Hyperpyrexia Anticholinergics, salicylates, amphetamine, cocaine
Muscle fasciculation Organophosphates, theophylline
Muscle rigidity Cyclic antidepressants, PCP, phenothiazines, haloperidol
Peripheral neuropathy Lead, arsenic, mercury, organophosphates
Altered behavior LSD, PCP, amphetamines, cocaine, alcohol, anticholinergics
LSD, Lysergic acid diethylamide; MSG, monosodium glutamate; NSAID, nonsteroidal anti-inflammatory drug; PCP, phencyclidine.
Acetaminophen Nausea, vomiting, pallor, delayed jaundice– hepatic failure (72–96 hr) Amphetamine, Tachycardia, hypertension, hyperthermia, cocaine, and psychosis and paranoia, seizures, mydriasis, sympathomimetics diaphoresis, piloerection, aggressive
Anticholinergics Mania, delirium, fever, red dry skin, dry mouth, tachycardia, mydriasis, urinary retention
Carbon monoxide Headache, dizziness, coma, other systems affected
Cyanide Coma, convulsions, hyperpnea, bitter almond odor
Ethylene glycol Metabolic acidosis, hyperosmolarity, (antifreeze) hypocalcemia, oxalate crystalluria
Iron Vomiting (bloody), diarrhea, hypotension, hepatic failure, leukocytosis, hyperglycemia, radiopaque pills on KUB, late intestinal stricture, Yersinia sepsis
Narcotics Coma, respiratory depression, hypotension, pinpoint pupils, bradycardia
Cholinergics Miosis, salivation, urination, diaphoresis, (organophosphates, lacrimation, bronchospasm (bronchorrhea), nicotine) muscle weakness and fasciculations, emesis, defecation, coma, confusion, pulmonary edema, bradycardia
Salicylates Tachypnea, fever, lethargy, coma, vomiting, diaphoresis, alkalosis (early), acidosis (late)
Cyclic Coma, convulsions, mydriasis, hyperreflexia, antidepressants arrhythmia (prolonged Q-T interval), cardiac arrest, shock
KUB, Kidney-ureter-bladder radiograph.
is assessed easily by measuring arterial blood gases, serum electrolyte levels, and urine pH. An osmolar gap, if present, strongly suggests the presence of an unmeasured component, such as methanol or ethylene glycol. These ingestions require thorough assessment and prompt intervention.
Dysrhythmias may be prominent signs of a variety of toxic ingestions, although ventricular arrhythmias are rare. Prolonged Q-T intervals may suggest phenothiazine or antihistamine ingestion, and widened QRS complexes are seen with ingestions of cyclic antidepressants and quinidine. Because many drug and chemical overdoses may lead to sinus tachycardia, this is not a useful or discriminating sign; however, sinus bradycardia suggests digoxin, cyanide, a cholinergic agent, or β-blocker ingestion (Table 45-4).
Gastrointestinal symptoms of poisoning include emesis, nausea, abdominal cramps, and diarrhea. These symptoms may be the result of direct toxic effects on the intestinal mucosa or of systemic toxicity after absorption.
Methanol,* metformin Uremia* Diabetic ketoacidosis* Paraldehyde,* phenformin Isoniazid, iron Lactic acidosis (cyanide, carbon monoxide) Ethanol,* ethylene glycol* Salicylates, starvation, seizures