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% O₂, 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 HydroxocobalaminSome Trade Names CYANOKIT Click for Drug Monograph 5 g IV (becoming the preferred treatment)
Cyfluthrin	See Pyrethroids	—
Cypermethrin	See Pyrethroids	—
DDD (2-dichlorethane)	See Chlorinated and other halogenated hydrocarbons	—
DDT (chlorophenothane)	See Chlorinated and other halogenated hydrocarbons	—
Demeton	See Organophosphates	—
Deodorizers, household	See Naphthalene and Paradichlorobenzene	—
Depilatories	See Barium compounds	—
DesipramineSome Trade Names NORPRAMIN Click for Drug Monograph	See Tricyclic antidepressants	—
Detergent powders	see Poisoning: Caustic Ingestion	—
DextroamphetamineSome Trade Names DEXEDRINE DEXTROSTAT Click for Drug Monograph	See Amphetamines	—
Diazinon	See Organophosphates	—
Dichlorvos	See Organophosphates	—
Dicofol	See Chlorinated and other halogenated hydrocarbons	—
Dicumarol	See WarfarinSome Trade Names COUMADIN Click for Drug Monograph	—
Dieldrin	See Chlorinated and other halogenated hydrocarbons	—
Dienochlor	See Chlorinated and other halogenated hydrocarbons	—
Diethylene glycol	See Ethylene glycol	—
Digitalis DigitoxinSome Trade Names No US trade name DigoxinSome Trade Names DIGITEK LANOXIN Click for Drug Monograph	See discussion of digitalis preparations on see Heart Failure: Digitalis preparations	—
Dilan	See Chlorinated and other halogenated hydrocarbons	—
Dimethoate	See Organophosphates	—
Dinitrobenzene	See Nitrobenzene	—
Dinitro-o-cresol Herbicides Pesticides	Fatigue, thirst, flushing, nausea, vomiting, abdominal pain, hyperpyrexia, tachycardia, loss of consciousness, dyspnea, respiratory arrest, skin absorption	Fluid therapy, O₂, anticipation of kidney and liver toxicity, no specific antidote, detergents to rinse skin
Diphenoxylate with atropineSome Trade Names ATROPEN ATROPINE-CARE SAL-TROPINE Click for Drug Monograph	Lethargy, nystagmus, pinpoint pupils, tachycardia, coma, respiratory depression (Note: Toxicity may be delayed up to 12 h.)	Activated charcoal, naloxoneSome Trade Names NARCAN Click for Drug Monograph , careful monitoring of all children for 12–18 h if ingestion is verified, supportive care
Diquat	See Paraquat	—
Dishwasher detergents	see Poisoning: Caustic Ingestion	—
Disulfoton	See Organophosphates	—
Diuretics, mercurial	See Mercury	—
Donovan solution	See Arsenic	—
DoxepinSome Trade Names SINEQUAN ZONALON Click for Drug Monograph	See Tricyclic antidepressants	—
Drain cleaners	see Poisoning: Caustic Ingestion	—
Endosulfan	See Chlorinated and other halogenated hydrocarbons	—
Endrin	See Chlorinated and other halogenated hydrocarbons	—
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, heparinSome Trade Names HEPFLUSH-10 Click for Drug Monograph plus phentolamineSome Trade Names No US trade name Click for Drug Monograph 5–10 mg in 10 mL normal saline IV or intra-arterially or nitroprussideSome Trade Names NIPRIDE Click for Drug Monograph 1–2 mcg/kg/min IV For coronary vasospasm, IV nitroglycerinSome Trade Names NITRO-BID NITRO-DUR NITROL NITROQUICK Click for Drug Monograph and nifedipineSome Trade Names ADALAT PROCARDIA Click for Drug Monograph
Eserine	See PhysostigmineSome Trade Names No US trade name Click for Drug Monograph	—
Esfenvalerate	See Pyrethroids	—
Ethanol	See Alcohol, ethyl	—
Ether	See Chloroform	—
Ethion	See Organophosphates	—
Ethyl alcohol	See Alcohol, ethyl	—
Ethyl biscoumacetate	See WarfarinSome Trade Names COUMADIN Click for Drug Monograph	—
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 fomepizoleSome Trade Names ANTIZOL Click for Drug Monograph 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	—
Famphur	See Organophosphates	—
Fava bean (favism)	Symptoms of hemolysis (Table: Anemias Caused by Hemolysis: Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency)	—
Fenthion	See Organophosphates	—
Ferric salts	See Iron	—
Ferrous salts (eg, gluconate, sulfate)	See Iron	—
Fireworks	See Barium compounds	—
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% CaCl₂ 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: O₂, respiratory support, prednisoneSome Trade Names DELTASONE Click for Drug Monograph for chemical pneumonitis (in adults, 15–40 mg po bid), management of pulmonary edema
Fluvalinate	See Pyrethroids	—
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, NaHCO₃ to correct acidosis, respiratory support, observation for perforations Skin contact: Washing with copious soap and water Inhalation: Flushing of eyes with saline, O₂, respiratory support
Fowler solution	See Arsenic	—
Fuel, canned	See Alcohol, methyl	—
Fuel oil	See Petroleum distillates	—
Furnace gas	See Carbon monoxide	—
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)	—
Gasoline	See Petroleum distillates	—
Glues, model airplane	See Acetone, Benzene (toluene), and Petroleum distillates	—
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	—	See Table 4: Poisoning: Guidelines for Chelation Therapy
Guaiacol	See Phenols	—
H₂ blockers (eg, cimetidineSome Trade Names TAGAMET Click for Drug Monograph , ranitidineSome Trade Names ZANTAC Click for Drug Monograph )	Minor GI problems, possibly altered levels of other drugs	Nonspecific supportive measures
Heptachlor	See Chlorinated and other halogenated hydrocarbons	—
Herbicides	See specific ingredient (eg, Arsenic, Dinitro-o-cresol, Chlorates and nitrates)	—
Heroin	See Opioids	—
Hexachlorocyclohexane	See γ-Benzene hexachloride	—
Hexaethyltetraphosphate	See Organophosphates	—
Histamine-2 blockers	See H₂ blockers	—
Hydrides, volatile	See Hydrogen sulfide	—
Hydrocarbons	See Benzene	—
Hydrocarbons, chlorinated	See Chlorinated and other halogenated hydrocarbons	—
Hydrocarbons, halogenated	See Chlorinated and other halogenated hydrocarbons	—
Hydrochloric acid	see Poisoning: Caustic Ingestion	—
Hydrocodone	See Opioids	—
Hydrocyanic acid	See Cyanides	—
Hydrofluoric acid	See Fluorides	—
Hydrogen chloride or fluoride	See Nitrogen oxides	—
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	O₂, respiratory support
Hyoscine (scopolamineSome Trade Names TRANSDERM SCOP Click for Drug Monograph ) HyoscyamineSome Trade Names HYOSINE LEVSIN Click for Drug Monograph Hyoscyamus	See Belladonna	—
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 ChlorpropamideSome Trade Names DIABINESE Click for Drug Monograph GlipizideSome Trade Names GLUCOTROL Click for Drug Monograph	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 octreotideSome Trade Names SANDOSTATIN Click for Drug Monograph 50–100 mcg IV or sc bid or tid
Illuminating gas	See Carbon monoxide	—
ImipramineSome Trade Names TOFRANIL Click for Drug Monograph	See Tricyclic antidepressants	—
Insecticides	See Chlorinated and other halogenated hydrocarbons, Organophosphates, Paradichlorobenzene, and Pyrethroids	—
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 NaHCO₃ or alcohol
Iron Carbonyl iron (see Carbon monoxide) Ferric salts Ferrous salts Ferrous gluconateSome Trade Names FERGON Click for Drug Monograph Ferrous sulfateSome Trade Names FEOSOL FER-GEN-SOL FER-IN-SOL Click for Drug Monograph Vitamins with iron (Note: 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, deferoxamineSome Trade Names DESFERAL Click for Drug Monograph IV infusion starting at 15 mg/kg/h and titrated to BP
Isofenphos	See Organophosphates	—
IsoniazidSome Trade Names INH NYDRAZID Click for Drug Monograph	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, 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 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	see Poisoning: Lead Poisoning
Lead, tetraethyl	Vapor inhalation, skin absorption, or ingestion: CNS symptoms (eg, insomnia, restlessness, ataxia, delusions, mania, seizures)	Supportive care, diazepamSome Trade Names VALIUM Click for Drug Monograph to control seizures, fluid and electrolytes, elimination of source
Lime, chlorinated	See Chlorine	—
LindaneSome Trade Names KWELL Click for Drug Monograph	See γ-Benzene hexachloride and Chlorinated and other halogenated hydrocarbons	—
Liquor	See Alcohol, ethyl	—
LithiumSome Trade Names ESKALITH LITHOBID LITHONATE Click for Drug Monograph salts	Nausea, vomiting, diarrhea, tremors, fasciculations, drowsiness, diabetes insipidus, ataxia, seizures, hypothyroidism	Acute: Hydration, diazepamSome Trade Names VALIUM Click for Drug Monograph , possibly dialysis for end-organ damage or serum lithiumSome Trade Names ESKALITH LITHOBID LITHONATE Click for Drug Monograph level > 4 mEq/L Chronic: If symptoms are severe, dialysis
Lye (sodium hydroxide [NaOH])	see Poisoning: Caustic Ingestion	—
Lysergic acid diethylamide (LSD)	Confusion, hallucinations, hyperexcitability, coma, flashbacks	Supportive care, benzodiazepines For severe agitation, haloperidolSome Trade Names HALDOL Click for Drug Monograph 2–10 mg IV or IM in adults (repeated as necessary)
Malathion	See Organophosphates	—
Manganese	See Potassium permanganate	—
Marsh gas	See Carbon monoxide	—
MeperidineSome Trade Names DEMEROL Click for Drug Monograph	See Opioids	—
MeprobamateSome Trade Names EQUANIL MILTOWN Click for Drug Monograph	See Barbiturates	—
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, penicillamineSome Trade Names CUPRIMINE Click for Drug Monograph (or succimerSome Trade Names CHEMET Click for Drug Monograph —see Table 4: Poisoning: 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	—
Metaldehyde Slug bait	Nausea, vomiting, retching, abdominal pain, muscular rigidity, hyperventilation, seizures, coma	Supportive care, diazepamSome Trade Names VALIUM Click for Drug Monograph
Metals	See specific metals	See Table 4: Poisoning: Guidelines for Chelation Therapy
MetforminSome Trade Names GLUCOPHAGE Click for Drug Monograph	See Hypoglycemic drugs, oral	—
MethadoneSome Trade Names DOLOPHINE Click for Drug Monograph	See Opioids	—
Methamphetamine	See Amphetamines	—
Methanol	See Alcohol, methyl	—
Methidathion	See Organophosphates	—
MethotrexateSome Trade Names RHEUMATREX Click for Drug Monograph	Nausea, vomiting, diarrhea, stomatitis, bone marrow suppression, thrombocytopenia, cirrhosis	IV fluids, urinary alkalinization, folinic acid (leucovorin rescue), glucarpidase to deactivate methotrexateSome Trade Names RHEUMATREX Click for Drug Monograph
Methoxychlor	See Chlorinated and other halogenated hydrocarbons	—
Methyl alcohol	See Alcohol, methyl	—
Methyl parathion	See Organophosphates	—
Methyl salicylate	see Poisoning: Aspirin and Other Salicylate Poisoning	—
Mineral spirits	See Petroleum distillates	—
MirtazapineSome Trade Names REMERON Click for Drug Monograph	Usually benign Most commonly, sedation, confusion, tachycardia	Observation for ≥ 8 h
Model airplane glues, solvents	See Acetone, Benzene, Petroleum distillates, and Toluene	—
Monoamine oxidase (MAO) inhibitors IsocarboxazidSome Trade Names MARPLAN Click for Drug Monograph PhenelzineSome Trade Names NARDIL Click for Drug Monograph SelegilineSome Trade Names ELDEPRYL Click for Drug Monograph TranylcypromineSome Trade Names PARNATE Click for Drug Monograph	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
MorphineSome Trade Names DURAMORPH MS CONTIN MSIR ROXANOL Click for Drug Monograph	See Opioids	—
Moth balls, crystals, or repellent cakes	See Naphthalene, Camphor, and Paradichlorobenzene	—
Mushrooms, poisonous	see Poisoning: Mushroom Poisoning	—
Nail polish remover	See Acetone	—
Naled	See Organophosphates	—
Naphtha	See Petroleum distillates	—
Naphthalene Deodorizer cakes Moth balls, crystals, or repellent cakes (see also Paradichlorobenzene)	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	—
Narcotics	See Opioids	—
NefazodoneSome Trade Names SERZONE Click for Drug Monograph	See TrazodoneSome Trade Names DESYREL Click for Drug Monograph	—
NeostigmineSome Trade Names PROSTIGMIN Click for Drug Monograph	See PhysostigmineSome Trade Names No US trade name Click for Drug Monograph	—
Nerve gas agents	See Organophosphates	—
Nickel	Hypersensitivity dermatitis Chronic inhalation: Pulmonary inflammation	Removal from the source, irrigation with water
Nickel carbonyl	Pneumonitis, cyanosis, delirium, seizures (see also Nickel)	Removal from source, decontamination, consideration of Na diethyldithiocarbamate po (mild exposure) or IV (severe exposure) or disulfiramSome Trade Names ANTABUSE Click for Drug Monograph if Na diethyldithiocarbamate is unavailable
NicotineSome Trade Names COMMIT NICORETTE NICOTROL Click for Drug Monograph	See Tobacco	—
Nitrates	See Chlorates and nitrates	—
Nitric acid	see Poisoning: Caustic Ingestion	—
Nitrites Amyl nitrite Butyl nitrite NitroglycerinSome Trade Names NITRO-BID NITRO-DUR NITROL NITROQUICK Click for Drug Monograph Potassium nitrite Sodium nitrite	Methemoglobinemia, cyanosis, anoxia, GI disturbance, vomiting, headache, dizziness, hypotension, respiratory failure, coma	O₂ For methemoglobinemia, 1% methylene blueSome Trade Names UROLENE BLUE Click for Drug Monograph 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
Nitrogen oxides (see also Chlorine, Fluorides, Hydrogen sulfide, Sulfur dioxide, 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, O₂ as soon as symptoms develop For excessive pulmonary edema, suction, postural drainage, mechanical ventilation, prednisoneSome Trade Names DELTASONE Click for Drug Monograph 30–80 mg/day in adults and dexamethasoneSome Trade Names DECADRON DEXASONE HEXADROL Click for Drug Monograph 1 mg/m² BSA in children to possibly prevent pulmonary fibrosis
NitroglycerinSome Trade Names NITRO-BID NITRO-DUR NITROL NITROQUICK Click for Drug Monograph	See Nitrites	—
NitroprussideSome Trade Names NIPRIDE Click for Drug Monograph	See Cyanides	—
Nitrous oxide	See Chloroform	—
NSAIDs IbuprofenSome Trade Names ADVIL MOTRIN NUPRIN Click for Drug Monograph	Nausea, vomiting, CNS toxicity (eg, seizures with massive overdoses)	Clinical observation, supportive care
NortriptylineSome Trade Names AVENTYL Click for Drug Monograph	See Tricyclic antidepressants	—
Octamethyl pyrophosphoramide	See Organophosphates	—
Oil of wintergreen	see Poisoning: Aspirin and Other Salicylate Poisoning	—
Oils	See Acetanilide (aniline oil) and Petroleum distillates (fuel oil, lubricating oils)	—
Opioids (see Drug Use and Dependence: Opioids) Alphaprodine CodeineSome Trade Names No US trade name Click for Drug Monograph FentanylSome Trade Names ACTIQ DURAGESIC SUBLIMAZE Click for Drug Monograph Heroin Hydrocodone MeperidineSome Trade Names DEMEROL Click for Drug Monograph MethadoneSome Trade Names DOLOPHINE Click for Drug Monograph MorphineSome Trade Names DURAMORPH MS CONTIN MSIR ROXANOL Click for Drug Monograph Opium OxycodoneSome Trade Names OXYCONTIN OXYIR Click for Drug Monograph PropoxypheneSome Trade Names DARVON DOLENE	Pinpoint pupils, drowsiness, shallow respirations, spasticity, respiratory failure	Charcoal, respiratory support, naloxoneSome Trade Names NARCAN Click for Drug Monograph IV as required to awaken patients and improve respiration, IV fluids to support circulation
Opium	See Opioids	—
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, atropineSome Trade Names ATROPEN ATROPINE-CARE SAL-TROPINE Click for Drug Monograph 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; pralidoximeSome Trade Names PROTOPAM Click for Drug Monograph chloride 1–2 g in adults or 20–40 mg/kg in children IV over 15–30 min, repeated in 1 h if needed; O₂; 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
OxycodoneSome Trade Names OXYCONTIN OXYIR Click for Drug Monograph	See Opioids	—
Oxydemeton-methyl	See Organophosphates	—
Paints	See Lead	—
Paint solvents	See Alcohol, methyl; Petroleum distillates (mineral spirits); and Turpentine	—
Paradichlorobenzene Insecticides Moth repellents Pesticides Toilet bowl deodorizers	Abdominal pain, nausea, vomiting, diarrhea, seizures, tetany (rare)	Fluid replacement, diazepamSome Trade Names VALIUM Click for Drug Monograph to control seizures
Paraldehyde	Acetic acid odor on breath, incoherence, miosis, depressed respiration, coma	O₂, 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 O₂, consultation with poison control center or manufacturer
Parathion	See Organophosphates	—
Paris green	See Arsenic	—
PentobarbitalSome Trade Names NEMBUTAL Click for Drug Monograph	See Barbiturates	—
Perchlordecone	See Chlorinated and other halogenated hydrocarbons	—
Permanent wave neutralizers	See Bromates	—
PermethrinSome Trade Names ELIMITE NIX RID SPRAY Click for Drug Monograph	See Pyrethroids	—
Pesticides	See specific compounds	—
Petroleum distillates (see Poisoning: 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, O₂, respiratory support
Phenacetin	See Acetanilide	—
PhencyclidineSome Trade Names No US trade name (PCP)	Inattentiveness with eyes open, agitation, violent behavior, unconsciousness, tachycardia, hypertension	Quiet environment Benzodiazepines if needed to provide sedation
Phenmetrazine	See Amphetamines	—
PhenobarbitalSome Trade Names LUMINAL Click for Drug Monograph	See Barbiturates	—
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, O₂, respiratory support, correction of fluid imbalance, observation for esophageal stricture
Phenothiazines ChlorpromazineSome Trade Names THORAZINE Click for Drug Monograph ProchlorperazineSome Trade Names COMPAZINE Click for Drug Monograph Promazine TrifluoperazineSome Trade Names STELAZINE Click for Drug Monograph	Extrapyramidal symptoms (eg, ataxia, muscular and carpopedal spasms, torticollis), usually idiosyncratic With overdose, dry mouth, drowsiness, seizures, coma, respiratory depression	DiphenhydramineSome Trade Names BENADRYL NYTOL Click for Drug Monograph 2–3 mg/kg IV or IM for extrapyramidal symptoms, diazepamSome Trade Names VALIUM Click for Drug Monograph to control seizures
Phenylpropanolamine	Nervousness, irritability, bradycardia, hypertension plus other sympathomimetic effects	Supportive care, diazepamSome Trade Names VALIUM Click for Drug Monograph For hypertension, phentolamineSome Trade Names No US trade name Click for Drug Monograph 5 mg IV over about 1 min or nitroprussideSome Trade Names NIPRIDE Click for Drug Monograph IV
Phorate	See Organophosphates	—
Phosdrin	See Organophosphates	—
Phosmet	See Organophosphates	—
Phosphine	See Hydrogen sulfide	—
Phosphodiesterase (PDE) 5 inhibitors Avanafil SildenafilSome Trade Names VIAGRA Click for Drug Monograph TadalafilSome Trade Names CIALIS Click for Drug Monograph VardenafilSome Trade Names LEVITRA Click for Drug Monograph	Hypotension, tachycardia, chest pain, arrhythmias, vision loss, priapism	Supportive care, IV fluids and vasopressors, urologic consultation to treat priapism, avoidance of nitrates
Phosphoric acid	see Poisoning: Caustic Ingestion	—
Phosphorus (yellow or white) Rat poisons Roach powders (Note: 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% NaHCO₃ 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)
PhysostigmineSome Trade Names No US trade name Click for Drug Monograph Eserine NeostigmineSome Trade Names PROSTIGMIN Click for Drug Monograph PilocarpineSome Trade Names ISOPTO CARPINE PILOPINE HS SALAGEN Click for Drug Monograph Pilocarpus genus	Dizziness, weakness, vomiting, cramping pain, bradycardia, possibly seizures, agitation	AtropineSome Trade Names ATROPEN ATROPINE-CARE SAL-TROPINE Click for Drug Monograph sulfate 0.6–1 mg in adults or 0.01 mg/kg in children sc or IV, repeated prn Benzodiazepine prn to provide sedation
PilocarpineSome Trade Names ISOPTO CARPINE PILOPINE HS SALAGEN Click for Drug Monograph	See PhysostigmineSome Trade Names No US trade name Click for Drug Monograph	—
Pilocarpus genus	See PhysostigmineSome Trade Names No US trade name Click for Drug Monograph	—
Pirimiphos-methyl	See Organophosphates	—
Potash (potassium hydroxide or potassium carbonate)	See Acids and alkalis	—
Potassium cyanide	See Cyanides	—
Potassium nitrite	See Nitrites	—
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
ProchlorperazineSome Trade Names COMPAZINE Click for Drug Monograph	See Phenothiazines	—
Prolan	See Chlorinated and other halogenated hydrocarbons	—
Promazine	See Phenothiazines	—
PropoxypheneSome Trade Names DARVON DOLENE	See Opioids	—
ProtriptylineSome Trade Names VIVACTIL Click for Drug Monograph	See Tricyclic antidepressants	—
Prussic acid	See Cyanides	—
Pyrethrin	See Pyrethroids	—
Pyrethroids Bifenthrin Cyfluthrin Cypermethrin Esfenvalerate Fluvalinate Lambda-cyhalothrin PermethrinSome Trade Names ELIMITE NIX RID SPRAY Click for Drug Monograph 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
RanitidineSome Trade Names ZANTAC Click for Drug Monograph	See CimetidineSome Trade Names TAGAMET Click for Drug Monograph	—
Rat poisons	See specific components(eg, Barium compounds, Fluorides, Phosphorus, Thallium salts, WarfarinSome Trade Names COUMADIN Click for Drug Monograph )	—
Resmethrin	See Pyrethroids	—
Resorcinol (resorcin)	Vomiting, dizziness, tinnitus, chills, tremor, delirium, seizures, respiratory depression, coma, methemoglobinemia	Respiratory support, methylene blueSome Trade Names UROLENE BLUE Click for Drug Monograph for methemoglobinemia
Roach poisons	See Fluorides, Phosphorus, and Thallium salts	—
Rubbing alcohol	See Alcohol, isopropyl	—
Salicylates	see Poisoning: Aspirin and Other Salicylate Poisoning	—
Salicylic acidSome Trade Names MEDIPLAST PROPA PH STRI-DEX Click for Drug Monograph	see Poisoning: Aspirin and Other Salicylate Poisoning	—
ScopolamineSome Trade Names TRANSDERM SCOP Click for Drug Monograph (hyoscine)	See Belladonna	—
SecobarbitalSome Trade Names SECONAL Click for Drug Monograph	See Barbiturates	—
SeleniumSome Trade Names SELSUN Click for Drug Monograph	See Arsenic and Thallium salts	—
Sewer gas	See Hydrogen sulfide	—
Silver salts Silver nitrate	Stained lips (white, brown, then black), gastroenteritis, shock, vertigo, seizures	Control of pain, diazepamSome Trade Names VALIUM Click for Drug Monograph to control seizures
Smog	See Sulfur dioxide	—
Soda, caustic (Na hydroxide)	see Poisoning: Caustic Ingestion	—
Sodium carbonate	See Acids and alkalis	—
Sodium cyanide	See Cyanides	—
Sodium fluoride	See Fluorides	—
Sodium hydroxide	see Poisoning: Caustic Ingestion	—
Sodium nitrite	See Nitrites	—
Sodium salicylate	see Poisoning: Aspirin and Other Salicylate Poisoning	—
Solder	See Cadmium and Lead	—
SSRIs CitalopramSome Trade Names CELEXA Click for Drug Monograph EscitalopramSome Trade Names LEXAPRO Click for Drug Monograph FluoxetineSome Trade Names PROZAC SARAFEM Click for Drug Monograph FluvoxamineSome Trade Names LUVOX Click for Drug Monograph ParoxetineSome Trade Names PAXIL Click for Drug Monograph SertralineSome Trade Names ZOLOFT Click for Drug Monograph	Commonly, sedation, vomiting, tremor, tachycardia Possibly, seizures, hallucinations, hypotension, serotonin syndrome Rarely, death With citalopramSome Trade Names CELEXA Click for Drug Monograph , 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	—
Stramonium	See Belladonna	—
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 diazepamSome Trade Names VALIUM Click for Drug Monograph , 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, O₂, positive pressure breathing, respiratory support
Sulfuric acid	see Poisoning: Caustic Ingestion	—
Sumithrin	See Pyrethroids	—
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 (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, diazepamSome Trade Names VALIUM Click for Drug Monograph 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 dimercaprolSome Trade Names BAL IN OIL Click for Drug Monograph (used with varying success) Avoidance of penicillamineSome Trade Names CUPRIMINE Click for Drug Monograph and diethyldithiocarbamate (which may redistribute thallium into the CNS) Consultation with poison control center for latest information advisable
TheophyllineSome Trade Names ELIXOPHYLLIN THEO-DUR Click for Drug Monograph	See AminophyllineSome Trade Names No US trade name Click for Drug Monograph	—
Thyroxine	Usually asymptomatic Rarely, increasing irritability progressing to thyroid storm in 5–7 days	Emesis, observation at home, diazepamSome Trade Names VALIUM Click for Drug Monograph , possibly antithyroid preparations and propranololSome Trade Names INDERAL Click for Drug Monograph but only if symptoms occur
Tobacco NicotineSome Trade Names COMMIT NICORETTE NICOTROL Click for Drug Monograph	Excitement, confusion, muscular twitching, weakness, abdominal cramps, generalized myoclonus, CNS depression, rapid respirations, palpitations, cardiovascular collapse, coma, respiratory failure	Activated charcoal, respiratory support, O₂, diazepamSome Trade Names VALIUM Click for Drug Monograph for seizures, thorough washing of skin if contaminated
Toilet bowl cleaners, deodorizers	see Poisoning: Caustic Ingestion and see Paradichlorobenzene	—
Toluene, toluol	See Benzene	—
Toxaphene	See Chlorinated and other halogenated hydrocarbons See Poisoning:	—
TrazodoneSome Trade Names DESYREL Click for Drug Monograph	CNS depression, orthostatic hypotension, seizures, QRS prolongation (but torsades de pointes is rare), hypotension (rare)	Airway protection For hypotension refractory to fluids, norepinephrineSome Trade Names LEVOPHED Click for Drug Monograph
Trichlorfon	See Organophosphates	—
Trichloromethane	See Chloroform	—
Tricyclic antidepressants AmitriptylineSome Trade Names ELAVIL ENDEP Click for Drug Monograph DesipramineSome Trade Names NORPRAMIN Click for Drug Monograph DoxepinSome Trade Names SINEQUAN ZONALON Click for Drug Monograph ImipramineSome Trade Names TOFRANIL Click for Drug Monograph NortriptylineSome Trade Names AVENTYL Click for Drug Monograph ProtriptylineSome Trade Names VIVACTIL Click for Drug Monograph	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 NaHCO₃ 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) DiazepamSome Trade Names VALIUM Click for Drug Monograph to control seizures Vasopressors (eg, norepinephrineSome Trade Names LEVOPHED Click for Drug Monograph ) to maintain BP For severe poisoning, consideration of IV lipid emulsion
TrifluoperazineSome Trade Names STELAZINE Click for Drug Monograph	See Phenothiazines	—
Triiodomethane	See Iodoform	—
Tungsten	See Interstitial Lung Diseases: Overview of Interstitial Lung Disease	—
Turpentine Some paint solvents Some varnishes	Turpentine odor, burning oral and abdominal pain, coughing, choking, respiratory failure, nephritis	Respiratory support, O₂, control of pain, monitoring of kidney function
ValproateSome Trade Names DEPAKENE Click for Drug Monograph	Progressive CNS and respiratory depression	Respiratory and cardiovascular supportive measures, monitoring of liver function
Varnish	See Alcohol, methyl and Turpentine	—
VenlafaxineSome Trade Names EFFEXOR Click for Drug Monograph	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	—
WarfarinSome Trade Names COUMADIN Click for Drug Monograph (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 K₁ (phytonadioneSome Trade Names MEPHYTON Click for Drug Monograph —see Vitamin Deficiency, Dependency, and Toxicity: 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 Cyanides	—
Wintergreen oil	see Poisoning: Aspirin and Other Salicylate Poisoning	—
Wood alcohol	See Alcohol, methyl	—
Xylene	See Benzene	—
Zinc	—	See Table 4: Poisoning: Guidelines for Chelation Therapy
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 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).

Symptoms and Treatment of Specific Poisons

Poison*

Symptoms

Treatment

ACE inhibitors	Angioedema, hypotension	Charcoal, supportive care, a bradykinin inhibitor (ecallantide or icatibant) For angioedema, epinephrineSome Trade Names ADRENALIN PRIMATENE MIST Click for Drug Monograph , antihistamines, or corticosteroids unlikely to be effective For hypotension, consideration of naloxoneSome Trade Names NARCAN Click for Drug Monograph
Acephate	See Organophosphates	—
AcetaminophenSome Trade Names GENAPAP TYLENOL VALORIN Click for Drug Monograph	see Poisoning: Acetaminophen Poisoning	see Poisoning: Acetaminophen Poisoning
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: O₂, respiratory support, blood transfusion For severe cyanosis, methylene blueSome Trade Names UROLENE BLUE Click for Drug Monograph 1–2 mg/kg IV
Acetic acid	Low concentration: Mild mucosal irritation High concentration: see Poisoning: 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, O₂ and fluids, correction of metabolic acidosis
Acetonitrile Cosmetic nail adhesive	Converted to cyanide, with usual symptoms and signs	See Poisoning:
Acetophenetidin	See Acetanilide	—
Acetylsalicylic acid	see Poisoning: Aspirin and Other Salicylate Poisoning	—
Acids and alkalis	See specific acids and alkalis (eg, Boric acid, Fluorides) and see Poisoning: Caustic Ingestion Eye contact: see Eye Trauma Skin contact: see Burns	—
Airplane glues or cements (model-building)	See Acetone, Benzene (toluene), and Petroleum distillates	—
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 H₂ 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	FomepizoleSome Trade Names ANTIZOL Click for Drug Monograph (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	—
Alkalis	See Acids and alkalis	—
Alphaprodine	See Opioids	—
AminophyllineSome Trade Names No US trade name Click for Drug Monograph Caffeine TheophyllineSome Trade Names ELIXOPHYLLIN THEO-DUR Click for Drug Monograph	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 theophyllineSome Trade Names ELIXOPHYLLIN THEO-DUR Click for Drug Monograph level, phenobarbitalSome Trade Names LUMINAL Click for Drug Monograph or diazepamSome Trade Names VALIUM Click for Drug Monograph 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, esmololSome Trade Names BREVIBLOC Click for Drug Monograph )
AmitriptylineSome Trade Names ELAVIL ENDEP Click for Drug Monograph	See Tricyclic antidepressants	—
Ammonia gas (anhydrous ammonia [NH₃])	Irritation of eyes and respiratory tract, cough, choking, abdominal pain	Flushing of eyes for 15 min with tap water or saline If severe toxicity, positive pressure O₂ to manage pulmonary edema, respiratory support
Ammonia water (ammonium hydroxide [NH₄OH])	see Poisoning: Caustic Ingestion	—
Ammoniated mercury (NH₂HgCl)	See Mercury	—
Ammonium carbonate ([NH₄]₂CO₃)	see Poisoning: Caustic Ingestion	—
Ammonium fluoride (NH₄F)	See Fluorides	—
AmobarbitalSome Trade Names AMYTAL Click for Drug Monograph	See Barbiturates	—
Amphetamines Amphetamine sulfate or phosphate DextroamphetamineSome Trade Names DEXEDRINE DEXTROSTAT Click for Drug Monograph 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	—
Aniline	See Acetanilide	—
Anticoagulants, direct thrombin inhibitors ArgatrobanSome Trade Names No US trade name Click for Drug Monograph BivalirudinSome Trade Names ANGIOMAX Click for Drug Monograph 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 FondaparinuxSome Trade Names ARIXTRA Click for Drug Monograph 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, heparinSome Trade Names HEPFLUSH-10 Click for Drug Monograph and low mol wt heparins HeparinSome Trade Names HEPFLUSH-10 Click for Drug Monograph (unfractionated) DalteparinSome Trade Names FRAGMIN Click for Drug Monograph EnoxaparinSome Trade Names LOVENOX Click for Drug Monograph TinzaparinSome Trade Names INNOHEP Click for Drug Monograph	Bleeding secondary to decreased thrombin and fibrin clot formation	Supportive care (eg, whole blood transfusion) Protamine sulfateSome Trade Names No US trade name (to reverse unfractionated heparinSome Trade Names HEPFLUSH-10 Click for Drug Monograph , but only partially neutralizes low mol wt heparins)
Anticoagulants, warfarins Dicumarol Superwarfarins WarfarinSome Trade Names COUMADIN Click for Drug Monograph	See WarfarinSome Trade Names COUMADIN Click for Drug Monograph	—
Antidepressants	See BupropionSome Trade Names WELLBUTRIN ZYBAN Click for Drug Monograph , MirtazapineSome Trade Names REMERON Click for Drug Monograph , SSRIs, TrazodoneSome Trade Names DESYREL Click for Drug Monograph , Tricyclic antidepressants, and VenlafaxineSome Trade Names EFFEXOR Click for Drug Monograph	—
Antifreeze	See Alcohol, methyl and Ethylene glycol	—
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 (Caution: Seizures—see Physostigmine), consideration of physostigmineSome Trade Names No US trade name Click for Drug Monograph 0.5–2.0 mg in adults or 0.02 mg/kg in children IV (slowly)
Antihyperglycemic drugs, 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 penicillamineSome Trade Names CUPRIMINE Click for Drug Monograph , dimercaprolSome Trade Names BAL IN OIL Click for Drug Monograph for patients who cannot take oral drugs, hydration, treatment of shock and pain
Antineoplastic drugs MercaptopurineSome Trade Names PURINETHOL Click for Drug Monograph MethotrexateSome Trade Names RHEUMATREX Click for Drug Monograph VincristineSome Trade Names ONCOVIN Click for Drug Monograph > 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) ChlorpromazineSome Trade Names THORAZINE Click for Drug Monograph FluphenazineSome Trade Names PROLIXIN DECANOATE PROLIXIN Click for Drug Monograph HaloperidolSome Trade Names HALDOL Click for Drug Monograph LoxapineSome Trade Names LOXITANE Click for Drug Monograph MesoridazineSome Trade Names SERENTIL MolindoneSome Trade Names MOBAN PerphenazineSome Trade Names TRILAFON Click for Drug Monograph PimozideSome Trade Names ORAP Click for Drug Monograph ProchlorperazineSome Trade Names COMPAZINE Click for Drug Monograph ThioridazineSome Trade Names MELLARIL Click for Drug Monograph ThiothixeneSome Trade Names NAVANE Click for Drug Monograph TrifluoperazineSome Trade Names STELAZINE Click for Drug Monograph 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, diphenhydramineSome Trade Names BENADRYL NYTOL Click for Drug Monograph or benztropineSome Trade Names COGENTIN Click for Drug Monograph For hypotension refractory to fluids, norepinephrineSome Trade Names LEVOPHED Click for Drug Monograph For ventricular arrhythmias, consideration of alkalinization
Antipsychotic drugs (2nd-generation) ClozapineSome Trade Names CLOZARIL Click for Drug Monograph OlanzapineSome Trade Names ZYPREXA Click for Drug Monograph QuetiapineSome Trade Names SEROQUEL Click for Drug Monograph RisperidoneSome Trade Names RISPERDAL Click for Drug Monograph ZiprasidoneSome Trade Names GEODON Click for Drug Monograph	CNS depression (particularly with olanzapineSome Trade Names ZYPREXA Click for Drug Monograph ), miosis, anticholinergic effects, hypotension, dystonia, QT prolongation (occasionally), fatal bone marrow suppression (rare)	For dystonia, diphenhydramineSome Trade Names BENADRYL NYTOL Click for Drug Monograph or benztropineSome Trade Names COGENTIN Click for Drug Monograph For hypotension refractory to fluids, norepinephrineSome Trade Names LEVOPHED Click for Drug Monograph For ventricular arrhythmias, consideration of alkalinization
Ant poison	See Arsenic (sodium arsenate) and Boric acid	—
Arsenic Donovan solution Fowler solution Herbicides Paris green Pesticides SeleniumSome Trade Names SELSUN Click for Drug Monograph Sodium arsenate	Same as for Antimony	Same as for Antimony
Arsine gas	Acute hemolytic anemia	Transfusions, diuresis
Artificial bitter almond oil	See Cyanides	—
Asphalt	See Petroleum distillates	—
AspirinSome Trade Names BUFFERIN ECOTRIN GENACOTE Click for Drug Monograph	see Poisoning: Aspirin and Other Salicylate Poisoning	—
AtropineSome Trade Names ATROPEN ATROPINE-CARE SAL-TROPINE Click for Drug Monograph	See Belladonna	—
Automobile exhaust	See Carbon monoxide	—
Barbiturates AmobarbitalSome Trade Names AMYTAL Click for Drug Monograph MeprobamateSome Trade Names EQUANIL MILTOWN Click for Drug Monograph PentobarbitalSome Trade Names NEMBUTAL Click for Drug Monograph PhenobarbitalSome Trade Names LUMINAL Click for Drug Monograph SecobarbitalSome Trade Names SECONAL Click for Drug Monograph	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 phenobarbitalSome Trade Names LUMINAL Click for Drug Monograph (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 DiazepamSome Trade Names VALIUM Click for Drug Monograph to control seizures For dyspnea and cyanosis, O₂
Belladonna AtropineSome Trade Names ATROPEN ATROPINE-CARE SAL-TROPINE Click for Drug Monograph HyoscyamineSome Trade Names HYOSINE LEVSIN Click for Drug Monograph Hyoscyamus ScopolamineSome Trade Names TRANSDERM SCOP Click for Drug Monograph (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 (Caution: Seizures—see Physostigmine), consideration of physostigmineSome Trade Names No US trade name Click for Drug Monograph 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, O₂, respiratory support, ECG monitoring (ventricular fibrillation can occur early) DiazepamSome Trade Names VALIUM Click for Drug Monograph to control seizures For severe anemia, blood transfusions Replacement of K as necessary Epinephrine contraindicated
γ-Benzene hexachloride Benzene hexachloride Hexachlorocyclohexane LindaneSome Trade Names KWELL Click for Drug Monograph	Irritability, CNS excitation, muscle spasms, atonia, tonic-clonic seizures, respiratory failure, pulmonary edema, nausea, vomiting, obtundation, coma	Supportive care, activated charcoal after airway control DiazepamSome Trade Names VALIUM Click for Drug Monograph to control seizures
Benzine (benzin)	See Petroleum distillates	—
Benzodiazepines AlprazolamSome Trade Names XANAX Click for Drug Monograph ChlordiazepoxideSome Trade Names LIBRIUM Click for Drug Monograph DiazepamSome Trade Names VALIUM Click for Drug Monograph FlurazepamSome Trade Names DALMANE Click for Drug Monograph	Sedation to coma, particularly if drugs are accompanied by alcohol Hypotension	Airway control For hypotension, IV fluids and vasopressors Avoidance of flumazenilSome Trade Names ROMAZICON Click for Drug Monograph (Caution: If tricyclic antidepressants are involved, flumazenil may precipitate seizures; in patients who depend on benzodiazepines, flumazenil may precipitate withdrawal.)
Benzol	See Benzene	—
Beta-blockers	Hypotension, bradycardia, seizures, cardiac arrhythmias, hypoglycemia, altered mental status	Close monitoring and attention to airway maintenance For symptomatic patients, consideration of dopamineSome Trade Names INTROPIN Click for Drug Monograph , epinephrineSome Trade Names ADRENALIN PRIMATENE MIST Click for Drug Monograph , other vasopressors, glucagon 3–5 mg IV followed by infusion, CaCl₂, IV insulinSome Trade Names HUMULIN NOVOLIN Click for Drug Monograph and glucose, cardiac pacing, intra-aortic balloon pump, and IV lipid emulsion
Bichloride of mercury	See Mercury	—
Bichromates	See Chromic acid	—
Bidrin (dicrotophos)	See Organophosphates	—
Bifenthrin	See Pyrethroids	—
Bishydroxycoumarin	See WarfarinSome Trade Names COUMADIN Click for Drug Monograph	—
Bismuth compounds	Acute: Abdominal pain, oliguria, acute renal failure Chronic: Poor absorption, ulcerative stomatitis, anorexia, progressive encephalopathy	Respiratory support, consideration of chelation with dimercaprolSome Trade Names BAL IN OIL Click for Drug Monograph and succimerSome Trade Names CHEMET Click for Drug Monograph (see Table 4: Poisoning: Guidelines for Chelation Therapy)
Bitter almond oil	See Cyanides	—
Bleach, chlorine	See Hypochlorites	—
β-Blockers	See Beta-blockers	—
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	—
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, furosemideSome Trade Names LASIX Click for Drug Monograph 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
BupropionSome Trade Names WELLBUTRIN ZYBAN Click for Drug Monograph HCl	Respiratory depression, ataxia, seizures	Charcoal, benzodiazepines, supportive care
Butyl nitrate	See Nitrites	—
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 succimerSome Trade Names CHEMET Click for Drug Monograph or dimercaptopropane sulfonate Dimercaprol contraindicated For inhalation, O₂, sometimes bronchodilators and corticosteroids
Caffeine	See AminophyllineSome Trade Names No US trade name Click for Drug Monograph	—
Ca channel blockers DiltiazemSome Trade Names CARDIZEM CARTIA DILACOR Click for Drug Monograph NifedipineSome Trade Names ADALAT PROCARDIA Click for Drug Monograph VerapamilSome Trade Names CALAN ISOPTIN Click for Drug Monograph 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 CaCl₂ (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 insulinSome Trade Names HUMULIN NOVOLIN Click for Drug Monograph 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	—
Camphor Camphorated oils	Camphor odor on breath, headache, confusion, delirium, hallucinations, seizures, coma	DiazepamSome Trade Names VALIUM Click for Drug Monograph to prevent and treat seizures, respiratory support
Canned fuel, solid	See Alcohol, methyl	—
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
CarbamazepineSome Trade Names TEGRETOL Click for Drug Monograph	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	—
Carbonates (ammonium, potassium, sodium)	see Poisoning: Caustic Ingestion	—
Carbon bisulfide	See Carbon disulfide	—
Carbon dioxide	Dyspnea, weakness, tinnitus, palpitations, asphyxia	Respiratory support, O₂
Carbon disulfide Carbon bisulfide	Garlic odor on breath, irritability, weakness, mania, narcosis, delirium, mydriasis, blindness, parkinsonism, seizures, coma, paralysis, respiratory failure	Washing of skin, O₂, diazepamSome Trade Names VALIUM Click for Drug Monograph 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% O₂ by mask, respiratory support if needed, immediate measurement of carboxyhemoglobin level; if carboxyhemoglobin is more than about 25%, consideration of hyperbaric O₂ in consultation with poison control center (see Poisoning: 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, O₂, respiratory support, monitoring of kidney and liver function and appropriate treatment
Carbonyl iron	See Iron	—
Caustic soda (sodium hydroxide)	see Poisoning: Caustic Ingestion	—
Chloral hydrateSome Trade Names NOCTEC Click for Drug Monograph 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 blueSome Trade Names UROLENE BLUE Click for Drug Monograph for methemoglobinemia, 10% thiosulfate to reduce chlorate to the less toxic chloride, transfusion for severe cyanosis, ascorbic acid, treatment of shock, O₂ For complex cases, possibly dialysis
Chlordane	See Chlorinated and other halogenated hydrocarbons	—
Chlorethoxyfos	See Organophosphates	—
Chlorinated and other halogenated hydrocarbons Aldrin Benzene hexachloride Chlordane Chlorothalonil DDD (2-dichlorethane) DDT (chlorophenothane) Dicofol Dieldrin Dienochlor Dilan Endosulfan Endrin Heptachlor LindaneSome Trade Names KWELL Click for Drug Monograph 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	DiazepamSome Trade Names VALIUM Click for Drug Monograph or phenobarbitalSome Trade Names LUMINAL Click for Drug Monograph to prevent and control tremors and seizures, cautious use of epinephrineSome Trade Names ADRENALIN PRIMATENE MIST Click for Drug Monograph , avoidance of sudden stimuli, parenteral fluids For renal and liver failure, monitoring
Chlorinated lime	See Chlorine	—
Chlorine (see also Hypochlorites) 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: O₂, respiratory support, observation for and treatment of pulmonary edema
Chloroaniline	See Acetanilide	—
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	—
Chlorothion	See Organophosphates	—
ChlorpromazineSome Trade Names THORAZINE Click for Drug Monograph	See Phenothiazines	—
Chlorpyrifos	See Organophosphates	—
Chromates	See Chromic acid	—
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-acetylcysteineSome Trade Names MUCOMYST Click for Drug Monograph 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	—
CimetidineSome Trade Names TAGAMET Click for Drug Monograph RanitidineSome Trade Names ZANTAC Click for Drug Monograph	Slight dryness and drowsiness, possible altered metabolism of concomitant drugs	No specific antidote available Monitoring for effect on metabolism of other drugs being taken
ClonidineSome Trade Names CATAPRES Click for Drug Monograph	Bradycardia, sedation, periodic apnea, hypotension, hypothermia	Supportive care; vasopressors; naloxoneSome Trade Names NARCAN Click for Drug Monograph 5 mcg/kg up to 2–20 mg, repeated prn, to possibly reduce sedation
Coal gas	See Carbon monoxide	—
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	—
Cocaine^†	Stimulation then depression, nausea, vomiting, loss of self-control, anxiety, hallucinations, sweating, hyperthermia, seizures, MI (rare)	DiazepamSome Trade Names VALIUM Click for Drug Monograph for excitation (primary treatment), O₂, respiratory and circulatory support if needed, IV NaHCO₃ For arrhythmias, extremely cautious use of IV esmololSome Trade Names BREVIBLOC Click for Drug Monograph Observation for myocardial or pulmonary disorder (usually before emergency department arrival) For hyperthermia, external cooling
CodeineSome Trade Names No US trade name Click for Drug Monograph	See Opioids	—
ColchicineSome Trade Names No US trade name Click for Drug Monograph	Nausea, hemorrhagic gastritis, multiorgan failure, sepsis	Multiple-dose activated charcoal, IV fluids, supportive care, granulocyte colony-stimulating factor
Copper	See Copper salts	—
Copper salts Cupric sulfate, acetate, or subacetate Cuprous chloride or oxide Zinc salts	Vomiting, burning sensation, metallic taste, diarrhea, pain, shock, jaundice, anuria, seizures	PenicillamineSome Trade Names CUPRIMINE Click for Drug Monograph or dimercaprolSome Trade Names BAL IN OIL Click for Drug Monograph (see Table 4: Poisoning: 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	—
Coumaphos	See Organophosphates	—
Creosote, cresols	See Phenols	—
Cyanides Bitter almond oil Hydrocyanic acid NitroprussideSome Trade Names NIPRIDE Click for Drug Monograph 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% O₂, 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 HydroxocobalaminSome Trade Names CYANOKIT Click for Drug Monograph 5 g IV (becoming the preferred treatment)
Cyfluthrin	See Pyrethroids	—
Cypermethrin	See Pyrethroids	—
DDD (2-dichlorethane)	See Chlorinated and other halogenated hydrocarbons	—
DDT (chlorophenothane)	See Chlorinated and other halogenated hydrocarbons	—
Demeton	See Organophosphates	—
Deodorizers, household	See Naphthalene and Paradichlorobenzene	—
Depilatories	See Barium compounds	—
DesipramineSome Trade Names NORPRAMIN Click for Drug Monograph	See Tricyclic antidepressants	—
Detergent powders	see Poisoning: Caustic Ingestion	—
DextroamphetamineSome Trade Names DEXEDRINE DEXTROSTAT Click for Drug Monograph	See Amphetamines	—
Diazinon	See Organophosphates	—
Dichlorvos	See Organophosphates	—
Dicofol	See Chlorinated and other halogenated hydrocarbons	—
Dicumarol	See WarfarinSome Trade Names COUMADIN Click for Drug Monograph	—
Dieldrin	See Chlorinated and other halogenated hydrocarbons	—
Dienochlor	See Chlorinated and other halogenated hydrocarbons	—
Diethylene glycol	See Ethylene glycol	—
Digitalis DigitoxinSome Trade Names No US trade name DigoxinSome Trade Names DIGITEK LANOXIN Click for Drug Monograph	See discussion of digitalis preparations on see Heart Failure: Digitalis preparations	—
Dilan	See Chlorinated and other halogenated hydrocarbons	—
Dimethoate	See Organophosphates	—
Dinitrobenzene	See Nitrobenzene	—
Dinitro-o-cresol Herbicides Pesticides	Fatigue, thirst, flushing, nausea, vomiting, abdominal pain, hyperpyrexia, tachycardia, loss of consciousness, dyspnea, respiratory arrest, skin absorption	Fluid therapy, O₂, anticipation of kidney and liver toxicity, no specific antidote, detergents to rinse skin
Diphenoxylate with atropineSome Trade Names ATROPEN ATROPINE-CARE SAL-TROPINE Click for Drug Monograph	Lethargy, nystagmus, pinpoint pupils, tachycardia, coma, respiratory depression (Note: Toxicity may be delayed up to 12 h.)	Activated charcoal, naloxoneSome Trade Names NARCAN Click for Drug Monograph , careful monitoring of all children for 12–18 h if ingestion is verified, supportive care
Diquat	See Paraquat	—
Dishwasher detergents	see Poisoning: Caustic Ingestion	—
Disulfoton	See Organophosphates	—
Diuretics, mercurial	See Mercury	—
Donovan solution	See Arsenic	—
DoxepinSome Trade Names SINEQUAN ZONALON Click for Drug Monograph	See Tricyclic antidepressants	—
Drain cleaners	see Poisoning: Caustic Ingestion	—
Endosulfan	See Chlorinated and other halogenated hydrocarbons	—
Endrin	See Chlorinated and other halogenated hydrocarbons	—
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, heparinSome Trade Names HEPFLUSH-10 Click for Drug Monograph plus phentolamineSome Trade Names No US trade name Click for Drug Monograph 5–10 mg in 10 mL normal saline IV or intra-arterially or nitroprussideSome Trade Names NIPRIDE Click for Drug Monograph 1–2 mcg/kg/min IV For coronary vasospasm, IV nitroglycerinSome Trade Names NITRO-BID NITRO-DUR NITROL NITROQUICK Click for Drug Monograph and nifedipineSome Trade Names ADALAT PROCARDIA Click for Drug Monograph
Eserine	See PhysostigmineSome Trade Names No US trade name Click for Drug Monograph	—
Esfenvalerate	See Pyrethroids	—
Ethanol	See Alcohol, ethyl	—
Ether	See Chloroform	—
Ethion	See Organophosphates	—
Ethyl alcohol	See Alcohol, ethyl	—
Ethyl biscoumacetate	See WarfarinSome Trade Names COUMADIN Click for Drug Monograph	—
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 fomepizoleSome Trade Names ANTIZOL Click for Drug Monograph 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	—
Famphur	See Organophosphates	—
Fava bean (favism)	Symptoms of hemolysis (Table: Anemias Caused by Hemolysis: Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency)	—
Fenthion	See Organophosphates	—
Ferric salts	See Iron	—
Ferrous salts (eg, gluconate, sulfate)	See Iron	—
Fireworks	See Barium compounds	—
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% CaCl₂ 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: O₂, respiratory support, prednisoneSome Trade Names DELTASONE Click for Drug Monograph for chemical pneumonitis (in adults, 15–40 mg po bid), management of pulmonary edema
Fluvalinate	See Pyrethroids	—
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, NaHCO₃ to correct acidosis, respiratory support, observation for perforations Skin contact: Washing with copious soap and water Inhalation: Flushing of eyes with saline, O₂, respiratory support
Fowler solution	See Arsenic	—
Fuel, canned	See Alcohol, methyl	—
Fuel oil	See Petroleum distillates	—
Furnace gas	See Carbon monoxide	—
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)	—
Gasoline	See Petroleum distillates	—
Glues, model airplane	See Acetone, Benzene (toluene), and Petroleum distillates	—
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	—	See Table 4: Poisoning: Guidelines for Chelation Therapy
Guaiacol	See Phenols	—
H₂ blockers (eg, cimetidineSome Trade Names TAGAMET Click for Drug Monograph , ranitidineSome Trade Names ZANTAC Click for Drug Monograph )	Minor GI problems, possibly altered levels of other drugs	Nonspecific supportive measures
Heptachlor	See Chlorinated and other halogenated hydrocarbons	—
Herbicides	See specific ingredient (eg, Arsenic, Dinitro-o-cresol, Chlorates and nitrates)	—
Heroin	See Opioids	—
Hexachlorocyclohexane	See γ-Benzene hexachloride	—
Hexaethyltetraphosphate	See Organophosphates	—
Histamine-2 blockers	See H₂ blockers	—
Hydrides, volatile	See Hydrogen sulfide	—
Hydrocarbons	See Benzene	—
Hydrocarbons, chlorinated	See Chlorinated and other halogenated hydrocarbons	—
Hydrocarbons, halogenated	See Chlorinated and other halogenated hydrocarbons	—
Hydrochloric acid	see Poisoning: Caustic Ingestion	—
Hydrocodone	See Opioids	—
Hydrocyanic acid	See Cyanides	—
Hydrofluoric acid	See Fluorides	—
Hydrogen chloride or fluoride	See Nitrogen oxides	—
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	O₂, respiratory support
Hyoscine (scopolamineSome Trade Names TRANSDERM SCOP Click for Drug Monograph ) HyoscyamineSome Trade Names HYOSINE LEVSIN Click for Drug Monograph Hyoscyamus	See Belladonna	—
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 ChlorpropamideSome Trade Names DIABINESE Click for Drug Monograph GlipizideSome Trade Names GLUCOTROL Click for Drug Monograph	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 octreotideSome Trade Names SANDOSTATIN Click for Drug Monograph 50–100 mcg IV or sc bid or tid
Illuminating gas	See Carbon monoxide	—
ImipramineSome Trade Names TOFRANIL Click for Drug Monograph	See Tricyclic antidepressants	—
Insecticides	See Chlorinated and other halogenated hydrocarbons, Organophosphates, Paradichlorobenzene, and Pyrethroids	—
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 NaHCO₃ or alcohol
Iron Carbonyl iron (see Carbon monoxide) Ferric salts Ferrous salts Ferrous gluconateSome Trade Names FERGON Click for Drug Monograph Ferrous sulfateSome Trade Names FEOSOL FER-GEN-SOL FER-IN-SOL Click for Drug Monograph Vitamins with iron (Note: 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, deferoxamineSome Trade Names DESFERAL Click for Drug Monograph IV infusion starting at 15 mg/kg/h and titrated to BP
Isofenphos	See Organophosphates	—
IsoniazidSome Trade Names INH NYDRAZID Click for Drug Monograph	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, 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 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	see Poisoning: Lead Poisoning
Lead, tetraethyl	Vapor inhalation, skin absorption, or ingestion: CNS symptoms (eg, insomnia, restlessness, ataxia, delusions, mania, seizures)	Supportive care, diazepamSome Trade Names VALIUM Click for Drug Monograph to control seizures, fluid and electrolytes, elimination of source
Lime, chlorinated	See Chlorine	—
LindaneSome Trade Names KWELL Click for Drug Monograph	See γ-Benzene hexachloride and Chlorinated and other halogenated hydrocarbons	—
Liquor	See Alcohol, ethyl	—
LithiumSome Trade Names ESKALITH LITHOBID LITHONATE Click for Drug Monograph salts	Nausea, vomiting, diarrhea, tremors, fasciculations, drowsiness, diabetes insipidus, ataxia, seizures, hypothyroidism	Acute: Hydration, diazepamSome Trade Names VALIUM Click for Drug Monograph , possibly dialysis for end-organ damage or serum lithiumSome Trade Names ESKALITH LITHOBID LITHONATE Click for Drug Monograph level > 4 mEq/L Chronic: If symptoms are severe, dialysis
Lye (sodium hydroxide [NaOH])	see Poisoning: Caustic Ingestion	—
Lysergic acid diethylamide (LSD)	Confusion, hallucinations, hyperexcitability, coma, flashbacks	Supportive care, benzodiazepines For severe agitation, haloperidolSome Trade Names HALDOL Click for Drug Monograph 2–10 mg IV or IM in adults (repeated as necessary)
Malathion	See Organophosphates	—
Manganese	See Potassium permanganate	—
Marsh gas	See Carbon monoxide	—
MeperidineSome Trade Names DEMEROL Click for Drug Monograph	See Opioids	—
MeprobamateSome Trade Names EQUANIL MILTOWN Click for Drug Monograph	See Barbiturates	—
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, penicillamineSome Trade Names CUPRIMINE Click for Drug Monograph (or succimerSome Trade Names CHEMET Click for Drug Monograph —see Table 4: Poisoning: 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	—
Metaldehyde Slug bait	Nausea, vomiting, retching, abdominal pain, muscular rigidity, hyperventilation, seizures, coma	Supportive care, diazepamSome Trade Names VALIUM Click for Drug Monograph
Metals	See specific metals	See Table 4: Poisoning: Guidelines for Chelation Therapy
MetforminSome Trade Names GLUCOPHAGE Click for Drug Monograph	See Hypoglycemic drugs, oral	—
MethadoneSome Trade Names DOLOPHINE Click for Drug Monograph	See Opioids	—
Methamphetamine	See Amphetamines	—
Methanol	See Alcohol, methyl	—
Methidathion	See Organophosphates	—
MethotrexateSome Trade Names RHEUMATREX Click for Drug Monograph	Nausea, vomiting, diarrhea, stomatitis, bone marrow suppression, thrombocytopenia, cirrhosis	IV fluids, urinary alkalinization, folinic acid (leucovorin rescue), glucarpidase to deactivate methotrexateSome Trade Names RHEUMATREX Click for Drug Monograph
Methoxychlor	See Chlorinated and other halogenated hydrocarbons	—
Methyl alcohol	See Alcohol, methyl	—
Methyl parathion	See Organophosphates	—
Methyl salicylate	see Poisoning: Aspirin and Other Salicylate Poisoning	—
Mineral spirits	See Petroleum distillates	—
MirtazapineSome Trade Names REMERON Click for Drug Monograph	Usually benign Most commonly, sedation, confusion, tachycardia	Observation for ≥ 8 h
Model airplane glues, solvents	See Acetone, Benzene, Petroleum distillates, and Toluene	—
Monoamine oxidase (MAO) inhibitors IsocarboxazidSome Trade Names MARPLAN Click for Drug Monograph PhenelzineSome Trade Names NARDIL Click for Drug Monograph SelegilineSome Trade Names ELDEPRYL Click for Drug Monograph TranylcypromineSome Trade Names PARNATE Click for Drug Monograph	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
MorphineSome Trade Names DURAMORPH MS CONTIN MSIR ROXANOL Click for Drug Monograph	See Opioids	—
Moth balls, crystals, or repellent cakes	See Naphthalene, Camphor, and Paradichlorobenzene	—
Mushrooms, poisonous	see Poisoning: Mushroom Poisoning	—
Nail polish remover	See Acetone	—
Naled	See Organophosphates	—
Naphtha	See Petroleum distillates	—
Naphthalene Deodorizer cakes Moth balls, crystals, or repellent cakes (see also Paradichlorobenzene)	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	—
Narcotics	See Opioids	—
NefazodoneSome Trade Names SERZONE Click for Drug Monograph	See TrazodoneSome Trade Names DESYREL Click for Drug Monograph	—
NeostigmineSome Trade Names PROSTIGMIN Click for Drug Monograph	See PhysostigmineSome Trade Names No US trade name Click for Drug Monograph	—
Nerve gas agents	See Organophosphates	—
Nickel	Hypersensitivity dermatitis Chronic inhalation: Pulmonary inflammation	Removal from the source, irrigation with water
Nickel carbonyl	Pneumonitis, cyanosis, delirium, seizures (see also Nickel)	Removal from source, decontamination, consideration of Na diethyldithiocarbamate po (mild exposure) or IV (severe exposure) or disulfiramSome Trade Names ANTABUSE Click for Drug Monograph if Na diethyldithiocarbamate is unavailable
NicotineSome Trade Names COMMIT NICORETTE NICOTROL Click for Drug Monograph	See Tobacco	—
Nitrates	See Chlorates and nitrates	—
Nitric acid	see Poisoning: Caustic Ingestion	—
Nitrites Amyl nitrite Butyl nitrite NitroglycerinSome Trade Names NITRO-BID NITRO-DUR NITROL NITROQUICK Click for Drug Monograph Potassium nitrite Sodium nitrite	Methemoglobinemia, cyanosis, anoxia, GI disturbance, vomiting, headache, dizziness, hypotension, respiratory failure, coma	O₂ For methemoglobinemia, 1% methylene blueSome Trade Names UROLENE BLUE Click for Drug Monograph 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
Nitrogen oxides (see also Chlorine, Fluorides, Hydrogen sulfide, Sulfur dioxide, 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, O₂ as soon as symptoms develop For excessive pulmonary edema, suction, postural drainage, mechanical ventilation, prednisoneSome Trade Names DELTASONE Click for Drug Monograph 30–80 mg/day in adults and dexamethasoneSome Trade Names DECADRON DEXASONE HEXADROL Click for Drug Monograph 1 mg/m² BSA in children to possibly prevent pulmonary fibrosis
NitroglycerinSome Trade Names NITRO-BID NITRO-DUR NITROL NITROQUICK Click for Drug Monograph	See Nitrites	—
NitroprussideSome Trade Names NIPRIDE Click for Drug Monograph	See Cyanides	—
Nitrous oxide	See Chloroform	—
NSAIDs IbuprofenSome Trade Names ADVIL MOTRIN NUPRIN Click for Drug Monograph	Nausea, vomiting, CNS toxicity (eg, seizures with massive overdoses)	Clinical observation, supportive care
NortriptylineSome Trade Names AVENTYL Click for Drug Monograph	See Tricyclic antidepressants	—
Octamethyl pyrophosphoramide	See Organophosphates	—
Oil of wintergreen	see Poisoning: Aspirin and Other Salicylate Poisoning	—
Oils	See Acetanilide (aniline oil) and Petroleum distillates (fuel oil, lubricating oils)	—
Opioids (see Drug Use and Dependence: Opioids) Alphaprodine CodeineSome Trade Names No US trade name Click for Drug Monograph FentanylSome Trade Names ACTIQ DURAGESIC SUBLIMAZE Click for Drug Monograph Heroin Hydrocodone MeperidineSome Trade Names DEMEROL Click for Drug Monograph MethadoneSome Trade Names DOLOPHINE Click for Drug Monograph MorphineSome Trade Names DURAMORPH MS CONTIN MSIR ROXANOL Click for Drug Monograph Opium OxycodoneSome Trade Names OXYCONTIN OXYIR Click for Drug Monograph PropoxypheneSome Trade Names DARVON DOLENE	Pinpoint pupils, drowsiness, shallow respirations, spasticity, respiratory failure	Charcoal, respiratory support, naloxoneSome Trade Names NARCAN Click for Drug Monograph IV as required to awaken patients and improve respiration, IV fluids to support circulation
Opium	See Opioids	—
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, atropineSome Trade Names ATROPEN ATROPINE-CARE SAL-TROPINE Click for Drug Monograph 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; pralidoximeSome Trade Names PROTOPAM Click for Drug Monograph chloride 1–2 g in adults or 20–40 mg/kg in children IV over 15–30 min, repeated in 1 h if needed; O₂; 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
OxycodoneSome Trade Names OXYCONTIN OXYIR Click for Drug Monograph	See Opioids	—
Oxydemeton-methyl	See Organophosphates	—
Paints	See Lead	—
Paint solvents	See Alcohol, methyl; Petroleum distillates (mineral spirits); and Turpentine	—
Paradichlorobenzene Insecticides Moth repellents Pesticides Toilet bowl deodorizers	Abdominal pain, nausea, vomiting, diarrhea, seizures, tetany (rare)	Fluid replacement, diazepamSome Trade Names VALIUM Click for Drug Monograph to control seizures
Paraldehyde	Acetic acid odor on breath, incoherence, miosis, depressed respiration, coma	O₂, 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 O₂, consultation with poison control center or manufacturer
Parathion	See Organophosphates	—
Paris green	See Arsenic	—
PentobarbitalSome Trade Names NEMBUTAL Click for Drug Monograph	See Barbiturates	—
Perchlordecone	See Chlorinated and other halogenated hydrocarbons	—
Permanent wave neutralizers	See Bromates	—
PermethrinSome Trade Names ELIMITE NIX RID SPRAY Click for Drug Monograph	See Pyrethroids	—
Pesticides	See specific compounds	—
Petroleum distillates (see Poisoning: 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, O₂, respiratory support
Phenacetin	See Acetanilide	—
PhencyclidineSome Trade Names No US trade name (PCP)	Inattentiveness with eyes open, agitation, violent behavior, unconsciousness, tachycardia, hypertension	Quiet environment Benzodiazepines if needed to provide sedation
Phenmetrazine	See Amphetamines	—
PhenobarbitalSome Trade Names LUMINAL Click for Drug Monograph	See Barbiturates	—
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, O₂, respiratory support, correction of fluid imbalance, observation for esophageal stricture
Phenothiazines ChlorpromazineSome Trade Names THORAZINE Click for Drug Monograph ProchlorperazineSome Trade Names COMPAZINE Click for Drug Monograph Promazine TrifluoperazineSome Trade Names STELAZINE Click for Drug Monograph	Extrapyramidal symptoms (eg, ataxia, muscular and carpopedal spasms, torticollis), usually idiosyncratic With overdose, dry mouth, drowsiness, seizures, coma, respiratory depression	DiphenhydramineSome Trade Names BENADRYL NYTOL Click for Drug Monograph 2–3 mg/kg IV or IM for extrapyramidal symptoms, diazepamSome Trade Names VALIUM Click for Drug Monograph to control seizures
Phenylpropanolamine	Nervousness, irritability, bradycardia, hypertension plus other sympathomimetic effects	Supportive care, diazepamSome Trade Names VALIUM Click for Drug Monograph For hypertension, phentolamineSome Trade Names No US trade name Click for Drug Monograph 5 mg IV over about 1 min or nitroprussideSome Trade Names NIPRIDE Click for Drug Monograph IV
Phorate	See Organophosphates	—
Phosdrin	See Organophosphates	—
Phosmet	See Organophosphates	—
Phosphine	See Hydrogen sulfide	—
Phosphodiesterase (PDE) 5 inhibitors Avanafil SildenafilSome Trade Names VIAGRA Click for Drug Monograph TadalafilSome Trade Names CIALIS Click for Drug Monograph VardenafilSome Trade Names LEVITRA Click for Drug Monograph	Hypotension, tachycardia, chest pain, arrhythmias, vision loss, priapism	Supportive care, IV fluids and vasopressors, urologic consultation to treat priapism, avoidance of nitrates
Phosphoric acid	see Poisoning: Caustic Ingestion	—
Phosphorus (yellow or white) Rat poisons Roach powders (Note: 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% NaHCO₃ 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)
PhysostigmineSome Trade Names No US trade name Click for Drug Monograph Eserine NeostigmineSome Trade Names PROSTIGMIN Click for Drug Monograph PilocarpineSome Trade Names ISOPTO CARPINE PILOPINE HS SALAGEN Click for Drug Monograph Pilocarpus genus	Dizziness, weakness, vomiting, cramping pain, bradycardia, possibly seizures, agitation	AtropineSome Trade Names ATROPEN ATROPINE-CARE SAL-TROPINE Click for Drug Monograph sulfate 0.6–1 mg in adults or 0.01 mg/kg in children sc or IV, repeated prn Benzodiazepine prn to provide sedation
PilocarpineSome Trade Names ISOPTO CARPINE PILOPINE HS SALAGEN Click for Drug Monograph	See PhysostigmineSome Trade Names No US trade name Click for Drug Monograph	—
Pilocarpus genus	See PhysostigmineSome Trade Names No US trade name Click for Drug Monograph	—
Pirimiphos-methyl	See Organophosphates	—
Potash (potassium hydroxide or potassium carbonate)	See Acids and alkalis	—
Potassium cyanide	See Cyanides	—
Potassium nitrite	See Nitrites	—
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
ProchlorperazineSome Trade Names COMPAZINE Click for Drug Monograph	See Phenothiazines	—
Prolan	See Chlorinated and other halogenated hydrocarbons	—
Promazine	See Phenothiazines	—
PropoxypheneSome Trade Names DARVON DOLENE	See Opioids	—
ProtriptylineSome Trade Names VIVACTIL Click for Drug Monograph	See Tricyclic antidepressants	—
Prussic acid	See Cyanides	—
Pyrethrin	See Pyrethroids	—
Pyrethroids Bifenthrin Cyfluthrin Cypermethrin Esfenvalerate Fluvalinate Lambda-cyhalothrin PermethrinSome Trade Names ELIMITE NIX RID SPRAY Click for Drug Monograph 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
RanitidineSome Trade Names ZANTAC Click for Drug Monograph	See CimetidineSome Trade Names TAGAMET Click for Drug Monograph	—
Rat poisons	See specific components(eg, Barium compounds, Fluorides, Phosphorus, Thallium salts, WarfarinSome Trade Names COUMADIN Click for Drug Monograph )	—
Resmethrin	See Pyrethroids	—
Resorcinol (resorcin)	Vomiting, dizziness, tinnitus, chills, tremor, delirium, seizures, respiratory depression, coma, methemoglobinemia	Respiratory support, methylene blueSome Trade Names UROLENE BLUE Click for Drug Monograph for methemoglobinemia
Roach poisons	See Fluorides, Phosphorus, and Thallium salts	—
Rubbing alcohol	See Alcohol, isopropyl	—
Salicylates	see Poisoning: Aspirin and Other Salicylate Poisoning	—
Salicylic acidSome Trade Names MEDIPLAST PROPA PH STRI-DEX Click for Drug Monograph	see Poisoning: Aspirin and Other Salicylate Poisoning	—
ScopolamineSome Trade Names TRANSDERM SCOP Click for Drug Monograph (hyoscine)	See Belladonna	—
SecobarbitalSome Trade Names SECONAL Click for Drug Monograph	See Barbiturates	—
SeleniumSome Trade Names SELSUN Click for Drug Monograph	See Arsenic and Thallium salts	—
Sewer gas	See Hydrogen sulfide	—
Silver salts Silver nitrate	Stained lips (white, brown, then black), gastroenteritis, shock, vertigo, seizures	Control of pain, diazepamSome Trade Names VALIUM Click for Drug Monograph to control seizures
Smog	See Sulfur dioxide	—
Soda, caustic (Na hydroxide)	see Poisoning: Caustic Ingestion	—
Sodium carbonate	See Acids and alkalis	—
Sodium cyanide	See Cyanides	—
Sodium fluoride	See Fluorides	—
Sodium hydroxide	see Poisoning: Caustic Ingestion	—
Sodium nitrite	See Nitrites	—
Sodium salicylate	see Poisoning: Aspirin and Other Salicylate Poisoning	—
Solder	See Cadmium and Lead	—
SSRIs CitalopramSome Trade Names CELEXA Click for Drug Monograph EscitalopramSome Trade Names LEXAPRO Click for Drug Monograph FluoxetineSome Trade Names PROZAC SARAFEM Click for Drug Monograph FluvoxamineSome Trade Names LUVOX Click for Drug Monograph ParoxetineSome Trade Names PAXIL Click for Drug Monograph SertralineSome Trade Names ZOLOFT Click for Drug Monograph	Commonly, sedation, vomiting, tremor, tachycardia Possibly, seizures, hallucinations, hypotension, serotonin syndrome Rarely, death With citalopramSome Trade Names CELEXA Click for Drug Monograph , 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	—
Stramonium	See Belladonna	—
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 diazepamSome Trade Names VALIUM Click for Drug Monograph , 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, O₂, positive pressure breathing, respiratory support
Sulfuric acid	see Poisoning: Caustic Ingestion	—
Sumithrin	See Pyrethroids	—
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 (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, diazepamSome Trade Names VALIUM Click for Drug Monograph 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 dimercaprolSome Trade Names BAL IN OIL Click for Drug Monograph (used with varying success) Avoidance of penicillamineSome Trade Names CUPRIMINE Click for Drug Monograph and diethyldithiocarbamate (which may redistribute thallium into the CNS) Consultation with poison control center for latest information advisable
TheophyllineSome Trade Names ELIXOPHYLLIN THEO-DUR Click for Drug Monograph	See AminophyllineSome Trade Names No US trade name Click for Drug Monograph	—
Thyroxine	Usually asymptomatic Rarely, increasing irritability progressing to thyroid storm in 5–7 days	Emesis, observation at home, diazepamSome Trade Names VALIUM Click for Drug Monograph , possibly antithyroid preparations and propranololSome Trade Names INDERAL Click for Drug Monograph but only if symptoms occur
Tobacco NicotineSome Trade Names COMMIT NICORETTE NICOTROL Click for Drug Monograph	Excitement, confusion, muscular twitching, weakness, abdominal cramps, generalized myoclonus, CNS depression, rapid respirations, palpitations, cardiovascular collapse, coma, respiratory failure	Activated charcoal, respiratory support, O₂, diazepamSome Trade Names VALIUM Click for Drug Monograph for seizures, thorough washing of skin if contaminated
Toilet bowl cleaners, deodorizers	see Poisoning: Caustic Ingestion and see Paradichlorobenzene	—
Toluene, toluol	See Benzene	—
Toxaphene	See Chlorinated and other halogenated hydrocarbons See Poisoning:	—
TrazodoneSome Trade Names DESYREL Click for Drug Monograph	CNS depression, orthostatic hypotension, seizures, QRS prolongation (but torsades de pointes is rare), hypotension (rare)	Airway protection For hypotension refractory to fluids, norepinephrineSome Trade Names LEVOPHED Click for Drug Monograph
Trichlorfon	See Organophosphates	—
Trichloromethane	See Chloroform	—
Tricyclic antidepressants AmitriptylineSome Trade Names ELAVIL ENDEP Click for Drug Monograph DesipramineSome Trade Names NORPRAMIN Click for Drug Monograph DoxepinSome Trade Names SINEQUAN ZONALON Click for Drug Monograph ImipramineSome Trade Names TOFRANIL Click for Drug Monograph NortriptylineSome Trade Names AVENTYL Click for Drug Monograph ProtriptylineSome Trade Names VIVACTIL Click for Drug Monograph	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 NaHCO₃ 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) DiazepamSome Trade Names VALIUM Click for Drug Monograph to control seizures Vasopressors (eg, norepinephrineSome Trade Names LEVOPHED Click for Drug Monograph ) to maintain BP For severe poisoning, consideration of IV lipid emulsion
TrifluoperazineSome Trade Names STELAZINE Click for Drug Monograph	See Phenothiazines	—
Triiodomethane	See Iodoform	—
Tungsten	See Interstitial Lung Diseases: Overview of Interstitial Lung Disease	—
Turpentine Some paint solvents Some varnishes	Turpentine odor, burning oral and abdominal pain, coughing, choking, respiratory failure, nephritis	Respiratory support, O₂, control of pain, monitoring of kidney function
ValproateSome Trade Names DEPAKENE Click for Drug Monograph	Progressive CNS and respiratory depression	Respiratory and cardiovascular supportive measures, monitoring of liver function
Varnish	See Alcohol, methyl and Turpentine	—
VenlafaxineSome Trade Names EFFEXOR Click for Drug Monograph	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	—
WarfarinSome Trade Names COUMADIN Click for Drug Monograph (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 K₁ (phytonadioneSome Trade Names MEPHYTON Click for Drug Monograph —see Vitamin Deficiency, Dependency, and Toxicity: 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 Cyanides	—
Wintergreen oil	see Poisoning: Aspirin and Other Salicylate Poisoning	—
Wood alcohol	See Alcohol, methyl	—
Xylene	See Benzene	—
Zinc	—	See Table 4: Poisoning: Guidelines for Chelation Therapy
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 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).

Last full review/revision February 2013 by Gerald F. O'Malley, DO; Rika O'Malley, MD

Content last modified March 2013

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