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  » First Aid  »  Specific Poisons: Symptom and Treatment
Poison Symptoms Treatment
Acetaminophen Early: Often asymptomatic; mild nausea, vomiting, diaphoresis, pallor; beginning signs of hepatotoxicity; oliguria Later (at 24-48 h): Nausea & protracted vomiting, right upper quadrant pain, jaundice, coagulation defects, hypoglycemia, encephalopathy, hepatic failure; renal failure, myocardiopathy may occur Emesis: gastric lavage and/or charcoal. Monitor plasma drug levels for prognosis: if > 160-200 m g/mL at 4 h, hepatic damage may occur; if > 300 m g/mL at 4 h, hepatic damage is almost certain. If given before 18 h, oral acetylcysteine (Mucomystâ ) 140 mg/kg to start and 70 mg/kg q 4 h for 4 to 18 doses has been effective in preventing significant hepatotoxicity
Acetanilid Aniline (indelible) inks Aniline oils Chloroaniline Phenacetin (acetophenetidin) Cyanosis due to formation of methemoglobin & sulfhemoglobin, dyspnea, weakness, vertigo, anginal pain, rashes & urticaria, vomiting, delirium, depression, respiratory & circulatory failure
  1. Inhalation: Give O2; support respiration. Blood transfusion. For severe cyanosis, methylene blue 1-2 mg/kg IV
  2. Skin: Remove clothing & and wash area with copious soap & water; then as in (1)
  3. Ingestion: Give ipecac emetic; if this fails, gastric lavage and/or charcoal; then as in (1)
Acetone Ketones Model airplane glues, cements Nail polish remover Inhalation: Bronchial irritation, pulmonary congestion & edema, decreased respirations, dyspnea, drunkenness, stupor, ketosis Ingestion: As above except direct pulmonary effect Remove from source; evacuate stomach except for small amounts; support respiration; give O2 & fluids; correct metabolic acidosis
Acetonitrile Cosmetic nail adhesive Converted to cyanide, with usual symptoms & signs Manage as for cyanide
Acids Acetic Hydrochloric Nitric Phosphoric Corrosive burns from inhalation, skin contact,eye contact, & ingestion; local pain. In general, alkali is more damaging to the GI tract Skin or eye: Flush with water for 15 min Ingestion: Dilute with water or milk; do not stimulate vomiting; consider gastric lavage if large amounts of alkali granules have been consumed
Sulfuric (some drain or toilet bowl cleaners, some dishwasher detergents) Alkalis Ammonia water (ammonium hydroxide) Potassium hydroxide (potash) Sodium hydroxide (caustic soda, lye) Carbonates of the above Detergent powders Some drain or toilet bowl cleaners; some dishwasher detergents Drooling & stridor are suggestive of damage NOTE: Even in the absence of mouth lesions, strong alkalis (pH > 10.5-11.0) can burn the esophagus; esophagoscopy is advised Hospitalize; give opiates for pain; treat shock if present; endoscopy is recommended; tracheostomy may be needed; for verified esophageal burns, give antibiotics & dexamethasone 1 mg/m2 BSA q 6 h or equivalent for 2-3 wk
Alcohol, ethyl (ethanol) Brandy, whiskey, & other liquors Emotional lability, impaired coordination, flushing, nausea & vomiting, stupor to coma, respiratory depression Emesis: gastric lavage; support respiration; IV glucose to prevent hypoglycemia, dialysis if blood levels > 300-350 mg/dL; generous fluid administration as serum alcohol increases serum osmolarity
Alcohol, isopropyl Rubbing alcohol Dizziness, incoordination, stupor to coma, gastroenteritis, hypotension; no retinal injury Emesis: gastric lavage; IV glucose; correct dehydration & electrolyte changes; dialysis
Alcohol, methyl (methanol, wood alcohol) Antifreeze Paint solvent Solid cannel fuel Varnish Very toxic: 60-250 mL (2-8 oz) fatal in adults; 8-10 mL (2 tsp) in children. Latency period 12-18 h; headache, weakness, leg cramps, vertigo, convulsions, dimness of vision, decreased respiration Combat acidosis with IV sodium bicarbonate; give 10% ethanol/5% dextrose solution IV; initially, a loading dose of 0.7 gm/kg of ethanol to impede methanol metabolism is infused over 1 h followed by 0.1-0.2 gm/kg/h to maintain a blood ethanol level of 100 mg/dL; investigate use of 4-methylpyrazole (currently pending FDA approval); hemodialysis
Aminophylline Caffeine Theophylline Wakefulness, restlessness, anorexia, vomiting, dehydration, convulsions; with hypersensitivity, immediate vasomotor collapse may occur. Adults are more susceptible than children If ingested, use emetic or charcoal (avoid emesis if seizures are imminent). Stop medication; obtain theophylline blood level; phenobarbital or diazepam for convulsions; give parenteral fluids; maintain BP; if serum level > 50-100 mg/dL, consider dialysis; consider using a b blocker, eg propranolol, if patient is nonasthmatic
Ammonia gas Irritation of eyes & respiratory tract; cough, choking; abdominal pain Flush eyes with tap water for 15 min. No gastric lavage or emetic. If severe, positive pressure O2 to manage pulmonary edema; support respiration
Amphetamines Amphetamine sulfate, phosphate Dextroamphetamine Methamphetamine Phenmetrazine Increased activity, exhilaration, talkativeness, insomnia, irritability, exaggerated reflexes, anorexia, dry mouth, arrhythmia, anginal chest pain, heart block, psychotic-like states and inability to concentrate or sit still Emesis, lavage, or charcoal may be effective long after ingestion because of recycling via gastric mucosa Sedate with chlorpromazine 0.5-1 mg/kg IM or orally q 30 min as needed; reduce external stimuli; hypothermia; combat cerebral edema; hemodialysis. Use of b blockers may be helpful in nonasthmatics
Antihistamines Excitation or depression, drowsiness, nervousness, disorientation, hallucinations, tachycardia, arrhythmias, hyperpyrexia, delirium, convulsions Ipecac emesis (avoid emesis if seizures are imminent), gastric lavage, charcoal; support respiration/BP; control seizures with diazepam; physostigmine 0.5-2.0 mg (adults), 0.02 mg/kg (children) IM or IV (slowly) only after all else fails. (CAUTION: Seizures [see Physostigmine])
Antineoplastic agents Methotrexate Mercaptopurine Vincristine Effects on hematopoietic system, nausea, vomiting Emesis > lavage; supportive care; “leucovorin rescue”; observe for post-acute problems (beyond 24-48 h)
Arsenic & antinomy Antinomy compounds Stibophen Tartar emetic Arsenic Donovan’s solution Fowler’s solution Herbicides Paris green Pesticides Throat constriction, dysphagia; burning GI pain, vomiting, diarrhea; dehydration; pulmonary edema; renal failure; liver failure Emesis; gastric lavage, then a demulcent; chelation with penicillamine; BAL if patient cannot take oral medication; hydration; treat shock, pain; sorbitol or saline cathartic (sodium sulfate 15-30 gm in water)
Arsine gas Acute hemolytic anemia Transfusions; diuresis
Barbiturates Amobarbital Meprobamate Pentobarbital Secobarbital Headache, confusion, ptosis, excitement, delirium, loss of corneal reflex, respiratory failure, coma Empty stomach up to 24 h after ingestion. If immediately after, use ipecac emetic; if sedated, use lavage and charcoal with cuffed endotracheal tube. Good nursing care; support respiration, give 02; correct any dehydration. Rarely dialysis, especially for long-acting barbiturates where alkalinization hastens excretion
Barium compounds (soluble) Barium acetate carbonate chloride hydroxide nitrate sulfide Depilatories Fireworks Rodenticides Vomiting, abdominal pain, diarrhea, tremors, convulsions, hypertension, cardiac arrest To precipitate barium in stomach, give 60 gm sodium or magnesium sulfate orally. Then emesis or gastric lavage. Control convulsions with diazepam; atropine s.c., IM or IV 0.5-1.0 mg (adults), 0.01 mg/kg (children) for colic; sublingual nitroglycerin 1/100-1/50 for hypertension; 02 for dyspnea & cyanosis; quinidine 100-300 mg (adults), 6 mg/kg (children) to prevent ventricular fibrillation; correct hypokalemia
Belladonna Atropine Hyoscyamine Hyoscyamus Scopolamine (Hyoscine) Stramonium Dry skin & mucous membranes; pupils dilated; flushing, hyperpyrexia; tachycardia, restlessness; coma; respiratory failure; convulsions Emesis or charcoal; support respiration. May need to catheterize bladder. Physostigmine 0.5-2.0 mg (adults), 0.02 mg/kg (children) IM or IV (slowly) may reverse peripheral and central effects, but use only for severe problems. (CAUTION: Seizures: [see Physostigmine])
Benzene Benzol Hydrocarbons Model airplane glue Toluene Toluol Xylene Dizziness, weakness, headache, euphoria, nausea, vomiting, ventricular arrhythmia, paralysis, convulsions; with chronic poisoning, aplastic anemia, leukemia If sizeable ingestion (> 0.5-1 mL/kg), emesis or cautious gastric lavage. Give 02; support respiration; monitor ECG – ventricular fibrillation can occur early. Control seizures with diazepam. Blood transfusion for severe anemia.

Do not give epinephrine

g -Benzene hexachloride BHC Hexachlorocyclohexane Lindane Irritability, CNS excitation, muscle spasms, atonia, clonic & tonic convulsions, respiratory failure, pulmonary edema Emesis immediately after ingestion; gastric lavage; diazepam for convulsions. Avoid all oils – they promote absorption. Charcoal hemoperfusion prn
Benzodiazepines Dalmaneâ Libriumâ Valiumâ Sedation to coma, particularly if accompanied by alcohol Emesis; lavage; supportive care; suicidal precautions. IV flumazenil antidotes benzodiazepine overdose. (CAUTION: If tricyclics are involved, seizures are a risk).
Bismuth compounds Poorly absorbed. Ulcerative stomatitis, anorexia, headache, rash, renal tubular damage Ipecac emesis; gastric lavage; respiratory support; BAL
b blockers Hypotension, bradycardia, seizures, cardiac arrhythmias Monitor closely, evacuate stomach, If symptomatic, initiate glucagon 3-5 mg IV or in saline; consider cardiac pacing
Borates Boric acid Nausea, vomiting, diarrhea, hemorrhagic, gastroenteritis, weakness, lethargy, CNS depression, convulsion, “boiled lobster” skin rash, shock Ipecac emesis; gastric lavage; remove from skin; prevent or treat electrolyte changes & shock; control convulsions. Rarely, dialysis for severe poisoning
Bromides Nausea, vomiting, rash (may be acneiform), slurred speech, ataxia, confusion, psychotic behavior, coma, paralysis Ipecac emesis, gastric lavage for acute ingestion; stop use as medication; promote mild diuresis by hydration & sodium chloride IV; ethacrynic acid is specifically useful. Hemodialysis only if severe
Cadmium Solder Severe gastric cramps, vomiting, diarrhea; dry throat, cough, dyspnea; headache; shock, coma; brown urine, renal failure (“ouch-ouch disease”) Ipecac emesis; gastric lavage with milk or albumin; respiratory support; hydration; intermittent positive pressure breathing (IPPB) for pulmonary edema. Give edetate calcium disodium
Camphor Camphorated oils Camphor odor on breath, headache, confusion, delirium, hallucinations, convulsions, coma Ipecac emesis (avoid emesis is seizures are imminent), charcoal, or gastric lavage. Prevent & treat convulsions with diazepam; support respiration. Lipid dialysis is still being explored
Cantharides Cantharidin Spanish fly Skin and mucous membranes irritated, vesicles; nausea, vomiting, bloody diarrhea; burning pain in back and urethra; respiratory depression; convulsions, coma; abortion, menorrhagia Avoid all oils; ipecac emesis; support respiration; treat convulsions; maintain fluid balance; no specific antidote
Carbamates Usually less intense than those for organophosphates See management of organophosphates, except for pralidoxime (2-PAM)
Carbon dioxide Dyspnea, weakness, tinnitus, palpitations Respiratory support; 02
Carbon disulfide Carbon bisulfide Garlic-breath odor, irritability, weakness, manic depression, narcosis, delirium, mydriasis, blindness, parkinsonism, convulsions, coma, paralysis, respiratory failure Wash skin; emesis; garlic lavage; 02; diazepam sedation; support respiration & circulation
Carbon monoxide Acetylene gas Automobile exhaust Carbonyl iron Coal gas Furnace gas Illuminating gas Marsh gas Toxicity varies with length of exposure, concentration inhaled, respiratory & circulatory rates. Symptoms vary with % carboxyhemoglobin in blood. Headache, vertigo, dyspnea, confusion, dilated pupils, convulsions, coma 100% 02 by mask; respiratory support if needed; obtain carboxyhemoglobin level immediately. Avoid all stimulants. Hyperbaric 02 appears to be effective if carboxyhemoglobin is > approx. 25%; primary value may be at level of cytochrome
Carbon tetrachloride Cleaning fluids (nonflammable) Nausea, vomiting, abdominal pain, headache, confusion, visual disturbances, CNS depression, ventricular fibrillation, renal injury, hepatic injury Wash from skin; emesis or gastric lavage; give 02; support respiration; monitor renal & hepatic function & treat appropriately. Avoid alcohol, epinephrine, ephedrine
Chloral hydrate Chloral amide Drowsiness, confusion, shock, coma; respiratory depression; renal injury, hepatic injury Ipecac emesis; gastric lavage; respiratory support; look for concomitant ingestions
Chlorates Bromates Nitrates Permanent wave neutralizers Vomiting, nausea, diarrhea, cyanosis (methemaglobin), toxic nephritis, shock, convulsions, CNS depression, coma, jaundice Ipecac emesis; gastric lavage; transfusion for severe cyanosis; do not use methylene blue for chlorates or bromates. Treat shock; 02; consider dialysis for complex cases
Bromine Chlorinated lime Chlorine water Tear gas Chlorine (Cont’d) Inhalation: Severe respiratory & ocular irritation, glottal spasm, cough, choking, vomiting; pulmonary edema; cyanosis Ingestion: Irritation, corrosion of mouth & GI tract, possible ulceration or perforation; abdominal pain, tachycardia, prostration, circulatory collapse Inhalation: 02; respiratory support; watch for & treat pulmonary edema Ingestion: Ipecac emesis; gastric lavage; treat shock
Chloroform Ether Nitrous oxide Trichloromethane Drowsiness, coma; with nitrous oxide, delirium Inhalation: Respiratory, cardiac, and circulatory support Ingestion: Ipecac emesis; gastric lavage; observe for renal and hepatic damage
Chromic acid Bichromates Chromates Chromium trioxide Corrosive due to oxidation. Ulcer and perforated nasal septum; severe gastroenteritis; shock, vertigo, coma; nephritis Milk or water to dilute; BAL (or penicillamine) for severe symptoms; fluids & electrolytes, with caution, to support renal function
Cimetidine; ranitidine Slight dryness & drowsiness; can alter metabolism of concomitant drugs No specific antidotal treatment available: maintain a focus of metabolism of other drugs
Clonidine Sedation; periodic apnea; hypotension Emesis; lavage; supportive care; tolazoline IV & dopamine drip; naloxone 5m g/kg up to 2-20 mg, repeated as necessary
Cocaine Stimulation, then depression; nausea & vomiting; loss of self-control, anxiety, hallucinations; sweating; respiratory difficulty progressing to failure; cyanosis; circulatory failure; convulsions Emetic early; charcoal or gastric lavage; if needed, IV propranolol, with extreme caution, for arrhythmias, diazepam for excitation; 02 respiratory & circulatory support. Observe for myocardial or pulmonary disorder (usually occurs prior to emergency room arrival)
Copper salts Cupric sulfate, acetate, subacetate Cuprous chloride, oxide Zinc salts Vomiting, burning sensation, metallic taste, diarrhea, pain, shock, jaundice, anuria, convulsions Emesis; gastric lavage; penicillamine or BAL; electrolyte & fluid balance; respiratory support; monitor GI tract; treat shock, control convulsions; monitor for hepatic & renal failure
Cyanides Bitter almond oil Hydrocyanic acid Nitroprusside Potassium cyanide Prussic acid Sodium cyanide Wild cherry syrup Tachycardia, headache, drowsiness, hypotension, coma, convulsions, death; venous blood bright red; very rapidly lethal (1-15 min) Speed essential. Remove from source if inhaled; immediate emesis or lavage, amyl nitrite inhalation, 0.2 mL (1 ampule) 30 sec of each min, 100% 02, support respiration; 10 mL 3% sodium nitrite 2.5-5 mL/min IV (in child: 10 mg/kg) then 25-50 mL 25% sodium thiosulfate at 2.5-5 mL/min IV; repeat the above if symptoms recur. Use Lilly cyanide kit
DDT (chlorophenotante) Aldrin Bulan Chlordane Chlorinated organic insecticides DDD Dieldrin Dilan Endrin Heptachlor Methoxychlor Prolan Toxaphene Vomiting (early or delayed); paresthesias, malaise; coarse tremors, convulsions; pulmonary edema, ventricular fibrillation, respiratory failure Emesis; gastric lavage if not convulsing, or charcoal; diazepam or phenobarbital to prevent & control tremors & convulsions; avoid epinephrine & sudden stimuli; parenteral fluids; monitor for renal & hepatic failure
Dinitro-o-cresol Herbicides Pesticides Fatigue, thirst, flushing; nausea, vomiting, abdominal pain; hyperpyrexia, tachycardia, loss of consciouseness; dyspnea, respiratory arrest. Also absorbed through skin Emesis; gastric lavage; fluid therapy; 02; anticipate renal & hepatic toxicity; no specific antidote. Rinse skin with detergents
Diphenoxylate with atropine Lethargy, nystagmus, pinpoint pupils, tachycardia, coma, respiratory depression (NOTE: toxicity may be delayed up to 12 h) Ipecac emesis, gastric lavage; activated charcoal; naloxone; admit all children for observation if ingestion is verified
Ergot derivatives Thirst, diarrhea, vomiting, lightheadedness, burning feet; convulsions, hypotension, coma, abortion; gangrene of feet; cataract Ipecac emesis; gastric lavage; benzodiazepine or short-acting barbiturate for convulsions; papaverine 60 mg IV, 1-2 mg/kg IV for children
Ethylene glycol Diethylene glycol Permanent antifreeze Eye contact: iridocyclitis Ingestion: Inebriation but no alcohol odor on breath; nausea, vomiting; carpopedal spasm, lumbar pain; oxalate crystalluria; oliguria progressing to anuria & acute renal failure; respiratory distress, convulsions, coma Flush eyes Ingestion: Emesis; gastric lavage, support respiration, correct electrolyte imbalance (anion gap); give ethanol (see Alcohol, methyl); hemodialysis
Fluorides Ammonium fluoride Hydrofluoric acid Rat poisons Roach poisons Sodium fluoride Soluble fluorides generally Inhalation: Intense eye, nasal irritation; headache; dyspnea, sense of suffocation, glottal edema, pulmonary edema, bronchitis, pneumonia; mediastinal & subcutaneous emphysema from bleb rupture Skin & mucosa: Superficial of deep burns Ingestion: Salty or soapy taste; in large doses: tremors, convulsions, CNS depression; shock, renal failure Inhalation: 02, respiratory support; prednisone for chemical pneumonitis (adults 30-80 mg/day in divided doses); manage pulmonary edema Skin: Copious flushing with cold water; debride white tissue; inject 10% calcium gluconate locally or intra-arterially & apply magnesium oxide paste Ingestion: Ipecac emesis; gastric lavage – leave aluminum hydroxide gel, calcium, or magnesium hydroxide or chloride in stomach; IV glucose & saline; 10% calcium gluconate, 10 mL IV (1 mL/kg in child); monitor for cardiac irritability; treat shock & dehydration
Formaldehyde Formalin (NOTE: May contain methyl alcohol) Inhalation: Irritation of eyes, nose, respiratory tract; laryngeal spasm & edema; dysphagia; bronchitis, pneumonia Skin: Irritation, coagulation, necrosis; dermatitis, hypersensitivity Ingestion: Oral & gastric pain, nausea, vomiting, hematemesis, shock, hematuria, anuria, coma, respiratory failure Inhalation: Flush eyes with saline; 02; support respiration Skin: Wash copiously with soap & water Ingestion: Give water or milk to dilute; treat shock; correct acidosis with sodium bicarbonate; support respiration; observe for perforations
Glutethimide Drowsiness, areflexia, mydriasis, hypotension, respiratory depression, coma Ipecac emesis; gastric lavage, activates charcoal; support respiration, maintain fluid & electrolyte balance; hemodialysis may help; treat shock
H2 blockers Minor GI problems; may after the concentration level of other drugs Nonspecific supportive measures
Hydrogen sulfide Alkali sulfides Phosphine Sewer gas Volatile hydrides “Gas eye”( subacute keratoconjunctivitis), lacrimation & burning; cough, dyspnea, pulmonary edema; caustic skin burns, erythema, pain; profuse salivation, nausea, vomiting, diarrhea; confusion, vertigo; sudden collapse & unconsciousness Give 02, support respiration; amyl nitrite & sodium nitrite as for cyanide (no thiosulfate)
Hypochlorites Bleach, chlorine Javelle water Usually mild pain & inflammation of oral & GI mucosa; cough, dyspnea, vomitingskin vesicles Usual 6% household preparation require little except milk dilution; treat shock; esophagoscopy only if concentrated forms have been ingested
Iodine Burning pain in mouth & esophagus; mucous membranes stained brown; laryngeal edema; vomiting, abdominal pain, diarrhea; shock, nephritis, circulatory collapse Give milk, starch or flour orally; gastric lavage; fluid & electrolytes, treat shock, tracheostomy for laryngeal edema
Iodoform Triiodomethane Dermatitis; vomiting; cerebral depression; excitation; coma; respiratory difficulty Skin: Wash with sodium bicarbonate or alcohol Ingestion: Emetic or gastric lavage; respiratory support
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; concern if > 40-70 mg/kg of elemental iron ingested Ipecac emesis, gastric lavage; if serum iron > 400-500 mg/dL at 3-6 h, give deferoxamine 1 gm IV (maximal rate of 15 mg/kg/h) or 1-2 gm IM q 312 h (urine turns red within 2 h; if no color change, no further dose is needed); for shock, give deferoxamine 1 gm IV (maximal rate 15 mg/kg/h); exchange transfusion
Isoniazid (INH) CNS stimulation, seizures, obtundation, coma Emesis; lavage; diazepam sedation; pyrodoxine (mg for mg INH ingested) up to 200 mg slowly IV for seizures, repeat prn; NaHCO3 for acidosis
Lead Lead salts Solder Some paints & painted surfaces Acute inhalation: Insomnia, headache, ataxia, mania, convulsions Acute ingestion: Thirst, burning abdominal pain, vomiting, diarrhea, CNS symptoms as above Lead encephalopathy: see LEAD POISONING See LEAD POISONING
Lead, tetraethyl Vapor inhalation, skin absorption, ingestion: CNS symptoms – insomnia, restlessness, ataxia, delusions, mania, convulsions Supportive treatment; eg, diazepam, chlorpromazine, fluid & electrolytes; eliminate the source
Lithium salts Nausea, vomiting, diarrhea, tremors, drowsiness, renal failure, diabetes insipidus Acute: Emesis; diazepam – consider dialysis Chronic: Reduce doze, supportive therapy
Lysergic acid diethylamide (LSD) Confusion, hallucinations, hyperexcitability – coma. Flashbacks Supportive therapy; diazepam; chlorpromazine (50-100 mg IM in adults)
Mercury All mercury compounds Ammoniated mercury Bichloride of mercury Calomel Corrosive sublimate Diuretics Mercuric chloride Mercury vapor Merthiolate Acute: Severe gastroenteritis, burning mouth pain, salivation, abdominal pain, vomiting; colitis, nephrosis, anuria, uremia. Skin burns from alkyl & phenyl mercurials Chronic: Gingivitis, mental disturbance, neurologic deficits Mercury vapor: severe pneumonitis Gastric lavage, activated charcoal; give penicillamine (or BAL), Chelation Therapy; maintain fluid & electrolyte balance; hemodialysis for renal failure; observe for GI perforation Skin: Scrub with soap & water Lungs: Supportive care
Metaldehyde Nausea, vomiting, retching, abdominal pain, muscular rigidity, hyperventilation, convulsions, coma Emesis, if not spontaneous; supportive therapy; diazepam
Metals Symptoms vary with metals; see specific metals Chelation Therapy
Deodorizer cakes Moth balls, crystals, repellent cakes Contact: Dermatitis, corneal ulceration Inhalation: Headache, confusion, vomiting, dyspnea Ingestion: Abdominal cramps, nausea, vomiting; headache, confusion; dysuria; intravascular hemolysis; convulsions. Hemolytic anemia in persons with G6PD deficiency Contact: Remove clothing if formerly stored with naphthalene moth balls; flush skin and eyes Ingestion: Ipecac emesis, gastric lavage; blood transfusion for severe hemolysis; alkalize urine for hemoglobinuria; control convulsions
Alphaprodine Codeine Heroin Meperidine Methadone Morphine Opium Propoxyphene Pinpoint pupils, drowsiness, shallow respirations, spasticity, respiratory failure Do not give emetics. Gastric lavage, charcoal, respiratory support. Naloxone 5 mg/kg IV to awaken & improve respiration; if patient doesn’t respond, give 2-20 mg naloxone (dosage may need to be repeated as often as 10-20 times); fluids IV to support circulation
Nitrites Amyl nitrite Butyl nitrite Nitroglycerin Potassium nitrite Sodium nitrite Methemoglobinemia, cyanosis, anoxia, GI disturbance, vomiting, headache, dizziness, hypotension, respiratory failure, coma Ipecac emesis, gastric lavage; 02; for methemoglobinemia, 1% methylene blue 1-2 mg/kg slowly IV; when > 40% methemoglobin, transfusion with whole blood
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 Acetanilid
Air contaminants that form atmospheric oxidants; liberated from missile fuels, explosives, agricultural wastes Cobaltous chloride Fluorine Hydrogen chloride Hydrogen fluoride Delayed onset of symptoms with nitrogen oxides unless heavy concentration; other irritate gases give warnings – local burning in eye, nasal, pharyngeal mucous membranes. Fatigue, cough, dyspnea, pulmonary edema; later, bronchitis, pneumonia Bed rest, 02 as soon as symptoms develop; for excessive pulmonary foam: suction, postural drainage, tracheostomy; to prevent pulmonary fibrosis: prednisone 30-80 mg/day (adults) and dexamethasone 1 mg/m2 BSA (children) have been used
Organophosphates Chlorothion Demeton Diazinon Dipterex (trichlorfon) HETP (hexaethyl tetraphosphate) Malathion Nerve gas agents OMPA (octamethyl pyrophosphoramide) Parathion Systox TEPP (tetraethyl pypophosphate) Nausea, vomiting, abdominal cramping, excessive salivation; increased pulmonary secretion, headache, rhinorrhea, blurred vision, miosis; slurred speech, mental confusion; breathing difficulty, frothing at mouth; coma. Absorbed through skin, via inhalation or orally Remove clothing, flush & wash skin. Empty stomach; atropine: adults 2 mg, children 0.01 mg/kg IV or IM q 15-60 min, if no signs of atropine toxicity, repeat as needed; pralidoxime chloride (RAM): adults 1-2 gm, children 20-40 mg/kg, IV over 15-30 min, repeat in 1 h if needed; 02; support respiration; correct dehydration. Do not use morphine or aminophylline. Attendant should avoid self-contamination.
Oxalic acid Ethylene glycol Oxalates Burning pain in throat, vomiting, intensive pain; hypotension, tetany, shock; glottal & renal damage; oxaluria Give milk or calcium lactate; careful gastric lavage if at all; 10% calcium gluconate 10-20 mL IV; pain control, saline IV for shock; demulcents by mouth; watch for glottal edema & stricture
Paradichlorobenzene Insecticide Moth repellent Toilet bowl deodorant Abdominal pain, nausea, vomiting, diarrhea, seizures, tetany Ipecac emesis, gastric lavage; fluid replacement; diazepam for seizure control
Paraldehyde Paraldehyde odor on breath, incoherent, pupils contracted, respirations depressed, coma Ingestion: Ipecac emesis, gastric lavage; support respiration, 02
Paraquat Immediate: GI pain and vomiting; within 24 h: respiratory failure Emesis, fuller’s each plus Na2CO4; limit 02; call poison center or manufacturer
Asphalt Benzine (benzin) Fuel oil Gasoline Kerosene Lubricating oils Mineral spirits Model airplane glue Naphtha Petroleum ether Tar Vapor inhalation: Euphoria; burning in chest; headache, nausea, weakness; CNS depression, confusion; dyspnea, tachypnea, rales Ingestion: Burning throat & stomach, vomiting, diarrhea; pneumonia, only if aspiration has occurred Aspiration: Early acute pulmonary changes Since major problems are consequential to aspiration, as opposed to GI absorption, in most instances no gastric evacuation is warranted; gastric lavage only with rapid-onset depression from large amounts ingested; arterial blood gas levels to monitor care; supportive care for pulmonary edema; 02, respiratory support
Phencyclidine (PCP) “Spaced-out”, unconscious; hypertension Quiet environment; prolonged gastric lavage; propranolol & diazepam
Phenols Carbolic acid Creosote Cresols Guaiacol Naphthols Corrosive. Mucous membrane burns; pallor, weakness, shock; convulsions in children; pulmonary edema; smoky urine; respiratory, cardiac, & circulatory failure Remove clothing, wash external burns. Lavage with water, activated charcoal. Do not use alcohol or mineral oil. Demulcents; pain relief; 02; support respiration; correct fluid imbalance; watch for esophageal stricture (rare)
Phenothiazine Chlorpromazine Prochlorperazine Promazine Trifluoperazine (etc) Extrapyramidal tract symptoms (ataxia, muscular & carpopedal spasms, torticollis), usually idiosyncratic; overdose results in dry mouth, drowsiness, coma, hypothermia, respiratory collapse. Leukopenia, jaundice, coagulation defect, skin rashes Ipecac emesis, charcoal or gastric lavage; diphenhydramine 2-3 mg/kg IV or IM for extrapyramidal symptoms; diazepam for convulsions; warm patient. Avoid levarterenol & epinephrine; dialysis is of no benefit
Phenylpropanolamine Nervousness, irritability, hypertension plus other sympathomimetic effects Supportive therapy; diazepam; treat hypertension with phentolamine (Regitineâ 5 mg) or nitroprussides
Phosphorus (yellow or white) Rat poisons Roach powders (NOTE: Red phosphorus is unabsorbable & nontoxic) 3 Stages of symptoms: 1st – Garilcky taste; garlic odor on breath; local irritation, skin & throat burns, nausea, vomiting, diarrhea 2nd – Symptom-free 8 h to several days 3rd – Nausea, vomiting, diarrhea, liver enlargement, jaundice, hemorrhages, renal damage, convulsions, coma Toxicity enhanced by alcohol, fats, digestible oils Protect patient & attendant form vomitus, gastric washing, feces. If phosphorus is imbedded in skin, keep patient’s body submerged in water. Gastric lavage copiously – some still recommended potassium permanganate (1:5000) or cupric sulfate (250 mg in 250 mL water); mineral oil 100 mL (to prevent absorption) & repeat in 2 h; combat shock; vitamin K1 IV; transfusion with fresh blood
Physostigmine Eserine Neostigmine (Prostigminâ ) Pilocarpine Pilocarpus Dizziness, weakness, vomiting, cramping pain; pupils dilated, than contracted Atropine sulfate 0.6 to 1 mg (adults), 0.01 mg/kg (children) s.c. or IV with repeat doses prn. (CAUTION: using physostigmine to counter anticholinergics is associated with a 15% seizure rate)
Potassium permanganate Brown discoloration & burns of oral mucosa, glottal edema; hypotension; renal involvement Gastric lavage, demulcents; maintain fluid balance
Propranolol Confusion and seizures Emesis; lavage; supportive care; diazepam sedation; pacemakers and glucagon (0.05 mg/kg stat plus 2-5 mg/h) have been effective
Pyrethrum Pyrethrin Allergic response (including anaphylactic reactions, skin sensitivity) in sensitive people. Otherwise low toxicity, unless vehicle is a petroleum distillate (see that entry) For sizeable ingestion, emesis if patient is alert; otherwise, endotracheal tube and gastric lavage; wash skin well
Resorcinol (resorcin) Vomiting, dizziness, tinnitus, chills, tremor, delirium, convulsions, respiratory depression, coma Emetic or gastric lavage; support respiration
Silver salts Silver nitrate (NOTE: Chloride, bromide, iodide & oxide salts are usually benign) Stain on lips (white, brown, then black); gastroenteritis, shock, vertigo, convulsions Gastric lavage with saline (0.9% sodium chloride) solution; control pain; control convulsions with diazepam
Strychnine Restlessness, hyperacuity of hearing, vision, etc; convulsions from minor stimuli, complete muscle relaxation between convulsions; perspiration; respiratory arrest Isolate & restrict stimulation to prevent convulsions. Activated charcoal orally; control convulsions with IV diazepam, curariform drugs; support respiration; acid diuresis with ammonium chloride or ascorbic acid; gastric lavage after convulsions are controlled
Sulfur dioxide Smog Respiratory tract irritation; sneezing, cough, dyspnea pulmonary edema Remove from contaminated area, give 02; positive pressure breathing, respiratory support
Thallium salts (formerly used in: Ant poison Rat poison Roach poison Abdominal pain (colic), vomiting (may be bloody), diarrhea (may be bloody), stomatitis, excessive salivation; tremors, leg pains, paresthesias, polyneuritis, ocular & facial palsy; delirium, convulsions, respiratory failure; loss of hair about 3 wk after poisoning Ipecac emesis; gastric lavage; treat shock, control convulsions with diazepam; chelation therapy is still experimental. Contact local poison center for latest information.
Tryroxine Most are asymptomatic; rarely, increasing irritability progressing to thyroid storm in 5-7 days Emesis; observation at home; diazepam; consider antithyroid preparations and propranolol only if actual symptoms occur
Tobacco Nicotine Excitement, confusion, muscular twitching, weakness, abdominal cramps, clonic convulsions, depression, rapid respirations, palpitations, collapse, coma, CNS paralysis, respiratory failure Ipecac emesis; gastric lavage; activated charcoal; support respiration, 02; diazepam for convulsions; wash skin well if contaminated
Tricyclic antidepressants Amitriptyline Desipramine Doxepin Imipramine Nortriptyline Protriptyline Tricyclic antidepressants (Cont’d) Anticholinergic effects, (eg, blurred vision, urinary hesitation); CNS effects (eg, drowsiness, stupor, coma, ataxia, restlessness, agitation, hyperactive reflexes, muscle rigidity, & convulsions); CVS effects (tachycardia & other arrhythmias, bundle branch block, impaired conduction, congestive heart failure). Respiratory depression, hypotension, shock, vomiting, hyperpyrexia, mydriasis & diaphoresis may also be present Symptomatic & supportive; emesis (avoid emesis if seizures are imminent), charcoal, gastric lavage; monitor vital signs & ECG; maintain airway & fluid intake. Sodium bicarbonate as a rapid IV injection (0.5-2 mEq/L), repeat periodically to maintain blood pH > 7.45, precludes development of arrhythmias. Diazepam controls most CNS problems; only if symptoms persist should physostigmine salicylate (slowly IV) be used to reverse both CNS and cardiac manifestations of overdosage – adults: 2 mg with repeat of 1-4 mg prn at 20 to 60 min intervals; children: 0.5 mg repeated prn at 5 min intervals to maximum 2 mg
Turpentine Paint solvent Varnish Turpentine odor; burning oral & abdominal pain, coughing, choking, respiratory failure; nephritis Emesis (alert patient) if 1-4 oz, gastric lavage; support respiration; 02; control pain; monitor renal function
Verapamil; nifedipine; diltiazem Nausea, vomiting, mental confusion, bradycardia, hypotension Emesis; atropine has reversed bradycardia; avoid bagonists
Warfarin Bishydroxycoumarin Dicumarol Ethyl biscoumacetate Superwarfarins Single ingestion not serious, multiple overdoses result in coagulopathy; even with “super” drugs, most are unevenful For hemorrhagic manifestations, vitamin K1 till prothrombin time is normal, transfusion with fresh blood if necessary