POISONING & DRUG OVERDOSE

fourth edition

POISONING & DRUG OVERDOSE

by the faculty, staff and associates of the California Poison Control System

Edited by Kent R. Olson, MD, FACEP, FACMT, FAACT Clinical Professor of Medicine, Pediatrics, and Pharmacy, University of California, San Francisco; Medical Director, California Poison Control System, San Francisco Division

Associate Editors

Ilene B. Anderson, PharmD Associate Clinical Professor of Pharmacy, University of California, San Francisco; Senior Toxicology Management Specialist, California Poison Control System, San Francisco Division

Richard F. Clark, MD, FACEP Professor of of Medicine, University of California, San Diego; Director, Division of Medical Toxicology and Medical Director, California Poison Control System, San Diego Division

Neal L. Benowitz, MD Professor of Medicine and Chief, Division of Clinical Pharmacology and Toxicology, University of California, San Francisco; Associate Medical Director, California Poison Control System, San Francisco Division

Paul D. Blanc, MD, MSPH Professor of Medicine and Chief, Division of Occupational and Environmental Medicine, University of California, San Francisco

Thomas E. Kearney, PharmD, ABAT Professor of Clinical Pharmacy, University of California, San Francisco; Managing Director, California Poison Control System, San Francisco Division

John D. Osterloh, MD, MS Chief Medical Officer, Division of Laboratory Sciences National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia

Lange Medical Books/McGraw-Hill

Medical Publishing Division

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Poisoning & Drug Overdose, Fourth Edition

Copyright ? 2004 by The McGraw-Hill Companies, Inc. All rights reserved. Printed in the United States of America. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a data base or retrieval system, without the prior written permission of the publisher.

Previous editions copyright ? 1999, 1994, 1990 by Appleton & Lange

1 2 3 4 5 6 7 8 9 0 DOC/DOC 0 9 8 7 6 5 4 3

ISBN: 0-8385-8172-2 ISSN: 1048-8847

Notice

Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in this work. Readers are encouraged to confirm the information contained herein with other sources. For example and in particular, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs.

The book was set by Pine Tree Composition, Inc. The editors were Shelley Reinhardt and Barbara Holton. The production supervisor was Phil Galea. The illustration manager was Charissa Baker. The index was prepared by Kathy Pitcoff. RR Donnelly was printer and binder.

This book is printed on acid-free paper.

Authors

Timothy E. Albertson, MD, PhD Professor of Medicine, Pharmacology, Toxicology and Anesthesiology, University of California, Davis School of Medicine; Medical Director, California Poison Control System, Sacramento Division tealbertson@ucdavis.edu Section II: Amphetamines; Barbiturates; Dextromethorphan; Opiates and Opioids

Judith A. Alsop, PharmD, DABAT Associate Clinical Professor, School of Pharmacy, University of California, San Francisco; Associate Clinical Professor, School of Medicine, University of California, Davis; Director, California Poison Control System, Sacramento Division jalsop@ Section II: Plants; Section III: Metoclopramide; Ondansetron; Potassium

Ilene B. Anderson, PharmD Associate Clinical Professor of Pharmacy, University of California, San Francisco; Senior Toxicology Management Specialist, California Poison Control System, San Francisco Division iba@itsa.ucsf.edu Section II: Botulism; Camphor and Other Essential Oils; Ethylene Glycol and Other Glycols; Lomotil and Other Antidiarrheals; Methanol; Warfarin and Related Rodenticides

John Balmes, MD Professor, Department of Medicine, University of California, San Francisco; Chief, Division of Occupational and Environmental Medicine, San Francisco General Hospital jbalmes@itsa.ucsf.edu Section II: Asbestos; Formaldehyde; Gases, Irritant; Molds; Phosgene; Sulfur Dioxide

Shireen Banerji, PharmD Specialist In Poison Information, Rocky Mountain Poison and Drug Center, Denver, Colorado shireen.banerji@ Section II: Angiotensin Blockers & ACE Inhibitors; Vasodilators

James David Barry, MD Fellow, Division of Medical Toxicology, and Clinical Instructor of Emergency Medicine, University of California, San Diego Medical Center jdavebarr@ Section II: Phenytoin

Neal L. Benowitz, MD Professor of Medicine and Chief, Division of Clinical Pharmacology and Toxicology, University of California, San Francisco; Associate Medical Director, California Poison Control System, San Francisco Division nbeno@itsa.ucsf.edu Section II: Anesthetics, Local; Antiarrhythmic Drugs; Antidepressants, General (Noncyclic); Antidepressants, Tricyclic; Beta-Adrenergic Blockers; Calcium Antagonists; Cardiac Glycosides; Chloroquine and Other Aminoquinolines; Cocaine; Ergot Derivatives; Lithium; Marijuana; Monoamine Oxidase Inhibitors; Nicotine; Nitrates and Nitrites; Nitroprusside; Pseudoephedrine, Ephedrine and Other Decongestants; Quinidine and Other Type IA Antiarrhythmic Drugs; Quinine; Vacor (PNU); Section III: Dopamine; Epinephrine; Norepinephrine

Kathleen Birnbaum, PharmD Toxicology Management Specialist, Department of Clinical Pharmacy, University of California, San Francisco kbirnbaum@ Section III: Insulin; Leucovorin Calcium

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AUTHORS

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Paul D. Blanc, MD, MSPH Professor of Medicine, University of California, San Francisco blancp@itsa.ucsf.edu Section II: Carbon Disulfide; Cyanide; Isocyanates; Manganese; Metal Fume Fever; Methemoglobinemia; Nitrogen Oxides; Section IV: Evaluation of the Patient with Occupational Chemical Exposure

Stephen C. Born, MD, MPH Associate Clinical Professor, Division of Occupational and Environmental Medicine, University of California, San Francisco sborn@itsa.ucsf.edu Section II: Dioxins, Ethylene Oxide

Alan Buchwald, MD Consultant in Medical Toxicology and Medical Director, Occupational Health Center, Dominican Santa Cruz Hospital, Santa Cruz, California albuchwald955@ Section II: Copper

F. Lee Cantrell, PharmD Assistant Clinical Professor of Pharmacy, School of Pharmacy, University of California, San Francisco; Assistant Director, California Poison Control System, San Diego Division fcantrel@ucsd.edu Section II: Thyroid Hormone; Section III: Cyproheptadine; Folic Acid

Terry Carlson, PharmD Toxicology Management Specialist, California Poison Control System, Fresno Division tcarlson@ Section III: Naloxone and Nalmefene

Gregory Cham, MBBS, FRCSEd Toxicology Fellow, California Poison Control System, San Francisco Division gwmcham@ Section II: Phencyclidine (PCP) and Ketamine

Chulathida Chomchai, MD Assistant Professor of Pediatrics, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand sirirajpedstox@ Section II: Ipecac Syrup

Summon Chomchai, MD, MPH Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand thaitox@ Section II: Phosphine and Phosphides; Phosphorus

Richard F. Clark, MD Professor of Medicine, University of California, San Diego; Director, Division of Medical Toxicology and Medical Director, California Poison Control System, San Diego Division Section II: Hymenoptera; Lionfish and Other Scorpaenidae; Scorpions; Snakebite; Section III: Antivenom, Crotalinae (Rattlesnake); Antivenom, Latrodectus Mactans (Black Widow Spider); Antivenom, Micrurus Fulvius (Coral Snake) and Exotic Antivenoms

Delia A. Dempsey, MD, MS Assistant Adjunct Professor of Pediatrics, Medicine, and Clinical Pharmacy; Assistant Medical Director, California Poison Control System, University of California, San Francisco Section I: Special Considerations in Pediatric Patients; Section II: Bromides; Methyl Bromide; Pentachlorophenol and Dinitrophenol

Jo Ellen Dyer, PharmD Associate Clincial Professor of Pharmacy, University of California, San Francisco; Senior Toxicology Management Specialist, California Poison Control System, San Francisco Division jodyer@itsa.ucsf.edu Section I: Special Consideration in the Evaluation of Drug-Facilitated Assault; Section II: Azide, Sodium; Gamma Hydroxybutyrate (GHB)

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POISONING & DRUG OVERDOSE

Andrew Erdman, MD Clinical Pharmacology Fellow, University of California, San Francisco andrewerdman@ Section II: Isoniazid (INH)

Gary W. Everson, PharmD Toxicology Management Specialist, California Poison Control System, Fresno Division geverson@ Section II: Phenol and Related Compounds; Section III: Mannitol

Thomas J. Ferguson, MD, PhD Associate Clinical Professor of Internal Medicine, University of California, Davis; Medical Director, Cowell Student Health Center, University of California, Davis tjferguson@ucdavis.edu Section II: Chromium; Thallium

Frederick Fung, MD, MS Clinical Professor of Occupational Medicine, University of California, Irvine; Chief Toxicologist, Sharp Rees-Stealy Medical Group, San Diego, California fred.fung@ Section II: Carbon Tetrachloride and Chloroform

Mark Galbo, MS Specialist, California Poison Control System, San Francisco Division mjgalbo@itsa.ucsf.edu Section II: Naphthalene and Paradichlorobenzene; Warfare Agents ? Chemical

Fabian Garza, PharmD Doctor of Pharamcy, School of Pharmacy, University of California, San Francisco; Toxicology Management Specialist, California Poison Control System, Fresno Division fgarza@ Section III: Methylene Blue

Richard J. Geller, MD, MPH Assistant Clinical Professor, University of California, San Francisco School of Medicine; Medical Director, California Poison Control System, Fresno Division Section II: Disulfiram; Selenium; Paraquat and Diquat; Section III: Atropine and Glycopyrrolate; Pralidoxime (2-PAM) & Other Oximes

Colin S. Goto, MD Attending Toxicologist, California Poison Control System, San Diego Division; Pediatric Emergency Medicine Physician, Children's Hospital and Health Center; Clinical Assistant Professor of Pediatrics, University of California, San Diego cgoto@ Section II: Hydrocarbons

Christine A. Haller, MD Assistant Adjunct Professor of Medicine, University of California, San Francisco; Assistant Medical Director, California Poison Control System, San Francisco Division dchaller@worldnet. Section II: Caffeine; Herbal and Alternative Products; Section III: L-Carnitine; Silibinin Or Milk Thisle (Silybum Marianum)

Patricia Hess Hiatt, BS Administrative Operations Manager, California Poison Control System, San Francisco Division phiatt@itsa.ucsf.edu Section IV: The Toxic Hazards of Industrial and Occupational Chemicals & Table IV-4

Yao-min Hung, MD Attending Physician, Division of Nephrology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan ymhung@isca..tw Section II: Colchicine

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