TABLE 3.2: Commonly Ingested Agents

Commonly Ingested Agents

Ingested AgentSigns and SymptomsAntidotea
AcetaminophenSee Section IV.
AmphetaminesSee sympathomimetics toxidrome in Table 3.1.Supportive care
Benzodiazepines for agitation
AnticholinergicsSee anticholinergic toxidrome in Table 3.1.Physostigmine
Anticholinesterase inhibitors (carbamates, donepezil)See cholinergic toxidrome in Table 3.1.Atropine
AntihistaminesSee anticholinergic toxidrome in Table 3.1; paradoxical CNS stimulation, dizziness, seizures, prolonged QTSupportive care
Button batteriesElectrical injury and necrosis in esophagus and surrounding tissuesLocation:
Esophagus: EMERGENT ENDOSCOPIC/SURGICAL REMOVAL
Stomach/beyond stomach: Consult GI
BenzodiazepinesSee sedative/hypnotic toxidrome in Table 3.1.Flumazenil
β-BlockersBradycardia, hypotension, AV conduction block, bronchospasm, hypoglycemiaGlucagon
See insulin/dextrose treatment in calcium channel blockers below.
High-dose pressors
Household bleach (small volume)Oral irritationSupportive care
Calcium channel blockersBradycardia, hypotension, AV conduction block, pulmonary edema, hyperglycemiaCalcium chloride (10%)
Calcium gluconate (10%)
Glucagon
High-dose insulin/dextrose12: 1 unit/kg bolus → infuse at 1–10 unit/kg/hr; give with D25W at 0.5 g/kg/hr. Monitor BG frequently.
High-dose pressors
ClonidineSymptoms resemble an opioid toxidrome. CNS depression, coma, lethargy, hypothermia, miosis, bradycardia, profound hypotension, respiratory depressionNaloxone
Supportive care
CocaineSee sympathomimetics toxidrome in Table 3.1.Supportive care
Detergent podsVomiting, sedation, aspiration, respiratory distressSupportive care
EcstasyHallucinations, teeth grinding, hyperthermia, hyponatremia, seizuresSupportive care
EthanolSee sedative/hypnotic toxidrome in Table 3.1.
Hypoglycemia in young children		Supportive care
Ethylene glycol/methanolSimilar to ethanol; additionally, blurry or double vision (methanol), renal failure/hypocalcemia (ethylene glycol), osmol gap with severe anion gap metabolic acidosisFomepizole
Ethanol (only to be used as second-line agent when fomepizole unavailable; risk of inappropriate dosing, CNS depression, aspiration, and hypoglycemia)
Consider dialysis.
IronVomiting, diarrhea, hypotension, lethargy, anion gap metabolic acidosis, cardiogenic shock, renal failureDeferoxamine
LeadSee Section V.
NicotineVomiting and see cholinergic toxidrome in Table 3.1Supportive care
NSAIDsNausea, vomiting, epigastric pain, headache, gastrointestinal hemorrhage, renal failureSupportive care
OpioidsSee opioid toxidrome in Table 3.1.Naloxone
OrganophosphatesSee cholinergic toxidrome in Table 3.1.Atropine
Pralidoxime
SalicylatesGastrointestinal upset, tinnitus, tachypnea, hyperpyrexia, dizziness, lethargy, dysarthria, seizure, coma, cerebral edemaSodium bicarbonate: 1–2 mEq/kg IV push, followed by D5W + 140 mEq/L NaHCO3 and 20 mEq/L KCl at 1.5× maintenance fluid rate with goal serum pH 7.45–7.55
Consider dialysis.
Serotonergic agentsSee serotonergic toxidrome in Table 3.1.Benzodiazepines (first-line)
Cyproheptadine
SulfonylureasHypoglycemia, dizziness, agitation, confusion, tachycardia, diaphoresisFood (if able)
Dextrose: 0.5–1 g/kg (2–4 mL/kg of D25W)
After euglycemia achieved: Octreotide: 1–1.25 mCg/kg SQ Q6–12 hr (max. dose 50 mCg) if rebound hypoglycemia
Synthetic cannabinoidsAgitation, altered sensorium, tachycardia, hypertension, vomiting, mydriasis, hypokalemiaSupportive care
TCAsTachycardia, seizures, delirium, widened QRS possibly leading to ventricular arrhythmias, hypotensionFor wide QRS complex:
Sodium bicarbonate: 1–2 mEq/kg IV push, followed by D5W + 140 mEq/L NaHCO3 and 20 mEq/L KCl at 1.5× maintenance fluid rate with goal serum pH 7.45–7.55
WarfarinBleedingPhytonadione/vitamin K1

BG, Blood glucose; CNS, central nervous system; KCl, potassium chloride; NaHCO3, sodium bicarbonate; NSAIDs, nonsteroidal antiinflammatory drugs; TCA, tricyclic antidepressant.
a See Formulary for dosing recommendations.

Data from Gummin DD, Mowry JB, Beuhler MC, et al. 2020 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 38th Annual Report. Clin Toxicol. 2021;59(12):1282–1501.