the references below) and are summarized as follows: APAP concentration over 1,000 mg/L if NAC is not administered, signs of mitochondrial dysfunction and an APAP concentration over 700 mg/L (4,630 mmol/L) if NAC is not administered, or signs of mitochondrial dysfunction and an APAP concentration over 900 mg/L (5,960 mmol/L) if NAC is administered Clinical indications for discharge or admission: Patients who not meet criteria for NAC administration and who are felt to be safe either from a psychiatric (intentional overdose) or social (exploratory ingestion, supratherapeutic ingestion) standpoint may be discharged Cardiac Drugs CLINICAL PEARLS β-Blockers, calcium channel blockers, clonidine, and digoxin all have the potential for significant toxicity even in exploratory, small-volume ingestions A triad of bradycardia, hypotension, and HYPOglycemia should prompt consideration of β-blocker toxicity A triad of bradycardia, hypotension, and HYPERglycemia should prompt consideration of calcium channel blocker toxicity A triad of sedation, bradycardia, and pinpoint pupils, especially in the absence of respiratory depression, should prompt consideration of clonidine toxicity β-Adrenergic Blockers and Calcium Channel Blockers Current Evidence The approaches to overdoses of these two categories of cardiovascular agents are discussed together because of similarities in clinical presentation and management approach They both are commonly prescribed to adult patients with a variety of cardiovascular disorders, including angina and past myocardial infarction, hypertension, and arrhythmias As such, experience with pediatric overdoses has been increasing in more recent years β-Adrenergic blockers (BBs) vary considerably in terms of receptor specificity and pharmacokinetics, but most overdose experience is with propranolol The calcium channel blockers (CCBs) most commonly used in the United States (verapamil, diltiazem, nifedipine, amlodipine, etc.) are chemically dissimilar and