For diagnostic or therapeutic trial or for treatment of severe symptoms refractory to sedation, which is rarely needed (CAUTION:

Nausea, vomiting, diarrhea, hemorrhagic gastroenteritis, weakness, lethargy, CNS depression, seizures, “boiled lobster” rash, shock

Nonspecific and highly variable symptoms, which are often delayed 6–24 hoursSympathomimetic toxidromes, headache, nausea, dystonia, hallucinations, nystagmus, fasciculations, diarrhea, seizures, agitation, muscle rigidityHypotension and bradycardia (which may be ominous)

Single ingestion—typically not seriousWith multiple ingestions, coagulopathy with increased PT/INRHigher risk of coagulopathy with single dose of superwarfarins

Ingestion: Abdominal cramps, nausea, vomiting, headache, confusion, dysuria, intravascular hemolysis, seizures, hemolytic anemia in people with G6PD deficiencySkin contact: Dermatitis, corneal ulcerationInhalation: Headache, confusion, vomiting, dyspnea

Ingestion: Oral and gastric pain, nausea, vomiting, hematemesis, shock, hematuria, anuria, coma, respiratory failureSkin contact: Irritation, coagulation necrosis (with high concentrations), dermatitis, hypersensitivityInhalation: Eye, nose, and respiratory tract irritation; laryngeal spasm and edema; dysphagia; bronchitis; pneumonia

Protection of patient and attendant from vomitus and fecesFor phosphorus embedded in skin:Submersion of the patient’s body in waterIrrigation with dilute K permanganate or cupric sulfate (250 mg in 250 mL of water), recommended by some expertsPrevention of shockMeticulous surgical debridement

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

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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)

Throat constriction, dysphagia, burning GI pain, vomiting, diarrhea, GI hemorrhage, dehydration, pulmonary edema, renal failure, lactic acidosis, liver failure, shock

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)

See specific components (eg, Barium compounds, Fluorides, Phosphorus [yellow or white], Thallium salts, Anticoagulants, warfarins)

See specific agentChlorinated and other halogenated hydrocarbons, Organophosphates, Paradichlorobenzene, and Pyrethroids

See specific components (eg, Barium compounds, Fluorides, Phosphorus [yellow or white], Thallium salts, Anticoagulants, warfarins)

See specific gas, eg, Ammonia gas, Carbon monoxide , Chlorine (tear gas), Hydrogen sulfide (sewer gas, volatile hydrides), and Organophosphates (nerve gas)

Acute: Severe gastroenteritis, burning mouth pain, salivation, abdominal pain, vomiting, colitis, nephrosis, anuria, uremia

Nitrogen oxides (see also Chlorine, Fluorides, Hydrogen sulfide, Sulfur dioxide; and Environmental Pulmonary Disease)Air contaminants that form atmospheric oxidants and that have been liberated from missile fuels, explosives, or agricultural wastesCobaltous chlorideHydrogen chlorideHydrogen fluoride

Corrosive effects, mucous membrane burns, pallor, weakness, shock, seizures in children, pulmonary edema, smoky urine, esophageal stricture (rare)

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

Slightly to highly toxic effects; similar to those of organophosphates except cholinesterase inhibition is not permanent

Thirst, diarrhea, vomiting, light-headedness, burning feet, increased heart rate and BP, cardiovascular collapse, seizures, hypotension, coma, abortion, gangrene of feet, cataracts

Nausea, vomiting, rash (may be acneiform), slurred speech, ataxia, confusion, psychotic behavior, coma, paralysis, negative anion gap

Delayed onset of symptoms with nitrogen oxides unless heavy concentrationFatigue, cough, dyspnea, pulmonary edemaLater, bronchitis, pneumonia

Corrosive effects due to oxidation, ulcerated and perforated nasal septum, severe gastroenteritis, shock, vertigo, coma, nephritis

Corrosive effects due to oxidation, ulcerated and perforated nasal septum, severe gastroenteritis, shock, vertigo, coma, nephritis

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

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lacrimation and burning eyes, cough, dyspnea, pulmonary edema, caustic skin burns, erythema, pain, profuse salivation, nausea, vomiting, diarrhea, confusion, vertigo, sudden collapse, unconsciousness

Restlessness; hyperacuity of hearing, vision, and tactile sensationViolent myoclonus that simulates generalized seizures but with intact mental status, caused by minor stimuli; complete muscle relaxation between apparent seizures; perspiration; respiratory arrest

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

Burning pain in mouth and esophagus, brown-stained mucous membranes, laryngeal edema, vomiting, abdominal pain, diarrhea, shock, nephritis, circulatory collapse

Inhalation: Bronchial irritation, pneumonia (pulmonary congestion and edema, decreased respiration, dyspnea), drunkenness, stupor, ketosis, cardiac arrhythmias

Flushing of eyes for 15 minutes with tap water or salineIf severe toxicity, positive pressure oxygen to manage pulmonary edema, respiratory support

Corrosive effects, mucous membrane burns, pallor, weakness, shock, seizures in children, pulmonary edema, smoky urine, esophageal stricture (rare)Respiratory, cardiac, and circulatory failure

See specific agentChlorinated and other halogenated hydrocarbons, Organophosphates, Paradichlorobenzene, and Pyrethroids

Dizziness, incoordination, stupor to coma, gastroenteritis, hemorrhagic gastritis, hypotensionKetosis without acidosisNo retinal injury or acidosis

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

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

Acute: Severe gastroenteritis, burning mouth pain, salivation, abdominal pain, vomiting, colitis, nephrosis, anuria, uremiaWith alkyl and phenyl mercurials, skin burnsChronic: Gingivitis, mental disturbance, neurologic deficits

Acute ingestion: Thirst, burning abdominal pain, vomiting, diarrhea; CNS symptoms (eg, irritability, inattentiveness, decreased level of consciousness, seizures)

Ingestion:Skin contact: Clothing removed and area washed with copious soap and water; then as for inhalationInhalation: Oxygen, respiratory support, blood transfusion

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

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Respiratory and cardiovascular supportive measures, monitoring of liver functionSymptomatic 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)

Ingestion: Irritation, corrosion of mouth and GI tract, possible ulceration or perforation, abdominal pain, tachycardia, prostration, circulatory collapse

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

Nausea, vomiting, abdominal pain, headache, confusion, visual disturbances, CNS depression, ventricular fibrillation, kidney injury, liver injury, cirrhosis

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

* 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.

Dizziness, weakness, headache, euphoria, nausea, vomiting, ventricular arrhythmia, paralysis, seizuresWith chronic poisoning, aplastic anemia, hypokalemia, leukemia, CNS depressionIrritability, CNS excitation, muscle spasms, atonia, tonic-clonic seizures, respiratory failure, pulmonary edema, nausea, vomiting, obtundation, coma

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)

Stimulation then depression, nausea, vomiting, loss of self-control, anxiety, hallucinations, sweating, hyperthermia, seizures, MI (rare)

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

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

Stained lips (white, brown, then black), argyria (slate gray or blue skin discoloration), gastroenteritis, shock, vertigo, seizures

Vapor inhalation, skin absorption, or ingestion: CNS symptoms (eg, insomnia, restlessness, ataxia, delusions, mania, seizures)

Tachycardia, tachypnea and hypoxia after inhalation, skin and mucous membrane irritation, glomerulonephritis, hypothyroidism (rare)

Symptomatic hyperammonemia: L-Carnitine 100 mg/kg (6 g maximum) IV over 30 minutes with maintenance dose of 15 mg/kg every 4 hours

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Throat constriction, dysphagia, burning GI pain, vomiting, diarrhea, GI hemorrhage, dehydration, pulmonary edema, renal failure, lactic acidosis, liver failure, shock

Nausea, vomiting, abdominal pain, headache, confusion, visual disturbances, CNS depression, ventricular fibrillation, kidney injury, liver injury, cirrhosis

Vapor inhalation, skin absorption, or ingestion: CNS symptoms (eg, insomnia, restlessness, ataxia, delusions, mania, seizures)

Ingestion: Burning throat and stomach, vomiting, diarrhea, pneumonia only if aspiration has occurredVapor 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

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

Throat constriction, dysphagia, burning GI pain, vomiting, diarrhea, GI hemorrhage, dehydration, pulmonary edema, renal failure, lactic acidosis, liver failure, shock

Observation for myocardial or pulmonary disorder (usually before emergency department arrival)For hyperthermia, external cooling

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.

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

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

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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

Ingestion: Observation for kidney and liver damage; respiratory, cardiac, and circulatory supportInhalation: Respiratory, cardiac, and circulatory support

Pyrethrin, and pyrethroidsBifenthrinCyfluthrinCypermethrinEsfenvalerateFluvalinateLambda-cyhalothrinPyrethrinResmethrinSumithrinTefluthrinTetramethrin

Severe toxicity with 60–250 mL (2–8 ounces) in adults or 8–10 mL (2 teaspoons) in childrenLatency period 12–18 hoursHeadache, weakness, leg cramps, vertigo, seizures, retinal injury, dimmed vision, metabolic acidosis, decreased respiration

Milk, starch, or flour po; early airway support; fluid and electrolytes; treatment of shock; early, aggressive airway management

Ingestion: Abdominal cramps, nausea, vomiting, headache, confusion, dysuria, intravascular hemolysis, seizures, hemolytic anemia in people with G6PD deficiency

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

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

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)

Removal from skin, prevention or treatment of electrolyte abnormalities and shock, control of seizuresFor severe poisoning (rare), dialysis

Cyanosis due to formation of methemoglobin and sulfhemoglobin, dyspnea, weakness, vertigo, angina, rashes and urticaria, vomiting, delirium, depression, respiratory and circulatory failure

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

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 minutesHigh-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

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.

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)

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

Irritated skin and mucous membranes, skin vesicles, nausea, vomiting, bloody diarrhea, burning pain in back and urethra, respiratory depression, seizures, coma, abortion, menorrhagia

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

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lacrimation and burning eyes, cough, dyspnea, pulmonary edema, caustic skin burns, erythema, pain, profuse salivation, nausea, vomiting, diarrhea, confusion, vertigo, sudden collapse, unconsciousness

Fatigue, thirst, flushing, nausea, vomiting, abdominal pain, hyperpyrexia, tachycardia, loss of consciousness, dyspnea, respiratory arrest, skin absorption

Commonly, sedation, vomiting, tremor, tachycardiaPossibly, seizures, hallucinations, hypotension, serotonin syndromeRarely, death

Stage 1:Stage 2: Symptom-free 8 hours to several daysStage 3: Nausea, vomiting, diarrhea, liver enlargement, jaundice, hemorrhages, kidney damage, seizures, comaToxicity enhanced by alcohol, fats, or digestible oils

Respiratory support, treatment of seizures, maintenance of fluid balance, avoidance of all oils derived from cantharides

Hypertension, tachycardia, MI, nausea, vomiting, agitation, hallucinations, psychoses, seizures, convulsions, strokeSee also Cannabinoids, synthetic

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

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

Mercury, compounds ofAmmoniated mercuryBichloride of mercuryCalomelCorrosive sublimateDiuretics, mercurialMercuric chloride (corrosive sublimate)Merthiolate

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

Nausea, vomiting, rash (may be acneiform), slurred speech, ataxia, confusion, psychotic behavior, coma, paralysis, negative anion gap

Fatigue, thirst, flushing, nausea, vomiting, abdominal pain, hyperpyrexia, tachycardia, loss of consciousness, dyspnea, respiratory arrest, skin absorption

For single ingestion, observationVitamin K Toxicity) until INR is normal, transfusion with fresh frozen plasma if necessary

Stimulation then depression, nausea, vomiting, loss of self-control, anxiety, hallucinations, sweating, hyperthermia, seizures, MI (rare)

Burning pain in mouth and esophagus, brown-stained mucous membranes, laryngeal edema, vomiting, abdominal pain, diarrhea, shock, nephritis, circulatory collapse

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

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

Ingestion: Observation for kidney and liver damage; respiratory, cardiac, and circulatory supportInhalation: Respiratory, cardiac, and circulatory support

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

If usual 6% household preparations have been ingested, dilution with milk (little else required)If concentrated forms have been ingested, esophagoscopy, treatment of shock

Irritated skin and mucous membranes, skin vesicles, nausea, vomiting, bloody diarrhea, burning pain in back and urethra, respiratory depression, seizures, coma, abortion, menorrhagia

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

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

Tachycardia, tachypnea and hypoxia after inhalation, skin and mucous membrane irritation, glomerulonephritis, hypothyroidism (rare)

Guidelines for Chelation Therapy)Maintenance of fluid and electrolyte balance, hemodialysis for renal failure, observation for GI perforationSkin contact: Soap and water for scrubbing

Wakefulness, restlessness, anorexia, vomiting, dehydration, seizures, tachycardiaIn adults, greater toxicity after acute overdose added to chronic intake

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Inhalation: Severe respiratory and ocular irritation, glottal spasm, cough, choking, vomiting, pulmonary edema, cyanosis

Vomiting, upper abdominal pain, pallor, cyanosis, diarrhea, drowsiness, shock; possible toxicity if > 20 mg/kg of elemental iron is ingested

Vomiting, upper abdominal pain, pallor, cyanosis, diarrhea, drowsiness, shock; possible toxicity if > 20 mg/kg of elemental iron is ingested

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

CyanidesBitter almond oil (artificial and natural)Hydrocyanic acidPotassium cyanidePrussic acidSodium cyanideWild cherry syrup

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

Agitation, sinus tachycardia, seizures, comaWithdrawal syndrome similar to withdrawal symptoms after stopping gamma-hydroxybutyrate (GHB)

Thirst, diarrhea, vomiting, light-headedness, burning feet, increased heart rate and BP, cardiovascular collapse, seizures, hypotension, coma, abortion, gangrene of feet, cataracts

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

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

Milk, starch, or flour po; early airway support; fluid and electrolytes; treatment of shock; early, aggressive airway management

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

Respiratory support, treatment of seizures, maintenance of fluid balance, avoidance of all oils derived from cantharidesNo specific antidote

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

Slightly to highly toxic effects; similar to those of organophosphates except cholinesterase inhibition is not permanentSee 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

Petroleum distillates (see Hydrocarbon Poisoning)AsphaltBenzine (benzin)Fuel oilGasolineKeroseneLubricating oilsMineral spiritsModel airplane glueNaphthaPetroleum etherTar

Ingestion: Severe gastric cramps, vomiting, diarrhea, dry throat, cough, dyspnea, headache, shock, coma, brown urine, renal failureInhalation: Pneumonitis with dyspnea and bilateral pulmonary infiltrates, hypoxia, death

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)

Headache, weakness, leg cramps, vertigo, seizures, retinal injury, dimmed vision, metabolic acidosis, decreased respiration

Tachycardia, headache, drowsiness, hypotension, coma, rapid severe acidosis, seizures, death, possibly bitter almond odor on breath, bright red venous bloodVery rapidly lethal (in 1–15 minutes)

Ingestion: Blood transfusion for severe hemolysis, urine alkalinization for hemoglobinuria, benzodiazepines to control seizuresSkin contact: Clothing removed if formerly stored with naphthalene moth balls, flushing of skin and eyes

Violent myoclonus that simulates generalized seizures but with intact mental status, caused by minor stimuli; complete muscle relaxation between apparent seizures; perspiration; respiratory arrest

Because major problems result from aspiration and not GI absorption, gastric evacuation usually not warrantedSupportive care for pulmonary edema, oxygen, respiratory support

Air contaminants that form atmospheric oxidants and that have been liberated from missile fuels, explosives, or agricultural wastes

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Throat constriction, dysphagia, burning GI pain, vomiting, diarrhea, GI hemorrhage, dehydration, pulmonary edema, renal failure, lactic acidosis, liver failure, shock

See specific gas, eg, Ammonia gas, Carbon monoxide , Chlorine (tear gas), Hydrogen sulfide (sewer gas, volatile hydrides), and Organophosphates (nerve gas)

Supportive care, IV glucose, correction of dehydration and electrolyte abnormalitiesFor gastritis, IV H2 blockers or proton pump inhibitors

Cyanosis due to formation of methemoglobin and sulfhemoglobin, dyspnea, weakness, vertigo, angina, rashes and urticaria, vomiting, delirium, depression, respiratory and circulatory failure

For diagnostic or therapeutic trial or for treatment of severe symptoms refractory to sedation, which is rarely needed (CAUTION:

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Variable toxicity depending on length of exposure, concentration inhaled, and respiratory and circulatory ratesVarious symptoms depending on % carboxyhemoglobin in bloodHeadache, vertigo, vomiting, dyspnea, confusion, dilated pupils, seizures, coma

RCC’s Loss Prevention Committee has developed a series of handbooks to provide retailers with information on de-escalation, violence prevention, security strategies, and crowd management.

Chlorinated and other halogenated hydrocarbons (in many insecticides)AldrinBenzene hexachlorideChlordaneChlorothalonilDDD (2-dichlorethane)DDT (chlorophenothane)DicofolDieldrinDienochlorDilanEndosulfanEndrinHeptachlorMethoxychlorPerchlordeconeProlanToxapheneOther chlorinated organic insecticides and industrial compounds

Ingestion: Blood transfusion for severe hemolysis, urine alkalinization for hemoglobinuria, benzodiazepines to control seizures

Acute ingestion: Thirst, burning abdominal pain, vomiting, diarrhea; CNS symptoms (eg, irritability, inattentiveness, decreased level of consciousness, seizures)Acute inhalation: Insomnia, headache, ataxia, mania, seizuresChronic exposure: Anemia, peripheral neuropathy, confusion, lead encephalopathy, acceleration of atherosclerosis

OrganophosphatesAcephateBidrinChlorethoxyfosChlorothionChlorpyrifosCoumaphosDemetonDiazinonDichlorvosDimethoateDisulfotonEthionFamphurFenthionHexaethyltetraphosphateIsofenphosLeptophosMerphosMethidathionMethyl parathionMipafoxNaledNerve gas agentsOctamethyl pyrophosphoramideOxydemeton-methylParathionPhoratePhosdrinPhosmetPirimiphos-methylTemefosTerbufosTetrachlorvinphosTrichlorfonTriorthocresyl phosphate

Ingestion: Irritation, corrosion of mouth and GI tract, possible ulceration or perforation, abdominal pain, tachycardia, prostration, circulatory collapseInhalation: Severe respiratory and ocular irritation, glottal spasm, cough, choking, vomiting, pulmonary edema, cyanosis

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

Nausea, vomiting, diarrhea, hemorrhagic gastroenteritis, weakness, lethargy, CNS depression, seizures, “boiled lobster” rash, shock

Airway protection; consideration of alkalinization for QRS widening; admission of patients who have symptoms > 6 hours after ingestionFor severe symptoms, consideration of IV lipid emulsion

Acute: Abdominal pain, oliguria, acute renal failureChronic: Poor absorption, ulcerative stomatitis, anorexia, progressive encephalopathy

Ingestion: Inebriation but no alcohol odor on breath, nausea, vomitingLater, carpopedal spasm, lumbar pain, oxalate crystalluria, oliguria progressing to anuria and acute renal failure, respiratory distress, seizures, comaEye contact: Iridocyclitis

Decontamination with water, avoidance of vomiting and aspiration, oxygen, respiratory support, ECG monitoring (ventricular fibrillation can occur early)For severe anemia, blood transfusionsReplacement of potassium as necessary

Ingestion of small or moderate doses: Salty or soapy tasteIngestion of large doses: Tremors, seizures, CNS depression, shock, renal failureSkin and mucosal contact: Painful superficial or deep burnsInhalation: Intense eye and nasal irritation, headache, dyspnea, sense of suffocation, glottal edema, pulmonary edema, bronchitis, pneumonia, mediastinal and subcutaneous emphysema due to bleb rupture

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Extrapyramidal symptoms (eg, ataxia, muscular and carpopedal spasms, torticollis), usually idiosyncraticWith overdose, dry mouth, drowsiness, seizures, coma, respiratory depression

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

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

Ingestion:Skin contact: Washing with copious soap and waterInhalation: Flushing of eyes with saline, oxygen, respiratory support

Nausea, vomiting, confusion, bradycardia, hypotension, total cardiovascular collapseToxicity sometimes occurring after hyperglycemia

See specific acids and alkalis (eg, , Fluorides) and Caustic IngestionEye contact: See Overview of Eye TraumaSkin contact: See Burns

Ingestion: As for inhalation, except for direct pulmonary effectInhalation: Bronchial irritation, pneumonia (pulmonary congestion and edema, decreased respiration, dyspnea), drunkenness, stupor, ketosis, cardiac arrhythmias

Stained lips (white, brown, then black), argyria (slate gray or blue skin discoloration), gastroenteritis, shock, vertigo, seizures