Poison*

Symptoms

Treatment

ACE inhibitors

Angioedema, hypotension

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

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

For hypotension, consideration of naloxone

Acephate

See Organophosphates

—

Acetaminophen

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 blue 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

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

Hemodialysis (which is definitive treatment)

Aldrin

See Chlorinated and other halogenated hydrocarbons

—

Alkalis

See Acids and alkalis

—

Alphaprodine

See Opioids

—

Aminophylline

Caffeine

Theophylline

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

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

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

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

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

Amitriptyline

See Tricyclic antidepressants

—

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

—

Amobarbital

See Barbiturates

—

Amphetamines

• Amphetamine sulfate or phosphate
• Dextroamphetamine
• Methamphetamine
• Phenmetrazine

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

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

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

Amyl nitrite

See Nitrites

—

Aniline

See Acetanilide

—

Anticoagulants, factor Xa inhibitors

• Fondaparinux
• Apixaban
• Rivaroxaban

Bleeding secondary to factor Xa inhibition

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

Oral activated charcoal and supportive care

Anticoagulants, warfarins

• Dicumarol
• Superwarfarins
• Warfarin

See Warfarin

—

Antidepressants

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

—

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 physostigmine 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 penicillamine, dimercaprol for patients who cannot take oral drugs, hydration, treatment of shock and pain

Antineoplastic drugs

• Mercaptopurine
• Methotrexate
• Vincristine
• > 50 others

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

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

Antipsychotic drugs (conventional)

• Chlorpromazine
• Fluphenazine
• Haloperidol
• Loxapine
• Mesoridazine
• Molindone
• Perphenazine
• Pimozide
• Prochlorperazine
• Thioridazine
• Thiothixene
• Trifluoperazine
• Triflupromazine

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

For dystonia, diphenhydramine or benztropine

For hypotension refractory to fluids, norepinephrine

For ventricular arrhythmias, consideration of alkalinization

Antipsychotic drugs (2nd-generation)

• Clozapine
• Olanzapine
• Quetiapine
• Risperidone
• Ziprasidone

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

For dystonia, diphenhydramine or benztropine

For hypotension refractory to fluids, norepinephrine

For ventricular arrhythmias, consideration of alkalinization

Ant poison

See Arsenic (sodium arsenate) and Boric acid

—

Arsenic

• Donovan solution
• Fowler solution
• Herbicides
• Paris green
• Pesticides
• Selenium
• 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

—

Aspirin

see Poisoning: Aspirin and Other Salicylate Poisoning

—

Atropine

See Belladonna

—

Automobile exhaust

See Carbon monoxide

—

Barbiturates

• Amobarbital
• Meprobamate
• Pentobarbital
• Phenobarbital
• Secobarbital

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

Charcoal up to 24 h after ingestion, supportive care, forced alkaline diuresis for phenobarbital (to aid in elimination)

For severe cases, hemodialysis

Barium compounds (soluble)

• Barium acetate
• Barium carbonate
• Barium chloride
• Barium hydroxide
• Barium nitrate
• Barium sulfide
• Depilatories
• Explosives
• Fireworks
• Rat poisons

Vomiting, abdominal pain, diarrhea, tremors, seizures, colic, hypertension, cardiac arrest, dyspnea and cyanosis, ventricular fibrillation, severe hypokalemia, skeletal muscle weakness

KCl 10–15 mEq/h IV, Na or Mg sulfate 60 g po to precipitate barium in stomach, then possibly gastric lavage

Diazepam to control seizures

For dyspnea and cyanosis, O₂

Belladonna

• Atropine
• Hyoscyamine
• Hyoscyamus
• Scopolamine (hyoscine)
• Stramonium

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

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

Benzene

• Benzol
• Hydrocarbons
• Model airplane glue
• Toluene
• Toluol
• Xylene

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

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

Decontamination with water, avoidance of vomiting and aspiration, O₂, respiratory support, ECG monitoring (ventricular fibrillation can occur early)

Diazepam to control seizures

For severe anemia, blood transfusions

Replacement of K as necessary

Epinephrine contraindicated

γ-Benzene hexachloride

Benzene hexachloride

Hexachlorocyclohexane

Lindane

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

Supportive care, activated charcoal after airway control

Diazepam to control seizures

Benzine (benzin)

See Petroleum distillates

—

Benzodiazepines

• Alprazolam
• Chlordiazepoxide
• Diazepam
• Flurazepam

Sedation to coma, particularly if drugs are accompanied by alcohol

Hypotension

Airway control

For hypotension, IV fluids and vasopressors

Avoidance of flumazenil (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 dopamine, epinephrine, other vasopressors, glucagon 3–5 mg IV followed by infusion, CaCl₂, IV insulin 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 Warfarin

—

Bismuth compounds

Acute: Abdominal pain, oliguria, acute renal failure

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

Respiratory support, consideration of chelation with dimercaprol and succimer (see 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, furosemide 10 mg IV q 6 h

For severe poisoning, hemodialysis

Bromine

Highly corrosive

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

Aggressive decontamination, supportive care

Bupropion HCl

Respiratory depression, ataxia, seizures

Charcoal, benzodiazepines, supportive care

Butyl nitrate

See Nitrites

—

Cadmium

• Cadmium oxide fumes (eg, from welding)

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

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

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

Dimercaprol contraindicated

For inhalation, O₂, sometimes bronchodilators and corticosteroids

Caffeine

See Aminophylline

—

Ca channel blockers

• Diltiazem
• Nifedipine
• Verapamil
• Others

Nausea, vomiting, confusion, bradycardia, hypotension, total cardiovascular collapse

Toxicity sometimes occurring after hyperglycemia

For sustained-release preparations, consideration of 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 insulin 10–100 units IV and 50–100 mL 50% dextrose plus 50–100 mL/h 10% dextrose IV infusion

Consideration of IV lipid emulsion

Calomel

See Mercury

—

Camphor

• Camphorated oils

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

Diazepam to prevent and treat seizures, respiratory support

Canned fuel, solid

See Alcohol, methyl

—

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

Carbamazepine

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

Supportive care after decontamination, heart rate monitoring

For arrhythmias, consideration of IV Na bicarbonate

Carbolic acid

See Phenols

—

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, diazepam sedation, respiratory and circulatory support

Carbon monoxide

• Acetylene gas
• Automobile exhaust
• Coal gas
• Furnace gas
• Illuminating gas
• Marsh gas

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

Various symptoms depending on % carboxyhemoglobin in blood

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

100% 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 hydrate

Chloral amide

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

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

Chlorates and nitrates

• Herbicides
• Manufacture of explosives and matches

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

Methylene blue for methemoglobinemia, 10% thiosulfate to reduce chlorate to the less toxic chloride, transfusion for severe cyanosis, ascorbic acid, treatment of shock, 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
• Lindane
• Methoxychlor
• Perchlordecone
• Prolan
• Toxaphene
• Other chlorinated organic insecticides and industrial compounds

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

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

Diazepam or phenobarbital to prevent and control tremors and seizures, cautious use of epinephrine, avoidance of sudden stimuli, parenteral fluids

For renal and liver failure, monitoring

Chlorinated lime

See Chlorine

—

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

—

Chlorpromazine

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-acetylcysteine and ascorbic acid to convert hexavalent to the less toxic trivalent compound

Chromium

Irritation of skin and mucous membranes

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

Chromium trioxide

See Chromic acid

—

Cimetidine

Ranitidine

Slight dryness and drowsiness, possible altered metabolism of concomitant drugs

No specific antidote available

Monitoring for effect on metabolism of other drugs being taken

Clonidine

Bradycardia, sedation, periodic apnea, hypotension, hypothermia

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

Coal gas

See Carbon monoxide

—

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)

Diazepam for excitation (primary treatment), O₂, respiratory and circulatory support if needed, IV NaHCO₃

For arrhythmias, extremely cautious use of IV esmolol

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

For hyperthermia, external cooling

Codeine

See Opioids

—

Colchicine

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

Penicillamine or dimercaprol (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
• Nitroprusside
• Potassium cyanide
• Prussic acid
• Sodium cyanide
• Wild cherry syrup

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

Very rapidly lethal (in 1–15 min)

Speed essential

Inhalation: Removal from source

Inhalation or ingestion: 100% 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

Hydroxocobalamin 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

—

Desipramine

See Tricyclic antidepressants

—

Detergent powders

see Poisoning: Caustic Ingestion

—

Dextroamphetamine

See Amphetamines

—

Diazinon

See Organophosphates

—

Dichlorvos

See Organophosphates

—

Dicofol

See Chlorinated and other halogenated hydrocarbons

—

Dicumarol

See Warfarin

—

Dieldrin

See Chlorinated and other halogenated hydrocarbons

—

Dienochlor

See Chlorinated and other halogenated hydrocarbons

—

Diethylene glycol

See Ethylene glycol

—

Digitalis

Digitoxin

Digoxin

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 atropine

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

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

Diquat

See Paraquat

—

Dishwasher detergents

see Poisoning: Caustic Ingestion

—

Disulfoton

See Organophosphates

—

Diuretics, mercurial

See Mercury

—

Donovan solution

See Arsenic

—

Doxepin

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

For coronary vasospasm, IV nitroglycerin and nifedipine

Eserine

See Physostigmine

—

Esfenvalerate

See Pyrethroids

—

Ethanol

See Alcohol, ethyl

—

Ether

See Chloroform

—

Ethion

See Organophosphates

—

Ethyl alcohol

See Alcohol, ethyl

—

Ethyl biscoumacetate

See Warfarin

—

Ethylene glycol

Diethylene glycol

• Most automotive antifreeze

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

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

Eye contact: Iridocyclitis

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

Hemodialysis, which is definitive treatment

Eye contact: Flushing of eyes

Explosives

See Barium compounds (fireworks) and Nitrogen oxides

—

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, prednisone 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, cimetidine, ranitidine)

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 (scopolamine)

Hyoscyamine

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

• Chlorpropamide
• Glipizide

Hypoglycemia, diaphoresis, lethargy, confusion

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

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

Illuminating gas

See Carbon monoxide

—

Imipramine

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 gluconate
• Ferrous sulfate
• 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, deferoxamine IV infusion starting at 15 mg/kg/h and titrated to BP

Isofenphos

See Organophosphates

—

Isoniazid

CNS stimulation, seizures, obtundation, coma

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

For acidosis, 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, diazepam to control seizures, fluid and electrolytes, elimination of source

Lime, chlorinated

See Chlorine

—

Lindane

See γ-Benzene hexachloride and Chlorinated and other halogenated hydrocarbons

—

Liquor

See Alcohol, ethyl

—

Lithium salts

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

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

Chronic: If symptoms are severe, dialysis

Lye (sodium hydroxide [NaOH])

see Poisoning: Caustic Ingestion

—

Lysergic acid diethylamide (LSD)

Confusion, hallucinations, hyperexcitability, coma, flashbacks

Supportive care, benzodiazepines

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

Malathion

See Organophosphates

—

Manganese

See Potassium permanganate

—

Marsh gas

See Carbon monoxide

—

Meperidine

See Opioids

—

Meprobamate

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, penicillamine (or succimer—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

Merthiolate (thimerosal)

See Mercury—usually nontoxic

—

Metaldehyde

• Slug bait

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

Supportive care, diazepam

Metals

See specific metals

See Table 4: Poisoning: Guidelines for Chelation Therapy

Metformin

See Hypoglycemic drugs, oral

—

Methadone

See Opioids

—

Methamphetamine

See Amphetamines

—

Methanol

See Alcohol, methyl

—

Methidathion

See Organophosphates

—

Methotrexate

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

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

Methoxychlor

See Chlorinated and other halogenated hydrocarbons

—

Methyl alcohol

See Alcohol, methyl

—

Methyl parathion

See Organophosphates

—

Methyl salicylate

see Poisoning: Aspirin and Other Salicylate Poisoning

—

Mineral spirits

See Petroleum distillates

—

Mirtazapine

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

• Isocarboxazid
• Phenelzine
• Selegiline
• Tranylcypromine

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

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

Hypotension and bradycardia (which may be ominous)

Consideration of gastric decontamination, supportive care

Monosodium glutamate

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

Supportive care

Morphine

See Opioids

—

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

—

Nefazodone

See Trazodone

—

Neostigmine

See Physostigmine

—

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 disulfiram if Na diethyldithiocarbamate is unavailable

Nicotine

See Tobacco

—

Nitrates

See Chlorates and nitrates

—

Nitric acid

see Poisoning: Caustic Ingestion

—

Nitrites

• Amyl nitrite
• Butyl nitrite
• Nitroglycerin
• Potassium nitrite
• Sodium nitrite

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

O₂

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

Nitrobenzene

• Artificial bitter almond oil
• Dinitrobenzene

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

See Acetanilide

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, prednisone 30–80 mg/day in adults and dexamethasone 1 mg/m² BSA in children to possibly prevent pulmonary fibrosis

Nitroglycerin

See Nitrites

—

Nitroprusside

See Cyanides

—

Nitrous oxide

See Chloroform

—

NSAIDs

• Ibuprofen

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

Clinical observation, supportive care

Nortriptyline

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
• Codeine
• Fentanyl
• Heroin
• Hydrocodone
• Meperidine
• Methadone
• Morphine
• Opium
• Oxycodone
• Propoxyphene

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

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

Opium

See Opioids

—

Organophosphates

• Acephate
• Bidrin
• Chlorethoxyfos
• Chlorothion
• Chlorpyrifos
• Coumaphos
• Demeton
• Diazinon
• Dichlorvos
• Dimethoate
• Disulfoton
• Ethion
• Famphur
• Fenthion
• Hexaethyltetraphosphate
• Isofenphos
• Leptophos
• Malathion
• Merphos
• Methidathion
• Methyl parathion
• Mipafox
• Naled
• Nerve gas agents
• Octamethyl pyrophosphoramide
• Oxydemeton-methyl
• Parathion
• Phorate
• Phosdrin
• Phosmet
• Pirimiphos-methyl
• Temefos
• Terbufos
• Tetrachlorvinphos
• Trichlorfon
• Triorthocresyl phosphate

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

Removal of clothing, flushing and washing of skin

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

Oxycodone

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, diazepam 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

—

Pentobarbital

See Barbiturates

—

Perchlordecone

See Chlorinated and other halogenated hydrocarbons

—

Permanent wave neutralizers

See Bromates

—

Permethrin

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

—

Phencyclidine (PCP)

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

Quiet environment

Benzodiazepines if needed to provide sedation

Phenmetrazine

See Amphetamines

—

Phenobarbital

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

• Chlorpromazine
• Prochlorperazine
• Promazine
• Trifluoperazine

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

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

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

Phenylpropanolamine

Nervousness, irritability, bradycardia, hypertension plus other sympathomimetic effects

Supportive care, diazepam

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

Phorate

See Organophosphates

—

Phosdrin

See Organophosphates

—

Phosmet

See Organophosphates

—

Phosphine

See Hydrogen sulfide

—

Phosphodiesterase (PDE) 5 inhibitors

• Avanafil
• Sildenafil
• Tadalafil
• Vardenafil

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

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

Phosphoric acid

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)

Physostigmine

• Eserine
• Neostigmine
• Pilocarpine
• Pilocarpus genus

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

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

Benzodiazepine prn to provide sedation

Pilocarpine

See Physostigmine

—

Pilocarpus genus

See Physostigmine

—

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

Prochlorperazine

See Phenothiazines

—

Prolan

See Chlorinated and other halogenated hydrocarbons

—

Promazine

See Phenothiazines

—

Propoxyphene

See Opioids

—

Protriptyline

See Tricyclic antidepressants

—

Prussic acid

See Cyanides

—

Pyrethrin

See Pyrethroids

—

Pyrethroids

• Bifenthrin
• Cyfluthrin
• Cypermethrin
• Esfenvalerate
• Fluvalinate
• Lambda-cyhalothrin
• Permethrin
• Pyrethrin
• Resmethrin
• Sumithrin
• Tefluthrin
• Tetramethrin

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

Thorough washing of skin, symptomatic and supportive care

Ranitidine

See Cimetidine

—

Rat poisons

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

—

Resmethrin

See Pyrethroids

—

Resorcinol (resorcin)

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

Respiratory support, methylene blue for methemoglobinemia

Roach poisons

See Fluorides, Phosphorus, and Thallium salts

—

Rubbing alcohol

See Alcohol, isopropyl

—

Salicylates

see Poisoning: Aspirin and Other Salicylate Poisoning

—

Salicylic acid

see Poisoning: Aspirin and Other Salicylate Poisoning

—

Scopolamine (hyoscine)

See Belladonna

—

Secobarbital

See Barbiturates

—

Selenium

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, diazepam 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

• Citalopram
• Escitalopram
• Fluoxetine
• Fluvoxamine
• Paroxetine
• Sertraline

Commonly, sedation, vomiting, tremor, tachycardia

Possibly, seizures, hallucinations, hypotension, serotonin syndrome

Rarely, death

With citalopram, QRS prolongation possible

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

For severe symptoms, consideration of IV lipid emulsion

Stibophen

See Arsenic

—

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 diazepam, respiratory support

For severe seizures, neuromuscular blockade and mechanical ventilatory support

Sulfur dioxide

• Smog

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

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

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

Consultation with poison control center for latest information advisable

Theophylline

See Aminophylline

—

Thyroxine

Usually asymptomatic

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

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

Tobacco

• Nicotine

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

Activated charcoal, respiratory support, O₂, diazepam 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:

—

Trazodone

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

Airway protection

For hypotension refractory to fluids, norepinephrine

Trichlorfon

See Organophosphates

—

Trichloromethane

See Chloroform

—

Tricyclic antidepressants

• Amitriptyline
• Desipramine
• Doxepin
• Imipramine
• Nortriptyline
• Protriptyline

Anticholinergic effects (eg, blurred vision, urinary hesitation), CNS effects (eg, drowsiness, stupor, coma, ataxia, restlessness, agitation, hyperactive reflexes, muscle rigidity, seizures), cardiovascular effects (eg, tachycardia, other arrhythmias, bundle branch block, QRS widening, impaired conduction, heart failure), respiratory depression, hypotension, shock, vomiting, hyperpyrexia, mydriasis, diaphoresis

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

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)

Diazepam to control seizures

Vasopressors (eg, norepinephrine) to maintain BP

For severe poisoning, consideration of IV lipid emulsion

Trifluoperazine

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

Valproate

Progressive CNS and respiratory depression

Respiratory and cardiovascular supportive measures, monitoring of liver function

Varnish

See Alcohol, methyl and Turpentine

—

Venlafaxine

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

Rarely death

Observation for ≥ 6 h

For QRS prolongation, consideration of alkalinization

Vitamins with iron

See Iron

—

Warfarin (sometimes used in pesticides)

• Bishydroxycoumarin
• Dicumarol
• Ethyl biscoumacetate
• Superwarfarins (sometimes used in pesticides)

Single ingestion not serious

With multiple ingestions, coagulopathy with increased PT/INR

For single ingestion, observation

For hemorrhagic manifestations, vitamin K₁ (phytonadione—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