MSD Manual

Please confirm that you are a health care professional

honeypot link

Specific Poisons


Gerald F. O’Malley

, DO, Grand Strand Regional Medical Center;

Rika O’Malley

, MD, Albert Einstein Medical Center

Last full review/revision Apr 2020| Content last modified Apr 2020
Click here for Patient Education
Topic Resources

Symptoms and treatment of specific poisons vary (see table Symptoms and Treatment of Specific Poisons ). Including all the specific complexities and details is impossible, although cross-references are made to other entries in the table where appropriate. Consultation with a poison control center is recommended for any poisonings except the mildest and most routine.


Symptoms and Treatment of Specific Poisons




ACE inhibitors

Angioedema, hypotension

Charcoal, supportive care, a bradykinin inhibitor (ecallantide or icatibant)

For angioedema, epinephrine, antihistamines, or corticosteroids unlikely to be effective

For hypotension, consideration of naloxone


See Organophosphates



Aniline dyes and oil


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 IV

Acetic acid

Low concentration: Mild mucosal irritation

High concentration: See Caustic Ingestion

Supportive care with irrigation and dilution



  • Model airplane glues or cements

  • Nail polish remover

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


Cosmetic nail adhesive

Converted to cyanide, with usual symptoms and signs

See Cyanides


See Acetanilide

Acetylsalicylic acid

Acids and alkalis

See specific acids and alkalis (eg, Boric acid, Fluorides) and Caustic Ingestion

Eye contact: See Overview of Eye Trauma

Skin contact: See Burns

Airplane glues or cements (model-building)

See Acetone, Benzene (toluene), and Petroleum distillates

Alcohol, ethyl (ethanol)

  • Brandy

  • Whiskey

  • Other liquors

Emotional lability, impaired coordination, flushing, nausea, vomiting, stupor to coma, respiratory depression

Supportive care, IV glucose to prevent hypoglycemia

Alcohol, isopropyl

  • Rubbing alcohol

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)

  • Antifreeze

  • Paint solvent

  • Solid canned fuel

  • Varnish

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)

Hemodialysis (which is definitive treatment)


See Chlorinated and other halogenated hydrocarbons


See Acids and alkalis


See Opioids





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 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)


See Tricyclic antidepressants

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


See Barbiturates


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

Amyl nitrite

See Nitrites


See Acetanilide

Anticoagulants, direct thrombin inhibitors

  • Argatroban

  • Bivalirudin

  • Dabigatran etexilate

  • Desirudin

Bleeding 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.

Anticoagulants, factor Xa inhibitors

  • Fondaparinux

  • Apixaban

  • Rivaroxaban

Bleeding secondary to factor Xa inhibition

For 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

High- vs low-dose of andexanet alpha determined by timing (greater than or less than 8 hours) and strength (greater than or less than 10 mg for rivaroxaban and greater than or less than 5 mg for apixaban) of the last dose of the Xa inhibitor

Anticoagulants, heparin and low molecular weight heparins

  • Heparin (unfractionated)

  • Dalteparin

  • Enoxaparin

  • Tinzaparin

Bleeding 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)

Anticoagulants, warfarins

  • Dicumarol

  • Superwarfarins

  • Warfarin

See Warfarin


See Bupropion, Mirtazapine, SSRIs, Trazodone, Tricyclic antidepressants, Venlafaxine


See Alcohol, methyl and Ethylene glycol


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 Physostigmine), consideration of physostigmine 0.5–2.0 mg in adults or 0.02 mg/kg in children IV (slowly)

Antihyperglycemic drugs, oral

See Hypoglycemic drugs, oral


  • Stibophen

  • Tartar emetic

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 drugs, hydration, treatment of shock and pain

Antipsychotic drugs (1st-generation)

  • Chlorpromazine

  • Fluphenazine

  • Haloperidol

  • Loxapine

  • Mesoridazine

  • Molindone

  • Perphenazine

  • Pimozide

  • Prochlorperazine

  • Thioridazine

  • Thiothixene

  • Trifluoperazine

  • Triflupromazine

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 benztropine

For hypotension refractory to fluids, norepinephrine

For ventricular arrhythmias, consideration of alkalinization

Antipsychotic drugs (2nd-generation)

  • Clozapine

  • Olanzapine

  • Quetiapine

  • Risperidone

  • Ziprasidone

CNS depression (particularly with olanzapine), miosis, anticholinergic effects, hypotension, dystonia, QT prolongation (occasionally), fatal bone marrow suppression (rare)

For dystonia, diphenhydramine or benztropine

For hypotension refractory to fluids, norepinephrine

For ventricular arrhythmias, consideration of alkalinization

Ant poison

See Arsenic (sodium arsenate) and Boric acid


  • Donovan solution

  • Fowler solution

  • Herbicides

  • Paris green

  • Pesticides

  • Sodium arsenate

Same as for Antimony

Same as for Antimony

Arsine gas

Transfusions, diuresis

Artificial bitter almond oil

See Cyanides


See Petroleum distillates



See Belladonna

Automobile exhaust

See Carbon monoxide


  • Amobarbital

  • Meprobamate

  • Pentobarbital

  • Phenobarbital

  • Secobarbital

Bradycardia, hypothermia, confusion, delirium, loss of corneal reflex, respiratory failure, drowsiness, ataxia, coma

Charcoal up to 24 hours after ingestion, supportive care, forced alkaline diuresis for phenobarbital (to aid in elimination)

For severe cases, hemodialysis

Barium compounds (soluble)

  • Barium acetate

  • Barium carbonate

  • Barium chloride

  • Barium hydroxide

  • Barium nitrate

  • Barium sulfide

  • Depilatories

  • Explosives

  • Fireworks

  • Rat poisons

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 lavage

Diazepam to control seizures

For dyspnea and cyanosis, oxygen


  • Atropine

  • Hyoscyamine

  • Hyoscyamus

  • Scopolamine (hyoscine)

  • Stramonium

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 Physostigmine), consideration of physostigmine 0.5–2.0 mg in adults or 0.02 mg/kg in children IV (slowly)


  • Benzol

  • Hydrocarbons

  • Model airplane glue

  • Toluene

  • Toluol

  • Xylene

Dizziness, weakness, headache, euphoria, nausea, vomiting, ventricular arrhythmia, paralysis, seizures

With chronic poisoning, aplastic anemia, hypokalemia, leukemia, CNS depression

Decontamination with water, avoidance of vomiting and aspiration, oxygen, respiratory support, ECG monitoring (ventricular fibrillation can occur early)

Diazepam to control seizures

For severe anemia, blood transfusions

Replacement of potassium as necessary

Epinephrine contraindicated

Gamma-benzene hexachloride

Benzene hexachloride



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 seizures

Benzine (benzin)

See Petroleum distillates


  • Alprazolam

  • Chlordiazepoxide

  • Diazepam

  • Flurazepam

Sedation to coma, particularly if drugs are accompanied by alcohol


Airway control

For hypotension, IV fluids and vasopressors

Avoidance of flumazenil (CAUTION: If tricyclic antidepressants are involved, flumazenil may precipitate seizures; in patients who depend on benzodiazepines, flumazenil may precipitate withdrawal.)


See Benzene


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 emulsion

Bichloride of mercury

See Mercury


See Chromic acid

Bidrin (dicrotophos)

See Organophosphates


See Pyrethroids


See Warfarin

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 Guidelines for Chelation Therapy)

Bitter almond oil

See Cyanides

Bleach, chlorine

See Hypochlorites


See Selenium

Boric 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


See Alcohol, ethyl


Vomiting, diarrhea, epigastric pain, acidosis, deafness

Supportive care, thiosulfate to reduce bromate to less toxic bromide

For renal failure, hemodialysis


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

Discontinuation of drug, hydration and sodium chloride IV to promote diuresis, furosemide 10 mg IV every 6 hours

For severe poisoning, hemodialysis


Highly corrosive

With exposure to liquid or vapor, skin and mucous membrane burns

Aggressive decontamination, supportive care

Bupropion hydrochloride

Respiratory depression, ataxia, seizures

Charcoal, benzodiazepines, supportive care

Butyl nitrate

See Nitrites


  • Cadmium oxide fumes (eg, from welding)

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 sulfonate

Dimercaprol contraindicated

For inhalation, oxygen, sometimes bronchodilators and corticosteroids


See Aminophylline

Calcium channel blockers

  • Diltiazem

  • Nifedipine

  • Verapamil

  • Others

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 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 pump

Consideration 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


See Mercury


  • Camphorated oils

Camphor odor on breath, headache, confusion, delirium, hallucinations, seizures, coma

Diazepam to prevent and treat seizures, respiratory support

Cannabinoids, synthetic (synthetic marijuana)

  • Cannabicyclohexanol

  • CP-47

  • JWH-018

  • JWH-073

  • JWH-200

Hypertension, tachycardia, MI, nausea, vomiting, agitation, hallucinations, psychoses, seizures, convulsions, stroke

Supportive care with IV fluids, benzodiazepines for agitation and seizures, phenobarbital for seizures

Beta-blockers may help relieve cardiac symptoms, but are rarely necessary

Canned fuel, solid

See Alcohol, methyl


  • Cantharidin

  • Spanish fly

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


  • Aldicarb

  • Bendiocarb

  • Benomyl

  • Carbaryl

  • Carbofuran

  • Fenothiocarb

  • Methiocarb

  • Methomyl

  • Oxamyl

  • Propoxur

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

See Organophosphates


Progressive CNS depression, seizures (occasional), cardiac arrhythmia (rare)

Supportive care after decontamination, heart rate monitoring

For arrhythmias, consideration of IV sodium bicarbonate

Carbolic acid

See Phenols

Carbonates (ammonium, potassium, sodium)

Carbon bisulfide

See Carbon disulfide

Carbon dioxide

Dyspnea, weakness, tinnitus, palpitations, asphyxia

Respiratory support, oxygen

Carbon disulfide

  • Carbon bisulfide

Garlic 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 support

Carbon monoxide

  • Acetylene gas

  • Automobile exhaust

  • Coal gas

  • Furnace gas

  • Illuminating gas

  • Marsh gas

Variable toxicity depending on length of exposure, concentration inhaled, and respiratory and circulatory rates

Various symptoms depending on % carboxyhemoglobin in blood

Headache, vertigo, vomiting, dyspnea, confusion, dilated pupils, seizures, coma

100% Oxygen by mask, respiratory support if needed, immediate measurement of carboxyhemoglobin level; if carboxyhemoglobin is more than about 25%, consideration of hyperbaric oxygen in consultation with poison control center (see Carbon Monoxide Poisoning)

Carbon tetrachloride (sometimes used in chemical manufacturing)

  • Cleaning fluids (nonflammable)

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)

  • Bath salts

  • Methedrone (4-MeO)

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

  • Herbicides

  • Manufacture of explosives and matches

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, oxygen

For complex cases, possibly dialysis


See Chlorinated and other halogenated hydrocarbons


See Organophosphates

Chlorinated and other halogenated hydrocarbons

  • Aldrin

  • Benzene hexachloride

  • Chlordane

  • Chlorothalonil

  • DDD (2-dichlorethane)

  • DDT (chlorophenothane)

  • Dicofol

  • Dieldrin

  • Dienochlor

  • Dilan

  • Endosulfan

  • Endrin

  • Heptachlor

  • Lindane

  • Methoxychlor

  • Perchlordecone

  • Prolan

  • Toxaphene

  • Other chlorinated organic insecticides and industrial compounds

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 fluids

For renal and liver failure, monitoring, and supportive care

Chlorinated lime

See Chlorine

Chlorine (see also Hypochlorites)

  • Chlorinated lime

  • Chlorine water

  • Tear gas

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)


See Acetanilide



Drowsiness, coma

Possible acute liver injury

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

Inhalation: Respiratory, cardiac, and circulatory support


See Chlorinated and other halogenated hydrocarbons


See Organophosphates


See Phenothiazines


See Organophosphates


See Chromic acid

Chromic acid

  • Bichromates

  • Chromates

  • Chromium trioxide

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 compound


Irritation of skin and mucous membranes

Thorough washing with water and 10% ascorbic acid solution for 15 minutes

Chromium trioxide

See Chromic acid



Slight dryness and drowsiness, possible altered metabolism of concomitant drugs

No specific antidote available

Monitoring for effect on metabolism of other drugs being taken


Bradycardia, sedation, periodic apnea, hypotension, hypothermia

Supportive care; vasopressors; naloxone 5 mcg/kg up to 2–20 mg, repeated as needed, to possibly reduce sedation

Coal gas

See Carbon monoxide


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

Supportive care, decontamination with water and soap

Cobaltous chloride

See Nitrogen oxides


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

Diazepam for excitation (primary treatment), oxygen, respiratory and circulatory support if needed, IV sodium bicarbonate

For arrhythmias, extremely cautious use of IV esmolol

Observation for myocardial or pulmonary disorder (usually before emergency department arrival)

For hyperthermia, external cooling


See Opioids


Nausea, hemorrhagic gastritis, multiorgan failure, pancytopenia, sepsis

Multiple-dose activated charcoal, IV fluids, supportive care, granulocyte colony-stimulating factor


See Copper salts

Copper salts

  • Cupric sulfate, acetate, or subacetate

  • Cuprous chloride or oxide

Vomiting, burning sensation, metallic taste, diarrhea, pain, shock, jaundice, anuria, seizures

Penicillamine or dimercaprol (see table Guidelines for Chelation Therapy), electrolyte and fluid balance, respiratory support, monitoring of GI tract, treatment of shock, control of seizures, monitoring for liver and renal failure

Corrosive sublimate (mercuric chloride)

See Mercury


See Organophosphates

Creosote, cresols

See Phenols


  • Bitter almond oil

  • Hydrocyanic acid

  • Nitroprusside

  • Potassium cyanide

  • Prussic acid

  • Sodium cyanide

  • Wild cherry syrup

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 recur

Hydroxocobalamin 5 g IV (preferred treatment)


See Pyrethroids


See Pyrethroids

DDD (2-dichlorethane)

See Chlorinated and other halogenated hydrocarbons

DDT (chlorophenothane)

See Chlorinated and other halogenated hydrocarbons


See Organophosphates

Deodorizers, household

See Naphthalene and Paradichlorobenzene


See Barium compounds


See Tricyclic antidepressants

Detergent powders


See Amphetamines


See Organophosphates


See Organophosphates


See Chlorinated and other halogenated hydrocarbons


See Warfarin


See Chlorinated and other halogenated hydrocarbons


See Chlorinated and other halogenated hydrocarbons

Diethylene glycol

See Ethylene glycol





See Chlorinated and other halogenated hydrocarbons


See Organophosphates


See Nitrobenzene


  • Herbicides

  • Pesticides

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 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


See Paraquat

Dishwasher detergents


See Organophosphates

Diuretics, mercurial

See Mercury

Donovan solution

See Arsenic


See Tricyclic antidepressants

Drain cleaners


See Chlorinated and other halogenated hydrocarbons


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 IV

For coronary vasospasm, IV nitroglycerin and nifedipine


See Physostigmine


See Pyrethroids


See Alcohol, ethyl


See Chloroform


See Organophosphates

Ethyl alcohol

See Alcohol, ethyl

Ethyl biscoumacetate

See Warfarin

Ethylene glycol

Diethylene glycol

  • Most automotive antifreeze

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 hours

Hemodialysis, which is definitive treatment

Eye contact: Flushing of eyes


See Barium compounds (fireworks) and Nitrogen oxides



Fava bean (favism)


See Organophosphates

Ferric salts

See Iron

Ferrous salts (eg, gluconate, sulfate)

See Iron


See Barium compounds


  • Ammonium fluoride

  • Fluorine

  • Hydrofluoric acid

  • Rat poisons

  • Roach poisons

  • Sodium fluoride

  • Soluble fluorides generally

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 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 gel

Inhalation: Oxygen, respiratory support, prednisone for chemical pneumonitis (in adults, 15–40 mg orally twice a day), management of pulmonary edema


See Pyrethroids


  • Formalin (may contain methyl alcohol)

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 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

Furnace gas

See Carbon monoxide


See Ammonia gas, Carbon monoxide (acetylene gas, automobile exhaust, coal gas, furnace gas, illuminating gas, marsh gas), Chlorine (tear gas), Hydrogen sulfide (sewer gas, volatile hydrides), and Organophosphates (nerve gas)


See Petroleum distillates

Glues, model airplane

See Acetone, Benzene (toluene), and Petroleum distillates


Drowsiness, areflexia, mydriasis, hypotension, respiratory depression, coma

Activated charcoal, respiratory support, maintenance of fluid and electrolyte balance, hemodialysis possibly helpful, treatment of shock

Gold salts

Gold chloride: Liver and kidney toxicity

Cyanide gold salts: Cyanide toxicity

See Cyanide


See Phenols

H2 blockers (eg, cimetidine, ranitidine)

Minor GI problems, possibly altered levels of other drugs

Nonspecific supportive measures


See Chlorinated and other halogenated hydrocarbons


See specific ingredient (eg, Arsenic, Dinitro-o-cresol, Chlorates and nitrates)


See Opioids


See gamma-benzene hexachloride


See Organophosphates

Histamine-2 blockers

See H2 blockers

Hydrides, volatile

See Hydrogen sulfide


See Benzene

Hydrocarbons, chlorinated

See Chlorinated and other halogenated hydrocarbons

Hydrocarbons, halogenated

See Chlorinated and other halogenated hydrocarbons

Hydrochloric acid


See Opioids

Hydrocyanic acid

See Cyanides

Hydrofluoric acid

See Fluorides

Hydrogen chloride or fluoride

See Nitrogen oxides

Hydrogen sulfide

  • Alkali sulfides

  • Phosphine

  • Sewer or manure gas

  • Volatile hydrides

Gas eye (subacute keratoconjunctivitis), lacrimation and burning, cough, dyspnea, pulmonary edema, caustic skin burns, erythema, pain, profuse salivation, nausea, vomiting, diarrhea, confusion, vertigo, sudden collapse, unconsciousness

Oxygen, respiratory support

Hyoscine (scopolamine)



See Belladonna


  • Bleach, chlorine

  • Javelle water

Usually mild pain and inflammation of oral and GI mucosa

Cough, dyspnea, vomiting, skin vesicles

If usual 6% household preparations have been ingested, dilution with milk (little else required)

If concentrated forms have been ingested, esophagoscopy, treatment of shock

Hypoglycemic drugs, oral


  • Chlorpropamide

  • Glipizide

  • Glyburide

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 glucose

For persistent hypoglycemia, consideration of octreotide 50–100 mcg IV or subcutaneously 2 or 3 times a day

For lactic acidosis, supportive care and hemodialysis

Illuminating gas

See Carbon monoxide


See Tricyclic antidepressants

Inhalational anesthetics

  • Chloroform

  • Ether

  • Nitrous oxide

  • Trichloromethane


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


See Chlorinated and other halogenated hydrocarbons, Organophosphates, Paradichlorobenzene, and Pyrethroids


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 alcohol


  • Carbonyl iron (see Carbon monoxide)

  • Ferric salts

  • Ferrous salts

  • Ferrous gluconate

  • Ferrous sulfate

  • Vitamins with 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 Organophosphates


CNS stimulation, seizures, obtundation, coma, hepatotoxicity

For seizures, pyridoxine given IV mg for mg ingested or, if amount ingested is unknown, 5 mg IV

For acidosis, sodium bicarbonate

Isopropyl alcohol

See Alcohol, isopropyl

Javelle water

See Hypochlorites


See Petroleum distillates


See Acetone


See Pyrethroids


  • Lead salts

  • Solder

  • Some paints and painted surfaces

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

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 source

Lime, chlorinated

See Chlorine


See Gamma-benzene hexachloride and Chlorinated and other halogenated hydrocarbons


See Alcohol, ethyl

Lithium 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 > 4 mEq/L (4 mmol/L)

Chronic: If symptoms are severe, dialysis

Lye (sodium hydroxide [NaOH])

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)


See Organophosphates


See Potassium permanganate

Marsh gas

See Carbon monoxide


See Opioids


See Barbiturates

Mercury, compounds of

  • Ammoniated mercury

  • Bichloride of mercury

  • Calomel

  • Corrosive sublimate

  • Diuretics, mercurial

  • Mercuric chloride

  • Merthiolate

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 Guidelines for Chelation Therapy)

Maintenance of fluid and electrolyte balance, hemodialysis for renal failure, observation for GI perforation

Skin contact: Soap and water for scrubbing

Mercury, elemental

  • Liquid (skin contact, ingestion)

  • Vapor

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


  • Slug bait

Nausea, vomiting, retching, abdominal pain, muscular rigidity, hyperventilation, seizures, coma

Supportive care, diazepam


See entries for specific metals


Lactic acidosis

For lactic acidosis, supportive care and hemodialysis


See Opioids


See Amphetamines


See Alcohol, methyl


See Organophosphates


Nausea, vomiting, diarrhea, stomatitis, bone marrow suppression, thrombocytopenia, cirrhosis

IV fluids, urinary alkalinization, folinic acid (leucovorin rescue), glucarpidase to deactivate methotrexate


See Chlorinated and other halogenated hydrocarbons

Methyl alcohol

See Alcohol, methyl

Methyl parathion

See Organophosphates

Methyl salicylate

Methylene chloride

See Carbon monoxide

See Carbon monoxide

Mineral spirits

See Petroleum distillates


Usually benign

Most commonly, sedation, confusion, tachycardia

Observation for 8 hours

Model airplane glues, solvents

See Acetone, Benzene, Petroleum distillates, and Toluene

Monoamine oxidase (MAO) inhibitors

  • Isocarboxazid

  • Phenelzine

  • Selegiline

  • Tranylcypromine

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


See Opioids

Moth balls, crystals, or repellent cakes

See Naphthalene, Camphor, and Paradichlorobenzene

Mushrooms, poisonous

Nail polish remover

See Acetone


See Organophosphates


See Petroleum distillates


  • Deodorizer cakes

  • Moth balls, crystals, or repellent cakes (see also Paradichlorobenzene)

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


See Phenols


See Opioids


See Trazodone


See Physostigmine

Nerve gas agents

See Organophosphates


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 unavailable


See Tobacco


See Chlorates and nitrates

Nitric acid


  • Amyl nitrite

  • Butyl nitrite

  • Nitroglycerin

  • Potassium nitrite

  • Sodium nitrite

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


For methemoglobinemia, 1% methylene blue 1–2 mg/kg IV slowly


  • Artificial bitter almond oil

  • Dinitrobenzene

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; andEnvironmental Pulmonary Disease)

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

  • Cobaltous chloride

  • Hydrogen chloride

  • Hydrogen fluoride

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/m2 BSA in children to possibly prevent pulmonary fibrosis


See Nitrites


See Cyanides

Nitrous oxide

See Chloroform

NSAIDs (eg, ibuprofen, naproxen)

Nausea, vomiting, CNS toxicity (eg, seizures with massive overdoses)

Clinical observation, supportive care


See Tricyclic antidepressants

Octamethyl pyrophosphoramide

See Organophosphates

Oil of wintergreen


See Acetanilide (aniline oil) and Petroleum distillates (fuel oil, lubricating oils)

  • Alphaprodine

  • Codeine

  • Fentanyl

  • Heroin

  • Hydrocodone

  • Meperidine

  • Methadone

  • Morphine

  • Opium

  • Oxycodone

  • Propoxyphene

Pinpoint pupils, drowsiness, shallow respirations, spasticity, respiratory failure

Meperidine: 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


See Opioids


  • Acephate

  • Bidrin

  • Chlorethoxyfos

  • Chlorothion

  • Chlorpyrifos

  • Coumaphos

  • Demeton

  • Diazinon

  • Dichlorvos

  • Dimethoate

  • Disulfoton

  • Ethion

  • Famphur

  • Fenthion

  • Hexaethyltetraphosphate

  • Isofenphos

  • Leptophos

  • Malathion

  • Merphos

  • Methidathion

  • Methyl parathion

  • Mipafox

  • Naled

  • Nerve gas agents

  • Octamethyl pyrophosphoramide

  • Oxydemeton-methyl

  • Parathion

  • Phorate

  • Phosdrin

  • Phosmet

  • Pirimiphos-methyl

  • Temefos

  • Terbufos

  • Tetrachlorvinphos

  • Trichlorfon

  • Triorthocresyl phosphate

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 dehydration

For attendants, avoidance of self-contamination

Oxalic acid


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 stricture


See Opioids


See Organophosphates


See Lead

Paint solvents

See Alcohol, methyl; Petroleum distillates (mineral spirits); and Turpentine


  • Insecticides

  • Moth repellents

  • Pesticides

  • Toilet bowl deodorizers

Abdominal pain, nausea, vomiting, diarrhea, seizures, tetany (rare)

Fluid replacement, diazepam to control seizures


Acetic acid odor on breath, incoherence, miosis, depressed respiration, coma

Oxygen, respiratory support

Paraquat (a strong corrosive)


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


See Organophosphates

Paris green

See Arsenic


See Barbiturates


See Chlorinated and other halogenated hydrocarbons

Permanent wave neutralizers

See Bromates


See Pyrethroids


See specific compounds

Petroleum distillates (see Hydrocarbon Poisoning)

  • Asphalt

  • Benzine (benzin)

  • Fuel oil

  • Gasoline

  • Kerosene

  • Lubricating oils

  • Mineral spirits

  • Model airplane glue

  • Naphtha

  • Petroleum ether

  • Tar

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


See Acetanilide

Inattentiveness with eyes open, agitation, violent behavior, unconsciousness, tachycardia, hypertension

Quiet environment

Benzodiazepines if needed to provide sedation


See Amphetamines


See Barbiturates


  • Carbolic acid

  • Creosote

  • Cresols

  • Guaiacol

  • Naphthols

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


  • Chlorpromazine

  • Prochlorperazine

  • Promazine

  • Trifluoperazine

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 seizures


Nervousness, irritability, bradycardia, hypertension plus other sympathomimetic effects

Supportive care, diazepam

For hypertension, phentolamine 5 mg IV over about 1 minute or nitroprusside IV


See Organophosphates


See Organophosphates


See Organophosphates


See Hydrogen sulfide

Phosphodiesterase (PDE) 5 inhibitors

  • Avanafil

  • Sildenafil

  • Tadalafil

  • Vardenafil

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)

  • Rat poisons

  • Roach powders (Note: Red phosphorus is unabsorbable and nontoxic.)

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)

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 K permanganate (1:5000) or hydrogen peroxide (eg, 1–2%), which may change phosphorus to nontoxic oxides

For phosphorus embedded in skin:

  • Submersion of the patient’s body in water

  • Irrigation with dilute K permanganate or cupric sulfate (250 mg in 250 mL of water), recommended by some experts

  • Mineral oil 100 mL (applied topically to prevent absorption), repeated in 2 hours

  • Prevention of shock

  • Meticulous surgical debridement

  • 5% sodium bicarbonate plus 3% cupric sulfate plus 1% hydroxyethyl cellulose as a paste, which is applied to exposed skin and is thoroughly washed off after 30 minutes (prolonged contact with cupric sulfate may result in copper poisoning)


  • Eserine

  • Neostigmine

  • Pilocarpine

  • Pilocarpus genus

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 needed

Benzodiazepine as needed to provide sedation


See Physostigmine

Pilocarpus genus

See Physostigmine


See Organophosphates

Potash (potassium hydroxide or potassium carbonate)

See Acids and alkalis

Potassium cyanide

See Cyanides

Potassium nitrite

See Nitrites

Potassium permanganate

Brown discoloration and burns of oral mucosa, glottal edema, hypotension, kidney involvement

Dilution with water or milk, consideration of early endoscopy, maintenance of fluid balance


Agitation, sinus tachycardia, seizures, coma

Withdrawal syndrome similar to withdrawal symptoms after stopping gamma-hydroxybutyrate (GHB)

Supportive care, benzodiazepines for seizures and agitation


See Phenothiazines


See Chlorinated and other halogenated hydrocarbons


See Phenothiazines


See Opioids


See Tricyclic antidepressants

Prussic acid

See Cyanides


See Pyrethroids


  • Bifenthrin

  • Cyfluthrin

  • Cypermethrin

  • Esfenvalerate

  • Fluvalinate

  • Lambda-cyhalothrin

  • Permethrin

  • Pyrethrin

  • Resmethrin

  • Sumithrin

  • Tefluthrin

  • Tetramethrin

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


See Cimetidine

Rat poisons

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


See Pyrethroids

Resorcinol (resorcin)

Vomiting, dizziness, tinnitus, chills, tremor, delirium, seizures, respiratory depression, coma, methemoglobinemia

Respiratory support, methylene blue for methemoglobinemia

Roach poisons

See Fluorides, Phosphorus, and Thallium salts

Rubbing alcohol

See Alcohol, isopropyl


Salicylic acid

Scopolamine (hyoscine)

See Belladonna


See Barbiturates


See Arsenic and Thallium salts

Sewer gas

See Hydrogen sulfide

Silver salts

Silver nitrate

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

Control of pain, diazepam to control seizures


See Sulfur dioxide

Soda, caustic (Na hydroxide)

Sodium carbonate

See Acids and alkalis

Sodium cyanide

See Cyanides

Sodium fluoride

See Fluorides

Sodium hydroxide

Sodium nitrite

See Nitrites

Sodium salicylate


See Cadmium and Lead


  • Citalopram

  • Escitalopram

  • Fluoxetine

  • Fluvoxamine

  • Paroxetine

  • Sertraline

Commonly, sedation, vomiting, tremor, tachycardia

Possibly, seizures, hallucinations, hypotension, serotonin syndrome

Rarely, death

With citalopram, QRS prolongation possible

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

For severe symptoms, consideration of IV lipid emulsion


See Arsenic


See Belladonna


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 support

For severe seizures, neuromuscular blockade and mechanical ventilatory support

Sulfur dioxide

  • Smog

Respiratory tract irritation, sneezing, cough, dyspnea, pulmonary edema

Removal from contaminated area, oxygen, positive pressure breathing, respiratory support

Sulfuric acid


See Pyrethroids

Syrup of wild cherry

See Cyanides


See Petroleum distillates

Tartar emetic

See Arsenic

Tear gas

See Chlorine (see also Hypochlorites)


See Pyrethroids


See Organophosphates


See Organophosphates


See Organophosphates

Tetraethyl lead

See Lead, tetraethyl


See Pyrethroids

Thallium salts (formerly used in ant, rat, and roach poisons)

Abdominal pain (colic), vomiting (may be bloody), diarrhea (may be bloody), stomatitis, excessive salivation, tremors, leg pains, paresthesias, polyneuritis, ocular and facial palsy, delirium, seizures, respiratory failure, loss of hair about 3 weeks after poisoning

Treatment of shock, supportive care, diazepam to control seizures, activated charcoal (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)

Avoidance of penicillamine and diethyldithiocarbamate (which may redistribute thallium into the CNS)

Consultation with poison control center for latest information advisable


See Aminophylline


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 occur


  • Nicotine

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

Toilet bowl cleaners, deodorizers

See Caustic Ingestion and Paradicholorobenzene

Toluene, toluol

See Benzene


See Chlorinated and other halogenated hydrocarbons


CNS depression, orthostatic hypotension, seizures, QRS prolongation (but torsades de pointes is rare), hypotension (rare)

Airway protection

For hypotension refractory to fluids, norepinephrine


See Organophosphates


See Chloroform

Tricyclic antidepressants

  • Amitriptyline

  • Desipramine

  • Doxepin

  • Imipramine

  • Nortriptyline

  • Protriptyline

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 > 7.45 (constant infusion may be needed)

Diazepam to control seizures

Vasopressors (eg, norepinephrine) to maintain BP

For severe poisoning, consideration of IV lipid emulsion


See Phenothiazines


See Iodoform (triiodomethane)



  • Some paint solvents

  • Some varnishes

Turpentine odor, burning oral and abdominal pain, coughing, choking, respiratory failure, nephritis

Respiratory support, oxygen, control of pain, monitoring of kidney function


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)


See Alcohol, methyl and Turpentine


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

Rarely death

Observation for 6 hours

For QRS prolongation, consideration of alkalinization

Vitamins with iron

See Iron

Warfarin (sometimes used in pesticides)

  • Bishydroxycoumarin

  • Dicumarol

  • Ethyl biscoumacetate

  • Superwarfarins (sometimes used in pesticides)

Single ingestion not serious

With multiple ingestions, coagulopathy with increased PT/INR

For single ingestion, observation

For hemorrhagic manifestations, vitamin K1 (phytonadione—see Vitamin K Toxicity) until INR is normal, transfusion with fresh frozen plasma if necessary

To achieve rapid reversal, prothrombin complex concentrate

Wild cherry syrup (natural, not artificially flavored)

See Cyanides

Wintergreen oil

Wood alcohol

See Alcohol, methyl


See Benzene


Zinc salts

See Copper salts

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.

* 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.

† 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).

Click here for Patient Education
NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version
Professionals also read

Also of Interest

Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID