| Drug/Toxin |
Management |
Acetaminophen
|
Induced
emesis/gastric lavage.
N-acetylcysteine 140 mg/kg PO, then 70 mg/kg q4h
x 17 doses.
Follow plasma acetaminophen levels, liver functions,
including transminases, prothrombin time.
Follow mental status.
Referral for liver transplantation if signs of liver failure. |
Alkaline
caustic ingestion
|
Ensure
patent airway.
Do not induce emesis.
GI referral for prompt endoscopy.
|
Isopropyl
alcohol
|
Ketosis
without acidosis.
Measure isopropyl alcohol levels in plasma.
Gastric lavage, activated charcoal administration if
patient presents within 30 minutes of ingestion.
Hemodialysis in severe cases. |
Methanol
|
Anion
gap metabolic acidosis.
Measure methanol and ethanol levels.
Gastric lavage, charcoal administration, folinic acid
(1 mg/kg (max 50 mg) IV, with folic acid 1 mg/kg
IV
q 4h x 6. Ethanol IV 10 mg/kg of 10% solution
loading dose if methanol level > 20 mg/dl.
Maintenance dose tailored to achieve blood ethanol
level of 100-150 mg/dl. Hemodialysis if methanol
level > 50 mg/dl, severe acidosis, renal failure,
visual symptoms. |
Ethylene
glycol and
diethylene glycol
|
Severe
anion gap metabolic acidosis, osmolar gap,
oxalate and hippurate crystalluria.
Gastric lavage, charcoal administration (if within 30
minutes of ingestion).
IV ethanol if ethylene glycol level > 20 mg/dl or if
anion gap metabolic acidosis. Pyridoxine (100 mg
IV qd) and thiamine (100 mg IV qd).
Hemodialysis in severe cases. |
Salicylates
|
Respiratory
alkalosis and/or anion gap metabolic
acidosis.
Induced emesis, charcoal administration and a
cathartic.
Alkaline diuresis for levels > 40 mg/dl -- give sodium
bicarbonate 88 mEq in 1 liter D5W at 10-15
ml/kg/hr until urine flow achieved.
Hemodialysis for levels > 100 mg/dl. |
Beta-adrenergic
antagonists
|
Follow
serum glucose and electrolyte levels, EKG and
continuous cardiac monitoring.
Gastric lavage/charcoal administration.
If bradycardia, atropine to 2 mg IV.
Consider cardiac pacing.
Consider Isoproterenol 2-20 ug/min.
Calcium chloride 10% 10 ml IV for refractory cases. |
Digoxin
|
Follow
digoxin levels, electrolytes.
EKG and continuous cardiac monitoring.
Induced emesis; charcoal administration.
Atropine for bradycardia.
Digoxin-immune FAB fragments for dysrythmias. |
Theophylline
|
Induced
emesis if seen within 60 minutes of ingestion.
Charcoal administration.
Monitor serum theophylline levels. |