Symptoms and treatment of specific poisons vary (see table). Including all the specific complexities and details is impossible, although cross-references are made to other entries in this table and elsewhere in THE MANUAL where appropriate. Consultation with a poison control center is recommended for any poisonings except the mildest and most routine.
(See also General Principles of Poisoning.)
Symptoms and Treatment of Specific Poisons
Poison* | Symptoms | Treatment |
|---|---|---|
ACE inhibitors | Angioedema, hypotension | |
Acephate | — | |
NAcetaminophen Poisoning: Treatment | ||
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: Skin contact: Clothing removed and area washed with copious soap and water; then as for inhalation Inhalation: Oxygen, respiratory support, blood transfusion |
Low concentration: Mild mucosal irritation High concentration: See Caustic Ingestion | Supportive care with irrigation and dilution | |
Acetone Ketones
| 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, oxygen and fluids, correction of metabolic acidosis |
Acetonitrile Cosmetic nail adhesive | Converted to cyanide, with usual symptoms and signs | See Cyanides |
Acetophenetidin | Acetanilide | — |
Acetylsalicylic acid | ||
Acids and alkalis | See specific acids and alkalis (eg, , Fluorides) and Caustic Ingestion Eye contact: See Overview of Eye Trauma Skin contact: See Burns | — |
Adhesives (eg, airplane glues or cements (model-building) | See Acetone, Benzene (toluene), and Petroleum distillates | — |
| Emotional lability, impaired coordination, flushing, nausea, vomiting, stupor to coma, respiratory depression | Supportive care, IV glucose for hypoglycemia |
Alcohol, isopropyl
| 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)
| Severe toxicity with 60–250 mL (2–8 ounces) in adults or 8–10 mL (2 teaspoons) in children Latency period 12–18 hours Headache, weakness, leg cramps, vertigo, seizures, retinal injury, dimmed vision, metabolic acidosis, decreased respiration | Hemodialysis (which is definitive treatment) |
Aldrin | See Chlorinated and other halogenated hydrocarbons | — |
Alkalis | See Acids and alkalis | — |
Aminophylline | Wakefulness, restlessness, anorexia, vomiting, dehydration, seizures, tachycardia In adults, greater toxicity after acute overdose added to chronic intake | > 50–100 mg/L (>278–555 micromol/L), acidosis, seizures, or coma, possibly dialysis |
Ammonia gas (anhydrous ammonia [NH3]) | Irritation of eyes and respiratory tract, cough, choking, abdominal pain | Flushing of eyes for 15 minutes with tap water or saline If severe toxicity, positive pressure oxygen to manage pulmonary edema, respiratory support |
Ammonia water (ammonium hydroxide [NH4OH]) | ||
Ammoniated mercury (NH2HgCl) | ||
Ammonium carbonate ([NH4]2CO3) | ||
Ammonium fluoride (NH4F) | See Fluorides | — |
Amphetamines
| Increased activity, exhilaration, talkativeness, insomnia, irritability, exaggerated reflexes, anorexia, diaphoresis, tachyarrhythmia, anginal chest pain, psychotic-like states, inability to concentrate or sit still, paranoia | For patients without asthma, beta-blockers possibly helpful but rarely necessary |
Aniline | See Acetanilide | — |
| Supportive care (eg, whole blood transfusion, consideration of prothrombin complex concentrates or hemodialysis) | |
Andexanet alfa competitively binds to the Xa inhibitor: Low-dose andexanet alpha: Initial IV bolus of 400 mg at 30 mg/min followed by 4 mg/min for up to 120 minutes High-dose andexanet alpha: Initial IV bolus of 800 mg at a rate of 30 mg/min followed by 8 mg/min for up to 120 minutes | ||
Supportive care (eg, whole blood transfusion) | ||
Anticoagulants, warfarins | Single ingestion—typically not serious With multiple ingestions, coagulopathy with increased PT/INR Higher risk of coagulopathy with single dose of superwarfarins | For single ingestion, observation Vitamin K Toxicity) until INR is normal, transfusion with fresh frozen plasma if necessary |
Antidepressants | See , , SSRIs, , Tricyclic antidepressants, | — |
Antifreeze | See 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: |
Antihyperglycemic drugs, oral | See Hypoglycemic drugs, oral | — |
Antimony
| Throat constriction, dysphagia, burning GI pain, vomiting, diarrhea, GI hemorrhage, dehydration, pulmonary edema, renal failure, lactic acidosis, liver failure, shock | |
Antipsychotic drugs (1st-generation) | 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 ventricular arrhythmias, consideration of alkalinization |
Antipsychotic drugs (2nd-generation) | For ventricular arrhythmias, consideration of alkalinization | |
Ant poison | Depends on ingredients, see Arsenic (sodium arsenate) and | — |
Arsenic
| Throat constriction, dysphagia, burning GI pain, vomiting, diarrhea, GI hemorrhage, dehydration, pulmonary edema, renal failure, lactic acidosis, liver failure, shock | |
Arsine gas | Transfusions, diuresis | |
Asphalt | See Petroleum distillates | — |
| 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: |
Automobile exhaust | See Carbon monoxide | — |
Barbiturates | Bradycardia, hypothermia, confusion, delirium, loss of corneal reflex, respiratory failure, drowsiness, ataxia, coma | For severe cases, hemodialysis |
Barium compounds (soluble)
| Vomiting, abdominal pain, diarrhea, tremors, seizures, colic, hypertension, cardiac arrest, dyspnea and cyanosis, ventricular fibrillation, severe hypokalemia, skeletal muscle weakness | For dyspnea and cyanosis, oxygen |
Bath salts | See Amphetamines | — |
Belladonna | See | — |
Benzene
| Dizziness, weakness, headache, euphoria, nausea, vomiting, ventricular arrhythmia, paralysis, seizures With chronic poisoning, aplastic anemia, hypokalemia, leukemia, CNS depression Irritability, CNS excitation, muscle spasms, atonia, tonic-clonic seizures, respiratory failure, pulmonary edema, nausea, vomiting, obtundation, coma | Decontamination with water, avoidance of vomiting and aspiration, oxygen, respiratory support, ECG monitoring (ventricular fibrillation can occur early) For severe anemia, blood transfusions Replacement of potassium as necessary |
Gamma-benzene hexachloride Hexachlorocyclohexane | Irritability, CNS excitation, muscle spasms, atonia, tonic-clonic seizures, respiratory failure, pulmonary edema, nausea, vomiting, obtundation, coma | |
Benzine (benzin) | See Petroleum distillates | — |
Benzodiazepines | Sedation to coma, particularly if drugs are accompanied by alcohol Hypotension | Airway control For hypotension, IV fluids and vasopressors ) |
Benzol | See Benzene | — |
Beta-blockers | Hypotension, bradycardia, seizures, cardiac arrhythmias, hypoglycemia, altered mental status | Close monitoring and attention to airway maintenance |
Bichloride of mercury | See Mercury | — |
Bichromates | See Chromic acid | — |
Bidrin (dicrotophos) | See Organophosphates | — |
Bifenthrin | See Pyrethroids | — |
Bismuth compounds | Acute: Abdominal pain, oliguria, acute renal failure Chronic: Poor absorption, ulcerative stomatitis, anorexia, progressive encephalopathy | Guidelines for Chelation Therapy) |
Bitter almond oil | See Cyanides | — |
Bleach, chlorine | See Hypochlorites | — |
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 | |
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 | For severe poisoning, hemodialysis |
Bromine | Highly corrosive With exposure to liquid or vapor, skin and mucous membrane burns | Aggressive decontamination, supportive care |
Respiratory depression, ataxia, seizures | ||
Butyl nitrate | See Nitrites | — |
Cadmium
| 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 | For inhalation, oxygen, sometimes bronchodilators and corticosteroids |
See Aminophylline | — | |
Calcium channel blockers | Nausea, vomiting, confusion, bradycardia, hypotension, total cardiovascular collapse Toxicity sometimes occurring after hyperglycemia | For sustained-release preparations, consideration of whole-bowel irrigation Consideration of IV lipid emulsion |
Calomel | See Mercury | — |
Camphor
| Camphor odor on breath, headache, confusion, delirium, hallucinations, seizures, coma | |
Cannabinoids, synthetic (synthetic marijuana) | Hypertension, tachycardia, MI, nausea, vomiting, agitation, hallucinations, psychoses, seizures, convulsions, stroke See also Cannabinoids, synthetic | Beta-blockers may help relieve cardiac symptoms, but are rarely necessary See also Cannabinoids, synthetic |
Canned fuel, solid | See Alcohol, methyl | — |
Cantharides
| Irritated skin and mucous membranes, skin vesicles, nausea, vomiting, bloody diarrhea, burning pain in back and urethra, respiratory depression, seizures, coma, abortion, menorrhagia | Respiratory support, treatment of seizures, maintenance of fluid balance, avoidance of all oils derived from cantharides No specific antidote |
Carbamates
| Slightly to highly toxic effects; similar to those of organophosphates except cholinesterase inhibition is not permanent See Organophosphates | See Organophosphates |
Progressive CNS depression, seizures (occasional), cardiac arrhythmia (rare) | Supportive care after decontamination, heart rate monitoring | |
Carbolic acid | See Phenols | — |
Carbonates (ammonium, potassium, sodium) | ||
Carbon bisulfide or disulfide | ||
Carbon dioxide | Dyspnea, weakness, tinnitus, palpitations, asphyxia | Respiratory support, oxygen |
Carbon monoxide | 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% Oxygen by mask, respiratory support if needed, immediate measurement of carboxyhemoglobin level; if carboxyhemoglobin is more than about 25%, consideration of hyperbaric oxygen in consultation with poison control center (see Carbon Monoxide Poisoning) |
Carbon tetrachloride (sometimes used in chemical manufacturing and some cleaning fluids) | Nausea, vomiting, abdominal pain, headache, confusion, visual disturbances, CNS depression, ventricular fibrillation, kidney injury, liver injury, cirrhosis | Washing of skin, oxygen, respiratory support, monitoring of kidney and liver function and appropriate treatment |
Carbonyl iron | See Iron | — |
Cathinones (substituted) | See Amphetamines | — |
Caustic soda (sodium hydroxide) | ||
Chloral hydrate Chloral amide | Drowsiness, confusion, shock, coma, respiratory depression, kidney injury, liver injury | For ventricular arrhythmias, respiratory support, assessment of concomitant ingestions, beta-blockers |
Chlorates and nitrates
| Vomiting, nausea, diarrhea, cyanosis (methemoglobin), toxic nephritis, shock, seizures, CNS depression, coma, jaundice | For complex cases, possibly dialysis |
Chlordane | See Chlorinated and other halogenated hydrocarbons | — |
Chlorethoxyfos | See Organophosphates | — |
Chlorinated and other halogenated hydrocarbons (in many insecticides)
| 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 | For renal and liver failure, monitoring, and supportive care |
Chlorine (see also Hypochlorites)
| 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: |
Chloroaniline | See Acetanilide | — |
Chloroform | Asphyxiation Drowsiness, coma Possible acute liver injury | 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 | — |
Chlorpyrifos | See Organophosphates | — |
Chromic acid and chromates
| 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 |
Irritation of skin and mucous membranes | ||
See Chromic acid | — | |
Bradycardia, sedation, periodic apnea, hypotension, hypothermia | ||
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 | — |
Stimulation then depression, nausea, vomiting, loss of self-control, anxiety, hallucinations, sweating, hyperthermia, seizures, MI (rare) | Observation for myocardial or pulmonary disorder (usually before emergency department arrival) For hyperthermia, external cooling | |
Nausea, hemorrhagic gastritis, multiorgan failure, pancytopenia, sepsis | ||
| Vomiting, burning sensation, metallic taste, diarrhea, pain, shock, jaundice, anuria, seizures | 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
| 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 minutes) | Speed essential Inhalation: Removal from source Inhalation or ingestion: 100% Oxygen, respiratory support |
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 Naphthaleneand Paradichlorobenzene | — |
Depilatories | See Barium compounds | — |
Detergent powders | ||
Diazinon | See Organophosphates | — |
Dichlorvos | See Organophosphates | — |
Dicofol | See Chlorinated and other halogenated hydrocarbons | — |
Dieldrin | See Chlorinated and other halogenated hydrocarbons | — |
Dienochlor | See Chlorinated and other halogenated hydrocarbons | — |
Diethylene glycol | See Ethylene glycol | — |
Digitalis Digitoxin | ||
Dilan | See Chlorinated and other halogenated hydrocarbons | — |
Dimethoate | See Organophosphates | — |
Dinitrobenzene | See Nitrobenzene | — |
Dinitro-o-cresol
| Fatigue, thirst, flushing, nausea, vomiting, abdominal pain, hyperpyrexia, tachycardia, loss of consciousness, dyspnea, respiratory arrest, skin absorption | Fluid therapy, oxygen, anticipation of kidney and liver toxicity, no specific antidote, detergents to rinse skin |
Lethargy, nystagmus, pinpoint pupils, tachycardia, coma, respiratory depression (NOTE: Toxicity may be delayed up to 12 hours.) | ||
Diquat | See Paraquat | — |
Dishwasher detergents | ||
Disulfoton | See Organophosphates | — |
Donovan solution | See Arsenic | — |
Drain cleaners | ||
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 |
Eserine | See | — |
Esfenvalerate | See Pyrethroids | — |
See Alcohol, ethyl | — | |
Ether | See Chloroform | — |
Ethion | See Organophosphates | — |
Ethylene glycol, diethylene glycol
| 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: Hemodialysis, which is definitive treatment Eye contact: Flushing of eyes |
Explosives | See Barium compounds (fireworks) and Nitrogen oxides | — |
Famphur | See Organophosphates | — |
Fava bean (favism) | ||
Fenthion | See Organophosphates | — |
Ferric salts | See Iron | — |
Ferrous salts (eg, gluconate, sulfate) | See Iron | — |
Fireworks | See Barium compounds | — |
Fluorides
| Ingestion of small or moderate doses: Salty or soapy taste Ingestion of 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: Skin and mucosal contact: Inhalation: |
Fluvalinate | See Pyrethroids | — |
Formaldehyde
| 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: Skin contact: Washing with copious soap and water Inhalation: Flushing of eyes with saline, oxygen, respiratory support |
Fowler solution | See Arsenic | — |
Fuel, canned | See Alcohol, methyl | — |
Fuel oil | See Petroleum distillates | — |
Gas | See specific gas, eg, Ammonia gas, Carbon monoxide , 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 | — |
Gold salts | Gold chloride: Liver and kidney toxicity Cyanide gold salts: Cyanide toxicity | See Cyanide Treatment (above) See Table Guidelines for Chelation Therapy |
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) | — |
Hexachlorocyclohexane | See Gamma-benzene hexachloride | |
Hexaethyltetraphosphate | See Organophosphates | — |
Histamine-2 blockers | See H2 blockers | — |
Hydrides, volatile | See Hydrogen sulfide | — |
Hydrocarbons | See petroleum distillates andHydrocarbon Poisoning | — and Hydrocarbon Poisoning |
Hydrocarbons, chlorinated | See Chlorinated and other halogenated hydrocarbons | — |
Hydrocarbons, halogenated | See Chlorinated and other halogenated hydrocarbons | — |
Hydrochloric acid | ||
Hydrocyanic acid | See Cyanides | — |
Hydrofluoric acid | See Fluorides | — |
Hydrogen chloride or fluoride | ||
Hydrogen sulfide
| lacrimation and burning eyes, cough, dyspnea, pulmonary edema, caustic skin burns, erythema, pain, profuse salivation, nausea, vomiting, diarrhea, confusion, vertigo, sudden collapse, unconsciousness | Oxygen, respiratory support |
Hyoscyamus | See Belladonna | — |
Hypochlorites
| 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) If concentrated forms have been ingested, esophagoscopy, treatment of shock |
Hypoglycemic drugs, oral Sulfonylureas
| Hypoglycemia, diaphoresis, lethargy, confusion | For lactic acidosis, supportive care and hemodialysis |
Inhalational anesthetics
| Asphyxiation Drowsiness, coma With nitrous oxide, delirium With chloroform, possible acute liver injury | Ingestion: Observation for kidney and liver damage; respiratory, cardiac, and circulatory support Inhalation: Respiratory, cardiac, and circulatory support |
Insecticides | See specific agentChlorinated 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: |
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 mcg/dL (>Iron Poisoning, Treatment |
Isofenphos | See Organophosphates | — |
CNS stimulation, seizures, obtundation, coma, hepatotoxicity | ||
Javelle water | See Hypochlorites | — |
Kerosene | See Petroleum distillates | — |
Ketones | See Acetone | — |
Lambda-cyhalothrin | See Pyrethroids | — |
Lead
| 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, acceleration of atherosclerosis | See Lead Poisoning |
Lead, tetraethyl | Vapor inhalation, skin absorption, or ingestion: CNS symptoms (eg, insomnia, restlessness, ataxia, delusions, mania, seizures) | |
Lime, chlorinated | See Chlorine | — |
See Gamma-benzene hexachloride and Chlorinated and other halogenated hydrocarbons | — | |
Nausea, vomiting, diarrhea, tremors,fasciculations, drowsiness, diabetes insipidus, ataxia, seizures, hypothyroidism | Acute:> 4 mEq/L (4 mmol/L) Chronic: If symptoms are severe, dialysis | |
Lye (sodium hydroxide [NaOH]) | Ingestion: see Caustic Ingestion Skin exposure, see Symptoms and Signs of Burns | Ingestion: see Caustic Ingestion Skin exposure, see Treatment of Burns |
Lysergic acid diethylamide (LSD) | Confusion, hallucinations, hyperexcitability, coma, flashbacks | Supportive care, benzodiazepines |
See Organophosphates | — | |
See Potassium permanganate | — | |
Mercury, compounds of
| 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 | 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: 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
| Nausea, vomiting, retching, abdominal pain, muscular rigidity, hyperventilation, seizures, coma | |
Metals | See entries for specific metals | See table Guidelines for Chelation Therapy |
Lactic acidosis | For lactic acidosis, supportive care and hemodialysis | |
Methanol, methyl alcohol | See Alcohol, methyl | — |
Methidathion | See Organophosphates | — |
Methoxychlor | See Chlorinated and other halogenated hydrocarbons | — |
Methyl parathion | See Organophosphates | — |
Methylene chloride | See Carbon monoxide | See Carbon monoxide |
Mineral spirits | See Petroleum distillates | — |
Usually benign Most commonly, sedation, confusion, tachycardia | Observation for ≥ 8 hours | |
Model airplane glues, solvents | See Acetone, Benzene, Petroleum distillates, and Toluene | — |
Monoamine oxidase (MAO) inhibitors | Nonspecific and highly variable symptoms, which are often delayed 6–24 hours Sympathomimetic toxidromes, headache, nausea, dystonia, hallucinations, nystagmus, fasciculations, diarrhea, seizures, agitation, muscle rigidity Hypotension and bradycardia (which may be ominous) | Consideration of gastric emptying, supportive care |
Monosodium glutamate | Burning sensations throughout the body, facial pressure, anxiety, chest pain (Chinese restaurant syndrome) | Supportive care |
Moth balls, crystals, or repellent cakes | See Naphthalene, Camphor, and Paradichlorobenzene | — |
Mushrooms, poisonous | ||
Nail polish remover | See Acetone | — |
Naled | See Organophosphates | — |
Naphtha | See Petroleum distillates | — |
Naphthalene
| 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 | — |
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) | |
See Tobacco | ||
Nitrates | See Chlorates and nitrates | — |
Nitric acid | ||
Nitrites
| Methemoglobinemia, cyanosis, anoxia, GI disturbance, vomiting, headache, dizziness, hypotension, respiratory failure, coma | Oxygen |
Nitrobenzene
| 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 Environmental Pulmonary Disease)
| Delayed onset of symptoms with nitrogen oxides unless heavy concentration Fatigue, cough, dyspnea, pulmonary edema Later, bronchitis, pneumonia | Bed rest, oxygen as soon as symptoms develop 2 BSA in children to possibly prevent pulmonary fibrosis |
See Cyanides | — | |
Nitrous oxide | See Chloroform | — |
Nausea, vomiting, CNS toxicity (eg, seizures with massive overdoses) | Clinical observation, supportive care | |
Octamethyl pyrophosphoramide | See Organophosphates | — |
Oil of wintergreen | ||
Oils | See Acetanilide (aniline oil) and Petroleum distillates (fuel oil, lubricating oils) | — |
Pinpoint pupils, drowsiness, shallow respirations, spasticity, respiratory failure | ||
Organophosphates
| 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 attendants, avoidance of self-contamination |
Oxalic acid Oxalates | Burning pain in throat, vomiting, intense pain, hypotension, tetany, shock, glottal and kidney damage, oxaluria | |
Oxydemeton-methyl | See Organophosphates | — |
Paints | For lead-containing paints, see Lead | — |
Paint thinners | See Alcohol, methyl; Petroleum distillates (mineral spirits); and Turpentine | — |
Paradichlorobenzene
| Abdominal pain, nausea, vomiting, diarrhea, seizures, tetany (rare) | |
Paraldehyde | Oxygen, respiratory support | |
Paraquat (a strong corrosive) Diquat | Immediate: GI pain and vomiting Within 24 hours: Respiratory failure (but no pulmonary problems with diquat) | |
Parathion | See Organophosphates | — |
Paris green | See Arsenic | — |
Perchlordecone | See Chlorinated and other halogenated hydrocarbons | — |
See Pyrethroids | — | |
Pesticides | See specific compounds | — |
Petroleum distillates (see Hydrocarbon Poisoning)
| 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, oxygen, 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 |
Phenols
| Corrosive effects, mucous membrane burns, pallor, weakness, shock, seizures in children, pulmonary edema, smoky urine, esophageal stricture (rare) Respiratory, cardiac, and circulatory failure | |
Phenothiazines | Extrapyramidal symptoms (eg, ataxia, muscular and carpopedal spasms, torticollis), usually idiosyncratic With overdose, dry mouth, drowsiness, seizures, coma, respiratory depression | |
Phenylpropanolamine | Nervousness, irritability, bradycardia, hypertension plus other sympathomimetic effects | |
Phorate | See Organophosphates | — |
Phosdrin | See Organophosphates | — |
Phosmet | See Organophosphates | — |
Phosphine | See Hydrogen sulfide | — |
Phosphodiesterase (PDE) 5 inhibitors | Hypotension, tachycardia, chest pain, arrhythmias, vision loss, priapism | Supportive care, IV fluids and vasopressors, urologic consultation to treat priapism, avoidance of nitrates |
Phosphoric acid | ||
Phosphorus (yellow or white)
| Stage 1: Stage 2: Symptom-free 8 hours 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 For phosphorus embedded in skin:
|
| Dizziness, weakness, vomiting, cramping pain, bradycardia, possibly seizures, agitation | Benzodiazepine as needed to provide sedation |
Pilocarpus genus | See | — |
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 |
Agitation, sinus tachycardia, seizures, coma Withdrawal syndrome similar to withdrawal symptoms after stopping gamma-hydroxybutyrate (GHB) | Supportive care, benzodiazepines for seizures and agitation | |
Prolan | See Chlorinated and other halogenated hydrocarbons | — |
Propoxyphene | See Opioids | — |
Prussic acid | See Cyanides | — |
Pyrethrin, and pyrethroids
| 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 |
Rat poisons | See specific components (eg, Barium compounds, Fluorides, Phosphorus [yellow or white], Thallium salts, Anticoagulants, warfarins) | — |
Resmethrin | See Pyrethroids | — |
Resorcinol (resorcin) | Vomiting, dizziness, tinnitus, chills, tremor, delirium, seizures, respiratory depression, coma, methemoglobinemia | |
Roach poisons | See Fluorides, Phosphorus, and Thallium salts | — |
Rubbing alcohol | See Alcohol, isopropyl | — |
Salicylates | ||
See Belladonna | — | |
See Arsenic and Thallium salts | — | |
Sewer gas | See Hydrogen sulfide | — |
Silver salts | Stained lips (white, brown, then black), argyria (slate gray or blue skin discoloration), gastroenteritis, shock, vertigo, seizures | |
Smog | See Sulfur dioxide | — |
Soda, caustic (Na hydroxide) | For ingestions, see Caustic Ingestion, for skin contact see Burns | |
Sodium carbonate | See Acids and alkalis | — |
Sodium cyanide | See Cyanides | — |
See Fluorides | — | |
Sodium hydroxide | See Caustic Ingestion for skin contact see Burns | See Caustic Ingestion for skin contact see Burns |
Solder | See Cadmium and Lead | — |
SSRIs | Commonly, sedation, vomiting, tremor, tachycardia Possibly, seizures, hallucinations, hypotension, serotonin syndrome Rarely, death | Airway protection; consideration of alkalinization for QRS widening; admission of patients who have symptoms > 6 hours 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 | For severe seizures, neuromuscular blockade and mechanical ventilatory support |
Sulfur dioxide
| Respiratory tract irritation, sneezing, cough, dyspnea, pulmonary edema | Removal from contaminated area, oxygen, positive pressure breathing, respiratory support |
Sulfuric acid | For ingestion, see Caustic Ingestion for skin contact see Burns | |
Sumithrin | See Pyrethroids | — |
Syrup of wild cherry | See Cyanides | — |
Tar | See Petroleum distillates | — |
Tartar emetic | See Arsenic | — |
Tear gas | See Chlorine (see also Hypochlorites) | — |
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 weeks after poisoning | Consultation with poison control center for latest information advisable |
See Aminophylline | — | |
Thyroxine | Usually asymptomatic Rarely, increasing irritability progressing to thyroid storm in 5–7 days | |
Tobacco | Excitement, confusion, muscular twitching, weakness, abdominal cramps, generalized myoclonus, CNS depression, rapid respirations, palpitations, cardiovascular collapse, coma, respiratory failure | |
Toilet bowl cleaners, deodorizers | See Symptoms of Caustic Ingestion and Paradicholorobenzene | See Treatment of Caustic Ingestion and — |
Toluene, toluol | See Benzene | — |
Toxaphene | See Chlorinated and other halogenated hydrocarbons | — |
Trichlorfon | See Organophosphates | — |
Trichloromethane | See Chloroform | — |
Tricyclic antidepressants | 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 | > 7.45 (constant infusion may be needed) For severe poisoning, consideration of IV lipid emulsion |
Triiodomethane | See Iodoform (triiodomethane) | — |
Tungsten | Exposure may cause diffuse interstitial pulmonary fibrosis. See Overview of Interstitial Lung Disease | |
Turpentine
| Turpentine odor, burning oral and abdominal pain, coughing, choking, respiratory failure, nephritis | Respiratory support, oxygen, control of pain, monitoring of kidney function |
Valproate | Progressive CNS and respiratory depression Hyperammonemia with or without hepatic toxicity | Respiratory and cardiovascular supportive measures, monitoring of liver function Symptomatic hyperammonemia: L-Carnitine 100 mg/kg (6 g maximum) IV over 30 minutes with maintenance dose of 15 mg/kg every 4 hours Asymptomatic hyperammonemia: L-Carnitine 100 mg/kg orally every 6 hours (3 g/day maximum) |
Varnish | See Alcohol, methyl and Turpentine | — |
Possibly sedation, seizures, QRS prolongation, sympathomimetic symptoms (eg, tremor, mydriasis, tachycardia, hypertension, diaphoresis), hypotension Rarely death | Observation for ≥ 6 hours For QRS prolongation, consideration of alkalinization | |
Vitamins with iron | See Iron | — |
See Anticoagulants, warfarins | — | |
Wild cherry syrup (natural, not artificially flavored) | See Cyanides | — |
Wintergreen oil | — | |
Wood alcohol | See Alcohol, methyl | — |
Xylene | See Benzene | — |
Zinc | See Zinc Toxicity | See table Guidelines for Chelation Therapy |
See | — | |
BP = blood pressure; BSA = body surface area; CNS = central nervous system; ECG = electrocardiogram; GI = gastrointestinal; INR = international normalized ratio; NGT = nasogastric tube; NSAID = nonsteroidal anti-inflammatory drug; PT = prothrombin time; SSRI = selective serotonin reuptake inhibitor. | ||
If a term is not readily visible in the alphabetical listing of poisons, try searching the current web page according to the conventions of your device and browser. | ||
* 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. Most drugs are included as members of a class (eg, beta blockers) and only the most common and important drugs will have a separate row entry. | ||
More Information
The following is an English-language resource that may be useful. Please note that THE MANUAL is not responsible for the content of this resource.
Hazardous Materials Tools: A searchable database of known toxic substances curated by the U.S. Library of Medicine's Wireless Information System for Emergency Responders (WISER)
