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 | Charcoal, supportive care, a bradykinin inhibitor (ecallantide or icatibant), supportive care, a bradykinin inhibitor (ecallantide or icatibant) For angioedema, epinephrine, antihistamines, or corticosteroids, although they may not be effective. Also consider giving tranexamic acid.For angioedema, epinephrine, antihistamines, or corticosteroids, although they may not be effective. Also consider giving tranexamic acid. For hypotension, consideration of naloxoneFor hypotension, consideration of naloxone |
Acephate | See Organophosphates | — |
AcetaminophenAcetaminophen | See table Stages of Acute Acetaminophen PoisoningStages of Acute Acetaminophen Poisoning | N-acetylcysteine, see Acute Acetaminophen 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:Charcoal; then as for inhalation Skin contact: Clothing removed and area washed with copious soap and water; then as for inhalation Inhalation: Oxygen, respiratory support, blood transfusion For severe cyanosis, methylene blue 1–2 mg/kg IVFor severe cyanosis, methylene blue 1–2 mg/kg IV |
Acetic acidAcetic acid | 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 | See Acetanilide | — |
Acetylsalicylic acid | See Aspirin and Other Salicylate PoisoningAspirin and Other Salicylate Poisoning | |
Acids and alkalis | See specific acids and alkalis (eg, Boric acidBoric acid, 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 | — |
Alcohol, ethyl (ethanol)Alcohol, ethyl (ethanol)
| 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 | Fomepizole (15 mg/kg, then 10 mg/kg every 12 hours); alternatively, 10% ethanol/5% D/W IV with an initial loading dose of 10 mL/kg over 1 hour, then 1–2 mL/kg/h to maintain a blood ethanol level of 100 mg/dL (22 mmol/L)Fomepizole (15 mg/kg, then 10 mg/kg every 12 hours); alternatively, 10% ethanol/5% D/W IV with an initial loading dose of 10 mL/kg over 1 hour, 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 | — |
Aminophylline CaffeineCaffeine GuaranaGuarana TheophyllineTheophylline | 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 blood pressure(for ingestion), discontinuation of drug, measurement of blood theophylline level, phenobarbital or diazepam for seizures, parenteral fluids, maintenance of blood pressure For theophylline, serum level For theophylline, serum level> 50–100 mg/L (> 278–555 micromol/L), acidosis, seizures, or coma, possibly dialysis For patients without asthma, possibly a beta-blocker (eg, esmolol)For patients without asthma, possibly a beta-blocker (eg, esmolol) |
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 | 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, beta-blockers possibly helpful but rarely necessary |
Aniline | See Acetanilide | — |
Anticoagulants, direct thrombin inhibitorsAnticoagulants, direct thrombin inhibitors
| Bleeding secondary to thrombin inhibitionBleeding secondary to thrombin inhibition | Supportive care (eg, whole blood transfusion, consideration of prothrombin complex concentrates or hemodialysis) Idarucizumab (available to reverse dabigatran) dose is 5 g total administered IV as 2 vials of 2.5 g in rapid succession.Idarucizumab (available to reverse dabigatran) dose is 5 g total administered IV as 2 vials of 2.5 g in rapid succession. |
Anticoagulants, factor Xa inhibitorsAnticoagulants, factor Xa inhibitors
| Bleeding secondary to factor Xa inhibitionBleeding secondary to factor Xa inhibition | For control of bleeding complications, supportive care (eg, whole blood transfusion) and/or prothrombin complex concentrateFor control of bleeding complications, supportive care (eg, whole blood transfusion) and/or prothrombin complex concentrate Oral activated charcoal and supportive care 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 Use of high- vs low-dose of andexanet alpha as an antidote is determined by timing (> or < 8 hours of presentation) and strength (> or < 10 mg for rivaroxaban and > or < 5 mg for apixaban) of the last dose of the Xa inhibitor; < 8 hours of presentation and higher Xa inhibitor dose requires high-dose andexanet alphaUse of high- vs low-dose of andexanet alpha as an antidote is determined by timing (> or or rivaroxaban and > or apixaban) of the last dose of the Xa inhibitor; < 8 hours of presentation and higher Xa inhibitor dose requires high-dose andexanet alpha |
Anticoagulants, heparin and low molecular weight heparinsAnticoagulants, heparin and low molecular weight heparins | Bleeding secondary to decreased thrombin and fibrin clot formationBleeding secondary to decreased thrombin and fibrin clot formation | Supportive care (eg, whole blood transfusion) Protamine sulfate (to reverse unfractionated heparin, but only partially neutralizes low-molecular-weight heparins)Protamine sulfate (to reverse unfractionated heparin, but only partially neutralizes low-molecular-weight heparins) |
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 For hemorrhagic manifestations, vitamin K1 (phytonadione—see For hemorrhagic manifestations, vitamin K1 (phytonadione—seeVitamin K Toxicity) until INR is normal, transfusion with fresh frozen plasma if necessary To achieve rapid reversal, administer prothrombin complex concentrateTo achieve rapid reversal, administer prothrombin complex concentrate |
Antidepressants | See BupropionBupropion, MirtazapineMirtazapine, SSRIs, TrazodoneTrazodone, Tricyclic antidepressants, VenlafaxineVenlafaxine | — |
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:Seizures—see PhysostigmineSeizures—see Physostigmine), consideration of physostigmine 0.5–2.0 mg in adults or 0.02 mg/kg in children IV (slowly)), consideration of physostigmine 0.5–2.0 mg in adults or 0.02 mg/kg in children IV (slowly) |
Antihyperglycemic medications, oral | See Hypoglycemic medications, oral | — |
Antimony
| 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 medications, hydration, treatment of shock and painChelation with penicillamine, dimercaprol for patients who cannot take oral medications, hydration, treatment of shock and pain |
Antipsychotic medications (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 dystonia, diphenhydramine or benztropineFor dystonia, diphenhydramine or benztropine For hypotension refractory to fluids, norepinephrineFor hypotension refractory to fluids, norepinephrine For ventricular arrhythmias, consideration of serum alkalinization |
Antipsychotic medications (2nd-generation) | CNS depression (particularly with olanzapine), miosis, anticholinergic effects, hypotension, dystonia, QT prolongation (occasionally), fatal bone marrow suppression (rare)CNS depression (particularly with olanzapine), miosis, anticholinergic effects, hypotension, dystonia, QT prolongation (occasionally), fatal bone marrow suppression (rare) | For dystonia, diphenhydramine or benztropineFor dystonia, diphenhydramine or benztropine For hypotension refractory to fluids, norepinephrineFor hypotension refractory to fluids, norepinephrine For ventricular arrhythmias, consideration of alkalinization |
Ant poison | Depends on ingredients, see Arsenic (sodium arsenate) and Boric acidBoric acid | — |
Arsenic
| 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 medications, hydration, treatment of shock and painChelation with penicillamine, dimercaprol for patients who cannot take oral medications, hydration, treatment of shock and pain |
Arsine gas | Transfusions, diuresis | |
Asphalt | See Petroleum distillates | — |
AspirinAspirin | See Aspirin and Other Salicylate PoisoningAspirin and Other Salicylate Poisoning | — |
Atropine and related compoundsAtropine and related compounds
| 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 PhysostigmineSeizures—see Physostigmine), consideration of physostigmine 0.5–2.0 mg in adults or 0.02 mg/kg in children IV (slowly)), consideration of physostigmine 0.5–2.0 mg in adults or 0.02 mg/kg in children IV (slowly) |
Automobile exhaust | See Carbon monoxide | — |
Barbiturates | Bradycardia, hypothermia, confusion, delirium, loss of corneal reflex, respiratory failure, drowsiness, ataxia, coma | Charcoal up to 24 hours after ingestion, supportive care; urine alkalinization for phenobarbital (to aid in elimination)up to 24 hours after ingestion, supportive care; urine alkalinization for phenobarbital (to aid in elimination) 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 | Potassium chloride 10–15 mEq/h (10–15 mmol/h) IV, sodium or magnesium sulfate 60 g orally to precipitate barium in stomach, then possibly gastric lavagePotassium chloride 10–15 mEq/h (10–15 mmol/h) IV, sodium or magnesium sulfate 60 g orally to precipitate barium in stomach, then possibly gastric lavage Diazepam to control seizuresDiazepam to control seizures For dyspnea and cyanosis, oxygen |
Bath salts | See Amphetamines | — |
Belladonna | See AtropineAtropine | — |
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) Diazepam to control seizuresDiazepam to control seizures For severe anemia, blood transfusions Replacement of potassium as necessary Epinephrine contraindicatedEpinephrine contraindicated Diazepam to control seizuresDiazepam to control seizures |
Benzene hexachloride (lindane)Benzene hexachloride (lindane) Gamma-benzene hexachloride Hexachlorocyclohexane LindaneLindane | 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 seizuresDiazepam to control seizures |
Benzine (benzin) | See Petroleum distillates | — |
Benzodiazepines | Sedation to coma, particularly if accompanied by alcohol Hypotension | Airway control For hypotension, IV fluids and vasopressors Avoidance of the benzodiazepine reversal agent flumazenil unless treating patients with side effects after acute administration of benzodiazepines for sedation who are not on TCAs (Avoidance of the benzodiazepine reversal agent flumazenil unless treating patients with side effects after acute administration of benzodiazepines for sedation who are not on TCAs (CAUTION: If tricyclic antidepressants are involved, flumazenil may precipitate seizures; in patients who depend on benzodiazepines, flumazenil may precipitate withdrawal.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, calcium dichloride, IV insulin and glucose, cardiac pacing, intra-aortic balloon pump, and IV lipid emulsionFor symptomatic patients, consideration of dopamine, epinephrine, other vasopressors, glucagon 3–5 mg IV followed by infusion, calcium dichloride, 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 | — |
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 Respiratory support, consideration of chelation with dimercaprol and succimer (see tableGuidelines for Chelation Therapy) |
Bitter almond oil | See Cyanides | — |
Bleach, chlorine | See Hypochlorites | — |
Boric acidBoric 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 |
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 medication, hydration and sodium chloride IV to promote diuresis, furosemide 10 mg IV every 6 hoursDiscontinuation of medication, hydration and sodium chloride IV to promote diuresis, furosemide 10 mg IV every 6 hours For severe poisoning, hemodialysis |
Bromine | Highly corrosive With exposure to liquid or vapor, skin and mucous membrane burns | Aggressive decontamination, supportive care |
Bupropion hydrochlorideBupropion hydrochloride | Respiratory depression, ataxia, seizures | Charcoal, benzodiazepines, supportive care |
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 | Dilution with milk or albumin, respiratory support, hydration, possibly chelation with succimer or dimercaptopropane sulfonateDilution with milk or albumin, respiratory support, hydration, possibly chelation with succimer or dimercaptopropane sulfonate Dimercaprol contraindicatedDimercaprol contraindicated For inhalation, oxygen, sometimes bronchodilators and corticosteroids |
CaffeineCaffeine | 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 Glucagon 5–10 mg IVGlucagon 5–10 mg IV For hypotension or severe arrhythmias, consideration of calcium dichloride (eg, 1 g–10 mL of a 10% solution) or 3 times as much calcium gluconate IV with additional amounts as needed, pacemaker, or intra-aortic balloon pumpFor hypotension or severe arrhythmias, consideration of calcium dichloride (eg, 1 g–10 mL of a 10% solution) or 3 times as much calcium 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 infusionConsideration 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 | — |
CamphorCamphor
| Camphor odor on breath, headache, confusion, delirium, hallucinations, seizures, comaCamphor odor on breath, headache, confusion, delirium, hallucinations, seizures, coma | Diazepam to prevent and treat seizures, respiratory supportDiazepam to prevent and treat seizures, respiratory support |
Cannabinoids, synthetic (synthetic marijuana) | Hypertension, tachycardia, MI, nausea, vomiting, agitation, hallucinations, psychoses, seizures, convulsions, stroke See also Cannabinoids, synthetic | Supportive care with IV fluids, benzodiazepines for agitation and seizures, phenobarbital for seizuresSupportive care with IV fluids, benzodiazepines for agitation and seizures, phenobarbital for seizures 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 |
CarbamazepineCarbamazepine | Progressive CNS depression, seizures (occasional), cardiac arrhythmia (rare) | Supportive care after decontamination, heart rate monitoring For arrhythmias, consideration of IV sodium bicarbonateFor arrhythmias, consideration of IV sodium bicarbonate |
Carbolic acid | See Phenols | — |
Carbonates (ammonium, potassium, sodium) | — | |
Carbon bisulfide or disulfide | Garlic odor on breath, irritability, weakness, mania, narcosis, delirium, mydriasis, blindness, parkinsonism, seizures, coma, paralysis, respiratory failureGarlic odor on breath, irritability, weakness, mania, narcosis, delirium, mydriasis, blindness, parkinsonism, seizures, coma, paralysis, respiratory failure | Washing of skin, oxygen, diazepam sedation, respiratory and circulatory supportWashing of skin, oxygen, diazepam sedation, respiratory and circulatory support |
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 approximately 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 | Methylene blue for methemoglobinemia, 10% thiosulfate to reduce chlorate to the less toxic chloride, transfusion for severe cyanosis, ascorbic acid, treatment of shock, oxygenMethylene blue for methemoglobinemia, 10% thiosulfate to reduce chlorate to the less toxic chloride, transfusion for severe cyanosis, ascorbic acid, treatment of shock, oxygen 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 | Diazepam or phenobarbital to prevent and control tremors and seizures, cautious use of epinephrine, avoidance of sudden stimuli, parenteral fluidsDiazepam 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, 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: Oxygen, respiratory support, observation for and treatment of pulmonary edema, nebulized sodium bicarbonate (4 mL of 4.2% NaHCO3)Oxygen, respiratory support, observation for and treatment of pulmonary edema, nebulized sodium bicarbonate (4 mL of 4.2% NaHCO3) |
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-acetylcysteine and ascorbic acid to convert hexavalent to the less toxic trivalent compoundand ascorbic acid to convert hexavalent to the less toxic trivalent compound |
ChromiumChromium | Irritation of skin and mucous membranes | Thorough washing with water and 10% ascorbic acid solution for 15 minutesThorough washing with water and 10% ascorbic acid solution for 15 minutes |
Chromium trioxideChromium trioxide | See Chromic acid | — |
ClonidineClonidine | Bradycardia, sedation, periodic apnea, hypotension, hypothermia | Supportive care; vasopressors; naloxone 5 mcg/kg up to 2–20 mg, repeated as needed, to possibly reduce sedationSupportive care; vasopressors; naloxone 5 mcg/kg up to 2–20 mg, repeated as needed, 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 | — |
CocaineCocaine† | Stimulation then depression, nausea, vomiting, loss of self-control, anxiety, hallucinations, sweating, hyperthermia, seizures, MI (rare) | Diazepam for excitation (primary treatment), oxygen, respiratory and circulatory support if needed, IV sodium bicarbonateDiazepam for excitation (primary treatment), oxygen, respiratory and circulatory support if needed, IV sodium bicarbonate For arrhythmias, extremely cautious use of IV esmololFor arrhythmias, extremely cautious use of IV esmolol Observation for myocardial or pulmonary disorder (usually before emergency department arrival) For hyperthermia, external cooling |
ColchicineColchicine | Nausea, hemorrhagic gastritis, multiorgan failure, pancytopenia, sepsis | Multiple-dose activated charcoal, IV fluids, supportive care, granulocyte colony-stimulating factor |
Copper saltsCopper salts
| Vomiting, burning sensation, metallic taste, diarrhea, pain, shock, jaundice, anuria, seizures | Penicillamine or dimercaprol (see table Penicillamine or dimercaprol (see tableGuidelines 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 Inhalation of amyl nitrite 0.2 mL (1 ampule) for 30 seconds of each minute; 3% sodium nitrite 10 mL at 2.5–5 mL/min IV (in children, 10 mg/kg), then 25% sodium thiosulfate 25–50 mL at 2.5–5 mL/min IV (cyanide kit); treatment repeated if symptoms recurInhalation of amyl nitrite 0.2 mL (1 ampule) for 30 seconds of each minute; 3% sodium nitrite 10 mL at 2.5–5 mL/min IV (in children, 10 mg/kg), then 25% sodium thiosulfate 25–50 mL at 2.5–5 mL/min IV (cyanide kit); treatment repeated if symptoms recur Hydroxocobalamin 5 g IV (preferred treatment)Hydroxocobalamin 5 g IV (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 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 DigoxinDigoxin | See Drugs for Heart Failure: DigoxinDrugs for Heart Failure: Digoxin | — |
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 |
Diphenoxylate with atropineDiphenoxylate with atropine | Lethargy, nystagmus, pinpoint pupils, tachycardia, coma, respiratory depression (NOTE: Toxicity may be delayed up to 12 hours.) | Activated charcoal, naloxone, careful monitoring of all children for 12–18 hours if ingestion is verified, supportive care, naloxone, careful monitoring of all children for 12–18 hours if ingestion is verified, supportive care |
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 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 IVFor 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 nifedipineFor coronary vasospasm, IV nitroglycerin and nifedipine |
Eserine | See PhysostigminePhysostigmine | — |
Esfenvalerate | See Pyrethroids | — |
Ethanol, ethyl alcoholEthanol, ethyl alcohol | 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: 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 every 12 hoursRespiratory 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 every 12 hours 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: Dilution with milk or water, IV glucose and saline, 10% calcium gluconate 30 mL IV (in children, 0.6 mL/kg) or 10% calcium dichloride 10 mL IV (in children, 0.1–0.2 mL/kg), monitoring for cardiac irritability, treatment of shock and dehydrationDilution with milk or water, IV glucose and saline, 10% calcium gluconate 30 mL IV (in children, 0.6 mL/kg) or 10% calcium dichloride 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% calcium gluconate locally but may be given intra-arterially, application of calcium gluconate or calcium carbonate paste or gelCopious flushing with water, debridement of white tissue, sometimes injection of 10% calcium gluconate locally but may be given intra-arterially, application of calcium gluconate or calcium carbonate paste or gel Inhalation: Oxygen, respiratory support, prednisone for chemical pneumonitis (in adults, 15–40 mg orally twice a day), management of pulmonary edemaOxygen, respiratory support, prednisone for chemical pneumonitis (in adults, 15–40 mg orally twice a day), management of pulmonary edema |
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: Dilution with water or milk; treatment of shock, sodium bicarbonate to correct acidosis, respiratory support, observation for perforationsDilution with water or milk; treatment of shock, sodium bicarbonate to correct acidosis, respiratory support, observation for perforations 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 |
H2 blockers (eg, cimetidine, ranitidine)H2 blockers (eg, cimetidine, ranitidine) | Minor GI problems, possibly altered levels of other medications | 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 and Hydrocarbon 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 |
Hyoscine (scopolamine)Hyoscine (scopolamine) HyoscyamineHyoscyamine 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 medications, oral Sulfonylureas
| 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 glucoseAdmission 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 subcutaneously 2 or 3 times a dayFor persistent hypoglycemia, consideration of octreotide 50–100 mcg IV or subcutaneously 2 or 3 times a day 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 agent: 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 sodium bicarbonate or alcoholWashing with sodium bicarbonate or alcohol |
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 (> 72–90 micromol/L) at 3–6 hours plus GI symptoms, deferoxamine IV infusion starting at 15 mg/kg/h and titrated to BP. See 72–90 micromol/L) at 3–6 hours plus GI symptoms, deferoxamine IV infusion starting at 15 mg/kg/h and titrated to BP. SeeIron Poisoning, Treatment |
Isofenphos | See Organophosphates | — |
IsoniazidIsoniazid | CNS stimulation, seizures, obtundation, coma, hepatotoxicity | For seizures, pyridoxine given IV mg for mg ingested or, if amount ingested is unknown, 5 mg IVFor seizures, pyridoxine given IV mg for mg ingested or, if amount ingested is unknown, 5 mg IV For acidosis, sodium bicarbonateFor acidosis, sodium bicarbonate |
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) | Supportive care, diazepam to control seizures, fluid and electrolytes, elimination of sourceSupportive care, diazepam to control seizures, fluid and electrolytes, elimination of source |
Lime, chlorinated | See Chlorine | — |
LindaneLindane | See Gamma-benzene hexachloride and Chlorinated and other halogenated hydrocarbons | — |
Lithium saltsLithium 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 Hydration, diazepam, possibly dialysis for end-organ damage or serum lithium level> 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 For severe agitation, haloperidol 2–10 mg IV or IM in adults (repeated as necessary)For severe agitation, haloperidol 2–10 mg IV or IM in adults (repeated as necessary) |
MalathionMalathion | See Organophosphates | — |
ManganeseManganese | 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 | Consideration of gastric lavage, activated charcoal, penicillamine (or succimer—see table , penicillamine (or succimer—see tableGuidelines 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 | Supportive care, diazepamSupportive care, diazepam |
Metals | See entries for specific metals | See table Guidelines for Chelation Therapy |
MetforminMetformin | 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 | — |
Methyl salicylateMethyl salicylate | See Aspirin and Other Salicylate PoisoningAspirin and Other Salicylate Poisoning | — |
Methylene chloride | See Carbon monoxide | See Carbon monoxide |
Mineral spirits | See Petroleum distillates | — |
MirtazapineMirtazapine | 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, CamphorCamphor, 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) | Removal from source, decontamination, consideration of sodium diethyldithiocarbamate orally (mild exposure) or IV (severe exposure) or disulfiram if sodium diethyldithiocarbamate is unavailableRemoval from source, decontamination, consideration of sodium diethyldithiocarbamate orally (mild exposure) or IV (severe exposure) or disulfiram if sodium diethyldithiocarbamate is unavailable |
NicotineNicotine | See Tobacco | — |
Nitrates | See Chlorates and nitrates | — |
Nitric acid | ||
Nitrites
| Methemoglobinemia, cyanosis, anoxia, GI disturbance, vomiting, headache, dizziness, hypotension, respiratory failure, coma | — For methemoglobinemia, 1% methylene blue 1–2 mg/kg IV slowlyFor methemoglobinemia, 1% methylene blue 1–2 mg/kg IV slowly |
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 For excessive pulmonary edema, suction, postural drainage, mechanical ventilation, prednisone 30–80 mg/day in adults and dexamethasone 1 mg/mFor 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 |
NitroprussideNitroprusside | See Cyanides | — |
Nitrous oxide | See Chloroform | — |
NSAIDs (eg, ibuprofen, naproxen)NSAIDs (eg, ibuprofen, naproxen) | Nausea, vomiting, CNS toxicity (eg, seizures with massive overdoses) | Clinical observation, supportive care |
Octamethyl pyrophosphoramide | See Organophosphates | — |
Oil of wintergreen | See Aspirin and Other Salicylate PoisoningAspirin and Other Salicylate Poisoning | — |
Oils | See Acetanilide (aniline oil) and Petroleum distillates (fuel oil, lubricating oils) | — |
Pinpoint pupils, drowsiness, shallow respirations, spasticity, respiratory failure Meperidine: SeizuresMeperidine: Seizures | Charcoal, respiratory support, naloxone IV (IM or intranasal if IV access unavailable) as required to awaken patients and improve respiration, IV fluids to support circulation, respiratory support, naloxone IV (IM or intranasal if IV access unavailable) as required to awaken patients and improve respiration, IV fluids to support circulation | |
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 increased secretions, atropine 2–5 mg in adults or 0.05 mg/kg in children IV or IM every 15–60 minutes, repeated and increased as needed (massive amounts may be necessary) as often as every 3–5 minutes; pralidoxime chloride 1–2 g in adults or 20–40 mg/kg in children IV over 15–30 minutes, repeated in 1 hour if needed; oxygen; respiratory support; correction of dehydrationFor increased secretions, atropine 2–5 mg in adults or 0.05 mg/kg in children IV or IM every 15–60 minutes, repeated and increased as needed (massive amounts may be necessary) as often as every 3–5 minutes; pralidoxime chloride 1–2 g in adults or 20–40 mg/kg in children IV over 15–30 minutes, repeated in 1 hour if needed; oxygen; 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 calcium lactate, 10% calcium gluconate 10–20 mL IV, pain control, saline IV for shock, observation for glottal edema and strictureMilk or calcium lactate, 10% calcium gluconate 10–20 mL IV, pain control, saline IV for shock, observation for glottal edema and stricture |
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) | Fluid replacement, diazepam to control seizuresFluid replacement, diazepam to control seizures |
Paraldehyde | Acetic acid odor on breath, incoherence, miosis, depressed respiration, comaAcetic acid odor on breath, incoherence, miosis, depressed respiration, coma | Oxygen, respiratory support |
Paraquat (a strong corrosive) Diquat | Immediate: GI pain and vomiting Within 24 hours: Respiratory failure (but no pulmonary problems with diquat) | Activated charcoal, fuller’s earth, limited oxygen, consultation with poison control center or manufacturer |
Parathion | See Organophosphates | — |
Paris green | See Arsenic | — |
Perchlordecone | See Chlorinated and other halogenated hydrocarbons | — |
PermethrinPermethrin | 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 | Removal of clothing, washing of external burns with water, activated charcoal, pain relief, oxygen, respiratory support, correction of fluid imbalance, observation for esophageal stricture |
Phenothiazines | 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 seizuresDiphenhydramine 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, diazepamSupportive care, diazepam For hypertension, phentolamine 5 mg IV over approximately 1 minute or nitroprusside IVFor hypertension, phentolamine 5 mg IV over approximately 1 minute or nitroprusside IV |
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: Garlicky taste, garlic odor on the breath, local irritation, nausea, vomiting, diarrhea, corrosive burns of skin, throat, and mucous membranes (due to explosiveness and flammability of phosphorus)Garlicky taste, garlic odor on the breath, local irritation, nausea, vomiting, diarrhea, corrosive burns of skin, throat, and mucous membranes (due to explosiveness and flammability of phosphorus) 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 GI lavage with dilute potassium permanganate (1:5000) or hydrogen peroxide (eg, 1–2%), which may change phosphorus to nontoxic oxidesGI lavage with dilute potassium permanganate (1:5000) or hydrogen peroxide (eg, 1–2%), which may change phosphorus to nontoxic oxides For phosphorus embedded in skin:
|
PhysostigminePhysostigmine
| Dizziness, weakness, vomiting, cramping pain, bradycardia, possibly seizures, agitation | Atropine sulfate 0.6–1 mg in adults or 0.01 mg/kg in children subcutaneously or IV, repeated as neededAtropine sulfate 0.6–1 mg in adults or 0.01 mg/kg in children subcutaneously or IV, repeated as needed Benzodiazepine as needed to provide sedation |
Pilocarpus genus | See PhysostigminePhysostigmine | — |
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 |
PregabalinPregabalin | 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, warfarinAnticoagulants, warfarin) | — |
Resmethrin | See Pyrethroids | — |
Resorcinol (resorcin) | Vomiting, dizziness, tinnitus, chills, tremor, delirium, seizures, respiratory depression, coma, methemoglobinemia | Respiratory support, methylene blue for methemoglobinemiaRespiratory support, methylene blue for methemoglobinemia |
Roach poisons | See Fluorides, Phosphorus, and Thallium salts | — |
Rubbing alcohol | See Alcohol, isopropyl | — |
Salicylates | See Aspirin and Other Salicylate PoisoningAspirin and Other Salicylate Poisoning | — |
Salicylic acidSalicylic acid | See Aspirin and Other Salicylate PoisoningAspirin and Other Salicylate Poisoning | — |
Scopolamine (hyoscine)Scopolamine (hyoscine) | See Belladonna | — |
Selenium (bluing agents)Selenium (bluing agents) | See Arsenic and Thallium salts | — |
SemaglutideSemaglutide | Nausea, vomiting, diarrhea, xerostomia | Supportive care with IV fluids, antinausea medication Rarely, hospitalization |
Sewer gas | See Hydrogen sulfide | — |
Silver salts Silver nitrateSilver nitrate | Stained lips (white, brown, then black), argyria (slate gray or blue skin discoloration), gastroenteritis, shock, vertigo, seizures | Control of pain, diazepam to control seizuresControl of pain, diazepam to control 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 | — |
Sodium fluorideSodium fluoride | 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 With citalopram, QRS prolongation possibleWith citalopram, QRS prolongation possible | Airway protection; consideration of serum 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 | Isolation and restricted stimulation to prevent myoclonic agitation, activated charcoal orally, IV diazepam, respiratory supportorally, IV diazepam, respiratory support 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 approximately 3 weeks after poisoning | Treatment of shock, supportive care, diazepam to control seizures, activated Treatment of shock, supportive care, diazepam to control seizures, activatedcharcoal (which effectively binds thallium and interrupts enterohepatic circulation), Prussian blue 60 mg/kg 4 times day via NGT (same purpose as charcoal), chelation therapy with dimercaprol (used with varying success)), chelation therapy with dimercaprol (used with varying success) Avoidance of penicillamine and diethyldithiocarbamate (which may redistribute thallium into the CNS)Avoidance of penicillamine and diethyldithiocarbamate (which may redistribute thallium into the CNS) Consultation with poison control center for latest information advisable |
TheophyllineTheophylline | 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 occurEmesis, observation at home, diazepam, possibly antithyroid preparations and propranolol but only if symptoms occur |
Tobacco
| Excitement, confusion, muscular twitching, weakness, abdominal cramps, generalized myoclonus, CNS depression, rapid respirations, palpitations, cardiovascular collapse, coma, respiratory failure | Activated charcoal, respiratory support, oxygen, diazepam for seizures, thorough washing of skin if contaminated, respiratory support, oxygen, diazepam for seizures, thorough washing of skin if contaminated |
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 | Symptomatic treatment and supportive care, charcoal, monitoring of vital signs and ECG, maintenance of airway Sodium bicarbonate as a rapid IV injection (0.5–2 mEq/kg [0.5–2 mmol/L]), repeated periodically to narrow the QRS, prevent arrhythmias, and maintain blood pH Sodium bicarbonate as a rapid IV injection (0.5–2 mEq/kg [0.5–2 mmol/L]), repeated periodically to narrow the QRS, prevent arrhythmias, and maintain blood pH> 7.45 (constant infusion may be needed) Diazepam to control seizuresDiazepam to control seizures Vasopressors (eg, norepinephrine) to maintain BPVasopressors (eg, norepinephrine) to maintain BP 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 | — |
VenlafaxineVenlafaxine | 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 | — |
WarfarinWarfarin | See Anticoagulants, warfarinAnticoagulants, warfarin | — |
Wild cherry syrup (natural, not artificially flavored) | See Cyanides | — |
Wintergreen oil | See Aspirin and Salicylate Poisoning: See Aspirin and Salicylate Poisoning:Symptoms and Signs | — |
Wood alcohol | See Alcohol, methyl | — |
Xylene | See Benzene | — |
Zinc | See Zinc Toxicity | See table Guidelines for Chelation Therapy |
Zinc saltsZinc salts | See Copper saltsCopper salts | — |
ACE = angiotensin-converting enzyme; BP = blood pressure; BSA = body surface area; CNS = central nervous system; ECG = electrocardiogram; GI = gastrointestinal; INR = international normalized ratio; IV = intravenous; NGT = nasogastric tube; NSAID = nonsteroidal anti-inflammatory drug; PT = prothrombin time; SSRI = selective serotonin reuptake inhibitor; TCA = tricyclic antidepressant. | ||
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 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 and medications are included as members of a class (eg, beta blockers) and only the most common and important drugs and medications will have a separate row entry. | ||
† Physicians should be aware of people who smuggle plastic bags of cocaine in the GI tract (inserted through the mouth or rectum) or the vagina (so-called packers) and people who hurriedly ingest poorly wrapped packs of drugs to avoid criminal consequences when being pursued by police (so-called stuffers).Physicians should be aware of people who smuggle plastic bags of cocaine in the GI tract (inserted through the mouth or rectum) or the vagina (so-called packers) and people who hurriedly ingest poorly wrapped packs of drugs to avoid criminal consequences when being pursued by police (so-called stuffers). | ||
More Information
The following English-language resources may be useful. Please note that The Manual is not responsible for the content of these resources.
Chemical Companion (ERDSS). Available as both a tablet app and downloadable software.
U.S. Department of Health and Human Services. Chemical Hazards Emergency Medical Management. Available as downloadable software.
U.S. Department of Transportation (DOT) Pipeline and Hazardous Materials Safety Administration. Emergency Response Guidebook. Available as a downloadable document and a mobile application.
National Oceanic and Atmospheric Administration. CAMEO Chemicals. Available as a mobile application and downloadable software
U.S. Department of Health and Human Services. Radiation Emergency Medical Management. Available as a mobile application.
