toxicity; poisoning; overdose

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Introduction

Also see toxidrome.

Etiology

Epidemiology

Clinical manifestations

(presentations) also see toxidrome

Laboratory

Diagnostic procedures

Complications

Management

# of vials =  [digoxin (ng/mL) x 5.6 x weight in kg / 600
    • benzodiazepines
    • antidote: flumazenil (Romazicon)
    • 0.2 mg over 30 seconds
    • repeat q30 seconds up to 3 mg
    • contraindications
      • coingestion of tricyclic antidepressants (TCA)
      • patients taking benzodiazepines for control of seizures
    • calcium channel blockers
      • antidote: calcium chloride
      • 1 gm CaCl2 given IV over 5 minutes with continuous cardiac monitoring
      • may be repeated in life-threatening situations
      • serum calcium should be monitored after 3rd dose
      • data supporting this treatment lacking
    • acetaminophen
      • antidote: N-acetylcysteine
      • loading dose: 140 mg/kg PO
      • 70 mg/kg PO every 4 hours for a total of 17 doses
      • if 4 hour serum acetaminophen level is in the toxic range, all 17 doses of N-acetylcysteine must be given
      • thiamine
  • hemodialysis may be useful for specific agents
  • urine alkalinization
    • aspirin
    • phenobarbital
  • consultation with regional poison control center
  • National poison hotline (800) 222-1222[1][2]

More general terms

More specific terms

Additional terms

References

  1. 1.0 1.1 Prescriber's Letter 9(3):13 2002
  2. 2.0 2.1 Prescriber's Letter 10(12):67 2003
  3. National poison hotline (800) 222-1222
  4. Prescriber's Letter 11(8): 2004 Poisonings in Toddlers Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=200807&pb=PRL (subscription needed) http://www.prescribersletter.com
  5. 5.0 5.1 Daubert GP, Emergency Medicine, University of California, Davis
  6. The National Academy of Clinical Biochemistry (NACB) Recommendations for the use of laboratory tests to support poisoned patients who present to the emergency department (Guideline withdrawn from National Guideline Clearinghouse March 2009) http://www.nacb.org/lmpg/emergency/emergency_lmpg.pdf
  7. CDC Grand Rounds: Prescription Drug Overdoses - a U.S. Epidemic MMWR January 13, 2012 / 61(01);10-13 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6101a3.htm
  8. 8.0 8.1 Walley AY et al Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis. BMJ 2013;346:f174 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23372174 <Internet> http://www.bmj.com/content/346/bmj.f174
  9. 9.0 9.1 9.2 9.3 9.4 Jones CM et al Pharmaceutical Overdose Deaths, United States, 2010 JAMA. 2013;309(7):657-659 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23423407 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1653518
  10. 10.0 10.1 Medical Knowledge Self Assessment Program (MKSAP) 16, 17. American College of Physicians, Philadelphia 2012, 2015
  11. Centers for Disease Control and Prevention (CDC) Vital Signs: Overdoses of Prescription Opioid Pain Relievers and Other Drugs Among Women - United States, 1999-2010 MMWR. July 5, 2013 / 62(26);537-542 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6226a3.htm
  12. 12.0 12.1 Orciari Herman. Sofair A Laundry Detergent Pods Remain Serious Risk, Despite Changes to Packaging. Physician's First Watch, May 18, 2015 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
    Davis MG, Casavant MJ, Spiller HA, Chounthirath T, Smith GA. Pediatric Exposures to Laundry and Dishwasher Detergents in the United States: 2013-2014 Pediatrics May 2016 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27244825
  13. 13.0 13.1 Haring RS, Sheffield ID, Frattaroli S Detergent Pod-Related Eye Injuries Among Preschool-Aged Children. JAMA Ophthalmol. Published online February 2, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28152145 <Internet> http://jamanetwork.com/journals/jamaophthalmology/article-abstract/2599445
  14. 14.0 14.1 Curtin SC, Tejada-Vera B, Warner M. Centers for Disease Control and Prevention (CDC) Drug Overdose Deaths Among Adolescents Aged 15-19 in the United States: 1999-2015. NCHS Data Brief No. 282, August 2017 https://www.cdc.gov/nchs/products/databriefs/db282.htm
  15. 15.0 15.1 Mack KA, Jones CM, Ballesteros MF. Illicit Drug Use, Illicit Drug Use Disorders, and Drug Overdose Deaths in Metropolitan and Nonmetropolitan Areas - United States. MMWR Surveill Summ 2017;66(No. SS-19):1-12 https://www.cdc.gov/mmwr/volumes/66/ss/ss6619a1.htm
  16. 16.0 16.1 Centers for Disease Control & Prevention (CDC) Vital Statistics Rapid Release. Mortality Dashboard. November 3, 2017 https://www.cdc.gov/nchs/nvss/vsrr/mortality-dashboard.htm
  17. 17.0 17.1 Shiels MS, Freedman ND, Thomas D, de Gonzalez AB Trends in U.S. Drug Overdose Deaths in Non-Hispanic Black, Hispanic, and Non-Hispanic White Persons, 2000-2015. Ann Intern Med. 2017. Dec 5. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29204603 <Internet> http://annals.org/aim/article-abstract/2665041/trends-u-s-drug-overdose-deaths-non-hispanic-black-hispanic
  18. 18.0 18.1 18.2 Hedegaard H, Warner M, Minino AM Drug Overdose Deaths in the United States, 1999-2016 NCHS Data Brief No. 294, December 2017 https://www.cdc.gov/nchs/data/databriefs/db294.pdf
  19. Kraut JA, Mullins ME. Toxic Alcohols. N Engl J Med 2018; 378:270-280. Jan 18 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29342392 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMra1615295
  20. 20.0 20.1 American Association of Poison Control Centers (AAPCC) HIGH ALERT: Intentional Exposures Among Teens to Single-Load Laundry Packets Continue to Rise. Press Release. Jan 22, 2018 http://www.aapcc.org/press/84/
  21. 21.0 21.1 Seth P, Scholl L, Rudd RA, Bacon S. Overdose Deaths Involving Opioids, Cocaine, and Psychostimulants - United States, 2015-2016. MMWR Morb Mortal Wkly Rep 2018;67:349-358 https://www.cdc.gov/mmwr/volumes/67/wr/mm6712a1.htm
  22. Erickson TB, Thompson TM, Lu JJ. The approach to the patient with an unknown overdose. Emerg Med Clin North Am 2007 May; 25:249. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17482020
  23. 23.0 23.1 Centers for Disease Control & Prevention (CDC) National Center for Health Statistics. Provisional Drug Overdose Death Counts. Vital Statistics Rapid Release. Aug. 2018 https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
  24. 24.0 24.1 Brauser D Top Ten Drugs Tied to Overdose Deaths Medscape Medical News. Dec 12, 2018 https://www.medscape.com/viewarticle/906434
    Hedegaard H, Bastian BA, Trinidad JP et al Drugs Most Frequently Involved in Drug Overdose Deaths: United States, 2011-2016, National Vital Statistics Reports. 67(9): Dec 12, 2018 https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_09-508.pdf
  25. 25.0 25.1 Hedegaard H, Minino AM, Warner M NCHS Data Brief No. 345, August 2019 Urban - rural Differences in Drug Overdose Death Rates, by Sex, Age, and Type of Drugs Involved, 2017. https://www.cdc.gov/nchs/products/databriefs/db345.htm
  26. 26.0 26.1 26.2 NEJM Knowledge+ Gastroenterology
  27. 27.0 27.1 Freund Y et al. Effect of noninvasive airway management of comatose patients with acute poisoning: A randomized clinical trial. JAMA. 2023 Dec 19;330(23):2267-2274. PMID: https://www.ncbi.nlm.nih.gov/pubmed/38019968 https://jamanetwork.com/journals/jama/fullarticle/2812429
  28. OD Prevention Program Locator Overdose Prevention Alliance http://www.overdosepreventionalliance.org/p/od-prevention-program-locator.html
  29. California Poison Control System (800) 222-1222