5607fm01.qxd_cs 9/9/03 1:11 PM Page iii 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 Thomas E Kearney, PharmD, ABAT Professor of Clinical Pharmacy, University of California, San Francisco; Managing 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 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 New York Chicago San Francisco Lisbon London Madrid New Delhi San Juan Seoul Singapore Sydney Toronto Mexico City Milan 5607fm01.qxd_cs 9/9/03 1:11 PM Page iv 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 DOC/DOC 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 5607fm01.qxd_cs 9/9/03 1:11 PM Page vi 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@calpoison.org 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@rmpdc.org 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@aol.com 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@calpoison.org Section III: Insulin; Leucovorin Calcium vi 5607fm01.qxd_cs 9/9/03 1:11 PM Page vii AUTHORS vii 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@pol.net 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@wbmsoft.com Section III: Naloxone and Nalmefene Gregory Cham, MBBS, FRCSEd Toxicology Fellow, California Poison Control System, San Francisco Division gwmcham@yahoo.com 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@hotmail.com Section II: Ipecac Syrup Summon Chomchai, MD, MPH Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand thaitox@aol.com 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) 5607fm01.qxd_cs 9/9/03 1:11 PM Page viii viii POISONING & DRUG OVERDOSE Andrew Erdman, MD Clinical Pharmacology Fellow, University of California, San Francisco andrewerdman@sbcglobal.net Section II: Isoniazid (INH) Gary W Everson, PharmD Toxicology Management Specialist, California Poison Control System, Fresno Division geverson@calpoison.org 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@sharp.com 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@calpoison.org 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@chsd.org 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.att.net 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.vghks.gov.tw Section II: Colchicine 5607fm01.qxd_cs 9/9/03 1:11 PM Page ix AUTHORS ix Leslie M Israel, DO, MPH Assistant Clinical Professor, Department of Medicine, Divison of Occupational and Environmental Medicine, University of California, San Francisco; Medical Director, University of California, San Francisco Employee and Occupational Health Services Section II: Cadmium Thomas E Kearney, PharmD, DABAT Professor of Clinical Pharmacy, University of California, San Francisco; Managing Director, California Poison Control System, San Francisco Division pcctk@itsa.ucsf.edu Section II: Carbamazepine; Valproic Acid; Section III: Introduction; Acetylcysteine (N-Acetylcysteine [NAC]); Apomorphine; Benzodiazepines (Diazepam, Lorazepam, and Midazolam); Benztropine; Bicarbonate, Sodium; Botulinum Antitoxin; Bretylium; Bromocriptine; Charcoal, Activated; Cimetidine and Other H2 Blockers; Dantrolene; Diazoxide; Digoxin-Specific Antibodies; Diphenhydramine; Esmolol; Ethanol; Fomepizole (4-Methylpyrazole, 4-MP); Glucagon; Glucose; Haloperidol and Droperidol; Isoproterenol; Labetalol; Lidocaine; Methocarbamol; Morphine; Neuromuscular Blockers; Nicotinamide (Niacinamide); Nitroprusside; Octreotide; Penicillamine; Pentobarbital; Phenobarbital; Phentolamine; Physostigmine and Neostigmine; Propranolol; Protamine; Pyridoxine (Vitamin B6); Thiamine (Vitamin B1); Vitamin K1 (Phytonadione) Susan Kim, PharmD Associate Professor of Clinical Pharmacy, University of California, San Francisco; Senior Toxicology Management Specialist, California Poison Control System, San Francisco Division susank@itsa.ucsf.edu Section II: Antidiabetic Agents; Antineoplastic Agents; Beta-2-Adrenergic Stimulants; Food Poisoning: Bacterial; Food Poisoning: Fish and Shellfish; Jellyfish and Other Cnidaria; Salicylates; Skeletal Muscle Relaxants; Section III: Thiosulfate, Sodium Michael J Kosnett, MD, MPH Associate Clinical Professor of Medicine, Department of Clinical Pharmacology and Toxicology, University of Colorado Health Sciences Center, Denver michael.kosnett@uchsc.edu Section II Arsenic; Arsine; Lead; Mercury; Section III: BAL (Dimercaprol); EDTA, Calcium (Calcium Disodium EDTA, Calcium Disodium Edetate, Calcium Disodium Versenate); Succimer (DMSA); Unithiol (DMPS) Amy Kunihiro, MD Department of Emergency Medicine, Community Hospital of Los Gatos, Los Gatos, California Section II: Isopropyl Alcohol Grant D Lackey, PharmD, CSPI, FASCP Toxicology Management Specialist, California Poison Control System, Sacramento Division; Assistant Clinical Professor of Medicine, University of California, Davis, and Assistant Clinical Professor of Medicine, Univeristy of California, San Francisco glackey@calpoison.org Section II: Antipsychotic Drugs; Arsenic; Section III: Phenytoin and Fosphenytoin Chi-Leung Lai, PharmD Assistant Clinical Professor of Pharmacy, University of California, San Francisco; Assistant Clinical Professor of Medicine, University of California, Davis Medical Center; Toxicology Management Specialist, California Poison Control System, Sacramento Division clai@calpoison.org Section II: Boric Acid, Borates, and Boron Rita Lam, PharmD Toxicology Management Specialist, California Poison Control System, San Francisco Division pearl@itsa.ucsf.edu Section II: Diuretics 5607fm01.qxd_cs 9/9/03 1:11 PM Page x x POISONING & DRUG OVERDOSE Shelly Lam, PharmD Toxicology Management Specialist, California Poison Control System, San Francisco Division Section II: Chlorinated Hydrocarbon Pesticides John P Lamb, PharmD Assistant Clinical Professor of Pharmacy, University of California, San Francisco; Associate Clinical Professor of Medicine, University of California, Davis School of Medicine; Toxicology Management Specialist, California Poison Control System, Sacramento Division jlamb@calpoison.org Section II: Pyrethrins and Pyrethroids Darren H Lew, PharmD Toxicology Management Specialist, California Poison Control System, Fresno Division dlew@calpoison.org Section II: Chlorinated Hydrocarbon Pesticides Diane Liu, MD, MPH Chief, Occupational Health Clinic, University Health Services, Tang Center, University of California, Berkeley dliu@uhs.berkeley.edu Section II: Polychlorinated Biphenyls (PCBS); Trichloroethane, Trichloroethylene and Perchloroethylene Binh T Ly, MD Associate Fellowship Director, Medical Toxicology; Associate Residency Director, Emergency Medicine; Assistant Clinical Professor of Medicine, University of California, San Diego Section II: Hydrogen Fluoride and Hydrofluoric Acid; Methylene Chloride; Section III: Calcium Richard Lynton, MD Toxicology Fellow, Department of Internal Medicine/Toxicology, University of California, Davis Medical Center Section III: Propofol Beth H Manning, PharmD Assistant Clinical Professor, School of Pharmacy, University of California, San Francisco; Toxicology Management Specialist, California Poison Control System, San Francisco Division habbie@itsa.ucsf.edu Section II: Anticholinergics; Antihistamines Anthony S Manoguerra, PharmD Professor of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco; Director, California Poison Control System, San Diego Division amanoguerra@ucsd.edu Section II: Iron; Section III: Deferoxamine; Inamrinone (Formerly Amrinone); Ipecac Syrup Kathy Marquardt, PharmD, DABAT Associate Clinical Professor, School of Pharmacy, University of California, San Francisco; Associate Clinical Professor, School of Medicine, University of California, Davis; Senior Toxicology Management Specialist, California Poison Control System, Sacramento Division kmarquardt@calpoison.org Section II: Mushrooms; Mushrooms, Amatoxin-Type Kathryn H Meier, PharmD Assistant Clinical Professor, School of Pharmacy, University of California, San Francisco; Toxicology Management Specialist, California Poison Control System, San Francisco Division kmpcc@itsa.ucsf.edu Section II: Dapsone; Fluoride; Magnesium; Section III: Hydroxocobalamin 5607fm01.qxd_cs 9/9/03 1:11 PM Page xi AUTHORS xi Michael A Miller, MD Program Director, Department of Emergency Medicine, Darnall Army Community Hospital, Ft Hood, Texas; Medical Toxicology Consultant, Central Texas Poison Center, Temple, Texas mellamiller@aol.com Section II: Lithium; Organophosphorus and Carbamate Insecticides; Warfare Agents – Chemical; Section III: DTPA; Iodine (Potassium Iodine, KI) Eileen Morentz Poison Information Provider, California Poison Control System, San Francisco Division morentz@itsa.ucsf.edu Section II: Nontoxic or Minimally Toxic Household Products Walter H Mullen, PharmD Assistant Clinical Professor of Pharmacy, University of California, San Francisco; Toxicology Management Specialist, California Poison Control System, San Francisco Division whm@itsa.ucsf.edu Section II: Caustic and Corrosive Agents; Iodine; Section III: Flumazenil; Nitrite, Sodium and Amyl Stephen W Munday, MD, MPH, MS Medical Toxicologist, Sharp Rees-Stealy Medical Group, San Diego, California stephen.munday@sharp.com Section II: Hydrogen Sulfide Steve Offerman, MD Assistant Clinical Professor of Emergency Medicine, University of California, San Diego School of Medicine; Medical Toxicology Fellow, Emergency Department Attending, University of California, San Diego Medical Center rxsteeps@aol.com Section II: Fluoroacetate 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 olson@itsa.ucsf.edu Section I: Emergency Evaluation and Treatment; Section II: Acetaminophen; Amantadine; Carbon Monoxide; Oxalic Acid; Smoke Inhalation; Theophylline; Vitamins; Section III: Oxygen & Hyperbaric Oxygen; Section IV: Emergency Medical Response to Hazardous Materials Incidents; The Toxic Hazards of Industrial and Occupational Chemicals Michael O’Malley, MD, MPH Associate Clinical Professor, School of Medicine, University of California, Davis maomalley@ucdavis.edu Section II: Chlorophenoxy Herbicides Manish Patel, MD Medical Toxicologist, Centers for Disease Control and Prevention, Atlanta, Georgia mmpatel@emory.edu Section II: Lysergic Acid Diethylamide (LSD) and Other Hallucinogens Cyrus Rangan, MD, FAAP Assistant Medical Director, California Poison Control System, San Francisco Division; Director, Toxics Epidemiology Program, Los Angeles County Department of Health Services; Attending Staff, Childrens Hospital Los Angeles crangan@calpoison.org Section II: Clonidine and Related Drugs Pending Freda M Rowley, PharmD Assistant Clinical Professor of Pharmacy, University of California, San Francisco; Toxicology Management Specialist, California Poison Control System, San Francisco Division frowley@calpoison.org Section II: Anticonvulsants, Newer 5607fm01.qxd_cs 9/9/03 1:11 PM Page xii xii POISONING & DRUG OVERDOSE Thomas R Sands, PharmD Assistant Clinical Professor, School of Pharmacy, University of California, San Francisco; Associate Clinical Professor, School of Medicine, University of California, Davis; Toxicology Management Specialist, California Poison Control System, Sacramento Division tsands@calpoison.org Section II: Bromates; Chlorates Aaron Schneir, MD Assistant Clinical Professor, University of California, San Diego Medical Center, and California Poison Control System, San Diego Division aschneir@ucsd.edu Section II: Nitrous Oxide Jay Schrader, CPhT Poison Information Provider, California Poison Control System, San Francisco Division jschrad@itsa.ucsf.edu Section II: Nontoxic or Minimally Toxic Household Products Kerry Schwarz, PharmD Toxicology Management Specialist, California Poison Control System, Sacramento Division kschwarz@calpoison.org Section II: Antiseptics and Disinfectants Dennis Shusterman, MD, MPH Professor of Clinical Medicine, University of California, San Francisco dennis@itsa.ucsf.edu Section II: Freons and Halons Karl A Sporer, MD Associate Clinical Professor, University of California, San Francisco; Attending Physician, San Francisco General Hospital ksporer@itsa.ucsf.edu Section II: Tetanus Jeffrey R Suchard, MD, FACEP Assistant Clinical Professor, Director of Medical Toxicology, Department of Emergency Medicine, University of California, Irvine Medical Center, Orange, California jsuchard@uci.edu Section II: Spiders Winnie W Tai, PharmD Assistant Clinical Professor of Pharmacy, University of California, San Francisco; Toxicology Management Specialist, California Poison Control System, San Francisco Division tai@itsa.ucsf.edu Section II: Metaldehyde; Nonsteroidal Anti-Inflammatory Drugs David A Tanen, MD Assistant Program Director and Research Director, Emergency Medicine Department, Naval Medical Center, San Diego, California dtanen@yahoo.com Section II: Warfare Agents - Biological John H Tegzes, VMD Associate Professor, Toxicology, Western University of Health Sciences, Pomona, California jtegzes@westernu.edu Section III: Tetanus Toxoid and Immune Globulin 5607fm01.qxd_cs 9/9/03 1:11 PM Page xiii AUTHORS xiii R Steven Tharratt, MD, MPVM, FACMT Professor of Medicine and Anesthesiology, University of California, Davis; Associate Medical Director, Califoria Poison Control System, Sacramento Division rstharratt@ucdavis.edu Section II: Ammonia; Chlorine; Section IV: Emergency Medical Response to Hazardous Materials Incidents Ben Tsutaoka, PharmD Assistant Clinical Professor, School of Pharmacy, University of California, San Francisco; Toxicology Management Specialist, California Poison Control System, San Francisco Division btsutaoka@calpoison.org Section II: Benzodiazepines; Sedative-Hypnotic Agents Peter Wald MD, MPH Associate Clinical Professor of Occupational Medicine, University of Southern California; Assistant Clinical Professor of Occupational Medicine, University of California Los Angeles and Irvine; Assistant Vice-President Wellness, USAA, San Antonio, Texas peter.wald@usaa.com Section II: Antimony and Stibine; Benzene Michael J Walsh, PharmD Assistant Clinical Professor, School of Pharmacy, University of California, San Francisco; Toxicology Management Specialist, California Poison Control System, Sacramento Division mwalsh@calpoison.org Section II: Detergents Janet Weiss, MD Director, TheToxDoc, Berkeley, California toxdoc@doctor.com Section II: Ethylene Dibromide; Toluene and Xylene R David West, PharmD Toxicology Management Specialist, California Poison Control System, Fresno Division dvwest@calpoison.org Section III: Magnesium Saralyn R Williams, MD Associate Clinical Professor of Medicine, University of California, San Diego; Assistant Medical Director, California Poison Control System, San Diego Division srwilliams@ucsd.edu Section II: Ethanol; Strychnine Olga F Woo, PharmD Associate Clinical Professor of Pharmacy, University of California, San Francisco; Clinical Pharmacist/Toxicologist, First DataBank, Inc., The Hearst Corporation, San Bruno, California olga_woo@firstdatabank.com Section II: Antibacterial Agents; Antiviral and Antiretroviral Agents; Barium Evan T Wythe MD Associate Director, Eden Emergency Medical Group, Inc., Castro Valley, California wythe@sbcglobal.net Section II: Radiation (Ionizing) 5607indx.qxd_mg 9/9/03 1:52 PM Page 704 704 Sedative-hypnotics (cont.) pentobarbital in management of, 485–486 phenobarbital in management of, 486–487 propofol in management of, 494–496 seizures caused by, 23t tachycardia caused by, 13t Seizures, 22–24, 23t anion gap/lactic acidosis associated with, 34t drugs and toxins causing, 23t rhabdomyolysis associated with, 27t treatment of, 23–24 benzodiazepines for, 24, 415–418 fosphenytoin for, 488–489 glucose for, 450–451 pentobarbital for, 24, 485–486 phenobarbital for, 24, 486–487 phenytoin for, 24, 303, 488–489 primidone for, 124–125 propofol for, 24, 494–496 valproic acid for, 362 Seldane See terfenadine, 97t, 98 Selegiline See also monoamine oxidase inhibitors, 269–271 amphetamine blood test interference and, 74 pharmacokinetics of, 400t toxicity of, 269–271 Selenic acid See also selenium, 337–339 toxicity of, 338t Selenious acid (gun bluing) See also selenium, 337–339 toxicity of, 337–338, 338t in children, 60t Selenium/elemental selenium, 337–339, 338t exposure limits for, 337, 610t hazard summary for, 610t neuropathy caused by, 31t odor caused by, 32t, 337, 338 toxicity of, 337–339, 338t Selenium dioxide (selenium oxide) See also selenium, 337–339 hazard summary for, 610t toxicity of, 338, 338t Selenium hexafluoride (selenium fluoride) See also selenium, 337–339 hazard summary for, 611t toxicity of, 338, 338t Selenium hydride (hydrogen selenide) See also selenium, 337–339 hazard summary for, 579t toxicity of, 338, 338t Selenium oxide (selenium dioxide) See also selenium, 337–339 hazard summary for, 610t toxicity of, 338, 338t Selenium oxychloride, hazard summary for, 611t Selenium salt See also selenium, 337–339 toxicity of, 338 Selenium trioxide (sodium selenite) See also selenium, 337–339 toxicity of, 338, 338t Self-contained breathing apparatus, for personal protection during response in hazardous materials incidents, 515 Semilente insulin (rapid insulin zinc) See also insulin, 93–96, 455–456 pharmacokinetics of, 391t toxicity of, 94t Semprex-D See acrivastine, 97t pseudoephedrine, 320–322 Senecio spp, 312t, 313t, 316t, 317t See also plants, 309–319 Senna, 217t See also herbal and alternative products, 215–218 Sensorcaine See bupivacaine, 75t Septra See sulfonamides (sulfamethoxazole), 83t, 400t trimethoprim, 81, 84t Sequoia sempervirens, 316t See also plants, 309–319 Serafem See fluoxetine, 88, 88t, 89 Serax See oxazepam, 130t Serenity See 1,4-butanediol, 210–213, 211t INDEX Serentil See mesoridazine, 107t Serevent (salmeterol) See beta-adrenergic agents, 133–135 Seroquel See quetiapine, 107t Serotonin reuptake inhibitors (SSRIs), 89 agitation caused by, 24t dyskinesias caused by, 26t monoamine oxidase inhibitor interaction and, 22, 89, 270, 270t psychosis caused by, 24t seizures caused by, 23t toxicity of, 89 Serotonin syndrome, 21t, 22, 89 cyproheptadine for, 22, 89, 430–431 dextromethorphan causing, 183 monoamine oxidase inhibitor overdose/interactions causing, 22, 89, 270, 271 propranolol for, 496–497 rigidity in, 22, 26 treatment of, 22, 89 Serotonin uptake inhibitors See serotonin reuptake inhibitors (SSRIs), 89 Sertraline, 88 See also antidepressants, noncyclic, 88–90 monoamine oxidase inhibitor interaction and, 89, 270, 270t pharmacokinetics of, 400t toxicity of, 88, 88t, 89 ventricular arrhythmias caused by, 14t Serum osmolality, in diagnosis of poisoning, 32–33, 32t, 33t Serzone See nefazodone, 88, 88t, 89 Sesbania spp, 316t See also plants, 309–319 Sevin (carbaryl) See also organophosphates and carbamates, 291–295 hazard summary for, 546t pralidoxime (2-PAM)/oximes for poisoning with, 492–494 toxicity of, 293t Sewage work, toxic exposures and, 521t Sewer gas (hydrogen sulfide), 224–225 anion gap/lactic acidosis caused by, 34t coma caused by, 19t, 224 exposure limits for, 224, 580t hazard summary for, 580t hypoxia caused by, 7t, nitrites for poisoning caused by, 224, 476–477 occupational exposure to, 521t, 523, 524 odor caused by, 32t seizures caused by, 23t, 224 stupor caused by, 19t, 224 tachycardia caused by, 13t toxicity of, 224–225 central nervous system effects and, 523 Sexual abuse, 58 SF4 (sulfur tetrafluoride), hazard summary for, 615t Shampoo See also low-toxicity products, 286 accidental exposure to, 287t Shamrock, 317t See also plants, 309–319 Shark cartilage, 217t See also herbal and alternative products, 215–218 Shaving cream See also low-toxicity products, 286 accidental exposure to, 287t Sheet-metal work, toxic exposures and, 521t Sheetrock See also nontoxic products, 286 accidental exposure to, 287t Shellac (dry) See also nontoxic products, 286 accidental exposure to, 287t Shellfish anaphylactic reaction caused by, 28t food poisoning caused by, 205–207, 206t Shigella, food poisoning/systemic infection caused by, 203, 204t See also food poisoning, bacterial, 203–205 Shipping papers, for identification of substance at hazardous materials incident site, 512 Shock anion gap/lactic acidosis associated with, 34t dopamine in management of, 438–439 norepinephrine in management of, 479–480 Shoe polish See also nontoxic products, 286 accidental exposure to, 287t Shout Aerosol Laundry and Soil Stain Remover See detergents (nonionic), 181–183 5607indx.qxd_mg 9/9/03 1:52 PM Page 705 INDEX hydrocarbons (isobutane/propane propellant), 219–221 petroleum naphtha, 219t SIADH (syndrome of inappropriate ADH secretion), 37 drugs and toxins causing, 36t “Sick building syndrome,” 268 Sildenafil, nitrate use and, 279 Silibide See silibinin, 500–501 Silibinin (milk thistle/Silybum marianum), 217t, 500–501 See also herbal and alternative products, 215–218 for amatoxin mushroom poisoning, 275, 500–501 pharmacology/use of, 500–501 toxicity of, 217t Silica amorphous, hazard summary for, 611t crystalline hazard summary for, 611t job processes associated with exposure to, 521t gel See also nontoxic products, 286 accidental exposure to, 287t hazard summary for, 611t Silicon, hazard summary for, 611t Silicon tetrachloride, hazard summary for, 612t Silicosis, 522 Silly putty See also nontoxic products, 286 accidental exposure to, 287t Silo work, toxic exposures and, 521t Silver, hazard summary for, 612t Silver nitrate See also caustic and corrosive agents, 157–159 toxicity of, 158t, 279–280 Silybinin (milk thistle/Silybum marianum), 500–501 See also herbal and alternative products, 215–218 for amatoxin mushroom poisoning, 275, 500–501 pharmacology/use of, 500–501 toxicity of, 217t Silymarin, 500, 501 See also silybinin, 500–501 Simethicone See also low-toxicity products, 286 accidental exposure to, 287t Simply Sleep See diphenhydramine, 97t, 98, 436–437 Sinemet See levodopa, 18t, 24t, 26t Sinequan See doxepin, 88t Sinus tachycardia, 12 propranolol in control of, 496–497 Skelaxin See metaxalone, 393t Skeletal muscle relaxants, 339–341, 340t benzodiazepines as, 415–418 toxicity of, 339–341, 340t Skin in arsenic poisoning, 117 decontamination of, 46, 47t topical agents for, 47t drug absorption in neonates and, 62 examination of, in diagnosis of poisoning, 31 hydrocarbons causing disorders of, 526 morphine for corrosive injury of, 468–469 occupational exposures associated with disorders of, 522t, 523 red (flushed) in carbon monoxide poisoning, 152 in diagnosis of poisoning, 31 Skin protection information about in occupational-exposure history, 519 for response in hazardous materials incident, 516 Skunk cabbage, 317t See also plants, 309–319 Sky-flower, 317t See also plants, 309–319 Sleep Eze See diphenhydramine, 97t, 98, 436–437 Sleepinal Maximum Strength See diphenhydramine, 97t, 98, 436–437 Slo-Bid See theophylline, 354–356 Slo-Niacin See niacin, 366–367 Slo-Phyllin See theophylline, 354–356 Slug poison, metaldehyde in See metaldehyde, 258 Smallpox, as biological weapon, 367, 368, 369t, 371 See also warfare agents, biological, 367–372 SMFA (sodium monofluoroacetate/fluoroacetate/compound 1080), 201–202 hazard summary for, 612t pharmacokinetics of, 202 toxicity of, 201–202 705 “Smoke bombs,” 341 See also smoke inhalation, 341–342 Smoke inhalation, 341–342 bronchospasm caused by, 9t cyanide poisoning associated with, thiosulfate for, 342, 505–506 hypoxia caused by, 7t Smoking benzene poisoning and, 128 bupropion for cessation of, 88 passive, hazard summary for, 568t Smoking stools, in phosphorus poisoning, 308 Snail poison, metaldehyde in See metaldehyde, 258 Snails, monoamine oxidase inhibitor interaction and, 270t Snakebites, 343–346, 343t antivenoms for, 345, 407–409, 408t, 410–411 hypotension caused by, 16t ventilatory failure caused by, 6t Snakeroot, 317t See also plants, 309–319 black, 311t “Sniffing” position, 1, 4f Snowberry, 317t See also plants, 309–319 Snow scenes See also low-toxicity products, 286 accidental exposure to, 288t Snow sprays See also low-toxicity products, 286 accidental exposure to, 288t SO2F2 (sulfuryl fluoride/Vikane) hazard summary for, 615t job processes associated with exposure to, 521t Soap See also detergents, 181–183 bar See also low-toxicity products, 286 accidental exposure to, 287t “Soap” (slang) See gamma-hydroxybutyrate (GHB), 210–213, 211t Soapy water, for emesis in gastrointestinal decontamination, 49 Sodium alterations in serum levels of, 35–37, 36t drugs and toxins associated with, 36t overdose of, hypernatremia caused by, 36t Sodium 2,3-dimercaptosuccinate, 503 See also 2,3-dimercaptosuccinic acid (succimer/DMSA), 501–503 Sodium azide, 122–124 anion gap/lactic acidosis caused by, 34t coma caused by, 19t hazard summary for, 612t pharmacokinetics of, 382t stupor caused by, 19t toxicity of, 122–124 Sodium bicarbonate, 419–420 for antiarrhythmic overdose, 80, 419–420 for antihistamine overdose, 98 for antipsychotic drug overdose, 109 for beta-adrenergic blocker overdose, 133 as binding agent, 53t for chloroquine overdose, 166 for hyperkalemia, 38 for opiate/opioid overdose, 290 pharmacology/use of, 419–420 for quinine overdose, 327 for radiation poisoning, 330t, 419–420 for rhabdomyolysis, 27, 419–420 for salicylate overdose, 333, 419–420 for tricyclic antidepressant overdose, 15, 92, 419–420 for type Ia antiarrhythmic overdose, 325, 419–420 for urinary alkalinization, 419–420 potassium as supplement to, 491–492 for ventricular arrhythmias, 15 Sodium bisulfide, hazard summary for, 612t Sodium bisulfite, hazard summary for, 612t Sodium borate/tetraborate (borates), 135–136 hazard summary for, 541t toxicity of, 135–136 Sodium channel blocking drugs, 78, 324–326, 324t See also antiarrhythmic drugs, 78–81 toxicity of, 324–326, 324t ventricular arrhythmias caused by, 14, 15 Sodium chlorate, toxicity of, 159–161 Sodium chloride abdominal x-ray showing, 46t for bromide poisoning, 141 5607indx.qxd_mg 9/9/03 1:52 PM Page 706 706 Sodium chloroplatinate, hazard summary for, 605t Sodium cyanide See also cyanide, 177–179 hazard summary for, 555t Sodium dichromate, hazard summary for, 552t Sodium fluoride, 200t See also fluoride, 200–201 Sodium fluoroacetate (fluoroacetate/compound 1080), 201–202 hazard summary for, 612t pharmacokinetics of, 202 toxicity of, 201–202 Sodium fluosilicate, 200t See also fluoride, 200–201 Sodium hydrogen sulfite (sodium bisulfite), hazard summary for, 612t Sodium hydroxide, hazard summary for, 613t Sodium hypochlorite, for chemical weapons decontamination, 378 Sodium iodide See also iodine, 226–228 toxicity of, 226 Sodium metabisulfite, hazard summary for, 613t Sodium monofluoroacetate (SMFA/fluoroacetate/compound 1080), 201–202 hazard summary for, 612t pharmacokinetics of, 202 toxicity of, 201–202 Sodium monofluorophosphate, 200t See also fluoride, 200–201 Sodium nitrate, toxicity of, 279–280 Sodium nitrite, 476–477, 477t for cyanide poisoning, 178, 476–477 pharmacology/use of, 476–477, 477t toxicity of, 279–280, 476 Sodium nitroprusside (nitroprusside), 281–282, 477–479 cyanide released from, 177, 178, 281–282, 478 hydroxocobalamin prophylaxis/treatment and, 282, 453–454, 478 thiosulfate prophylaxis/treatment and, 282, 478, 505–506 for ergot overdose, 190, 477–479 for hypertension, 18, 281, 477–479 hypotension caused by, 16t, 282 pharmacokinetics of, 396t pharmacology/use of, 477–479 thiocyanate intoxication caused by, 281–282, 478 toxicity of, 281–282, 478 Sodium oxybate See gamma-hydroxybutyrate (GHB), 210–213 Sodium phosphate, cellulose, as binding agent, 53t Sodium polystyrene sulfonate (kayexalate) as binding agent, 53t for hyperkalemia, 38 Sodium pyrosulfite (sodium metabisulfite), hazard summary for, 613t Sodium selenate See also selenium, 337–339 toxicity of, 338, 338t Sodium selenide See also selenium, 337–339 toxicity of, 338t Sodium selenite See also selenium, 337–339 toxicity of, 338, 338t Sodium sulfate, for barium poisoning, 127 Sodium thiosulfate, 505–506 for antineoplastic infusion extravasation, 106, 505–506 for bromate poisoning, 139, 505–506 for chlorate poisoning, 160 for cyanide poisoning, 178, 377, 505–506 nitroprusside-induced, 282, 478, 505–506 in smoke inhalation, 342, 505–506 for iodine poisoning, 227 pharmacology/use of, 505–506 Soil See also nontoxic products, 286 accidental ingestion of, 287t Solanine, 310t See also plants, 309–319 Solanum spp, 313t, 315t, 316t See also plants, 309–319 Solanum melongena, 313t See also plants, 309–319 Solanum nigrum, 315t See also plants, 309–319 Solanum pseudocapsicum, 314t, 315t See also plants, 309–319 Solarcaine Aerosol Spray See benzocaine, 75, 75t, 76 Solvents occupational exposure to, 519, 521t cardiovascular disorders caused by, 523 INDEX job processes associated with, 521t neurotoxic effects of, 523 ventricular arrhythmias caused by, 14t, 523 Soma See carisoprodol, 340, 340t Soma Compound See carisoprodol, 340, 340t salicylates, 331–333 Soman (GD) See also organophosphates and carbamates, 291–295 as chemical weapon, 372, 373, 374t See also warfare agents, chemical, 372–378 pralidoxime (2-PAM)/oximes for poisoning with, 377, 492–494 toxicity of, 372, 373, 374t Soma Solutions See 1,4-butanediol, 210–213, 211t Somatomax PM See gamma-hydroxybutyrate (GHB), 210–213, 211t SomatoPro caps See 1,4-butanediol, 210–213, 211t Sominex See pyrilamine, 97t Sominex See diphenhydramine, 97t, 98, 436–437 Sominex Pain Relief Formula See acetaminophen, 66–69 diphenhydramine, 97t, 98, 436–437 Somsanit See gamma-hydroxybutyrate (GHB), 210–213 Sonata See zaleplon, 129, 130t Sophora secundiflora, 312t, 315t See also plants, 309–319 Sorbitol, for gastrointestinal decontamination, 52 Sorrel, 317t See also plants, 309–319 garden, 313t Sotalol See also beta-adrenergic blockers, 131–133 pharmacokinetics of, 400t toxicity of, 131, 132t ventricular arrhythmias caused by, 14t Soursob, 317t See also plants, 309–319 Sparfloxacin, ventricular arrhythmias caused by, 14t Spathiphyllum/Spathiphyllum, 317t See also plants, 309–319 “Special K” (slang) See ketamine, 300–302 “Special LA Coke” (slang) See ketamine, 300–302 Spectinomycin See also antibacterial agents, 81–84 pharmacokinetics of, 400t toxicity of, 83t “Speed” (slang) See methamphetamine, 72, 73t “Speedball” (slang), 171 See also cocaine, 171–173; heroin, 286, 289t Spermicides (nonoxynol-9) See also low-toxicity products, 286 accidental exposure to, 287t Sphingomyelinase D, in Loxosceles spider venom, 346 Spider envenomation, 346–348 rigidity caused by, 26t, 347 Spindle tree, 317t See also plants, 309–319 Spironolactone See also diuretics, 187–189 pharmacokinetics of, 400t toxicity of, 188, 188t Spirulina, 217t See also herbal and alternative products, 215–218 Split leaf philodendron, 317t See also plants, 309–319 Squalua acanthius (shark cartilage), 217t See also herbal and alternative products, 215–218 Squill, 317t See also plants, 309–319 SSRIs (serotonin reuptake inhibitors), 89 agitation caused by, 24t dyskinesias caused by, 26t monoamine oxidase inhibitor interaction and, 22, 89, 270, 270t psychosis caused by, 24t seizures caused by, 23t toxicity of, 89 Stachybotrys spp See also molds, 267–269 toxicity of, 267, 267–268, 268 Stadol See butorphanol, 289, 289t Stamp pad ink See also nontoxic products, 286 accidental exposure to, 287t Stannous fluoride, 200t See also fluoride, 200–201 Staphylococcal enterotoxin B, as biological weapon, 370t See also warfare agents, biological, 367–372 Staphylococcus aureus, food poisoning caused by, 204t See also food poisoning, bacterial, 203–205 5607indx.qxd_mg 9/9/03 1:52 PM Page 707 INDEX Starch See also nontoxic products, 286 accidental exposure to, 287t, 288t Star-of-Bethlehem, 317t See also plants, 309–319 “Statin” drugs, rhabdomyolysis caused by, 27t Status epilepticus See also seizures, 22–24, 23t fosphenytoin for, 488–489 pentobarbital for, 485–486 phenobarbital for, 486–487 phenytoin for, 303, 488–489 propofol for, 494–496 renal failure/rhabdomyolysis caused by, 39t valproic acid for, 362 Stavudine, pharmacokinetics of, 400t Stearalkonium chloride See also detergents, 181–183 toxicity of, 181t Steatosis, hepatic, antiretroviral drugs causing, 111 Steel, galvanized, welding, toxic exposures and, 521t Stelazine See trifluoperazine, 107t Steroid creams See also low-toxicity products, 286 accidental exposure to, 287t Steroids agitation caused by, 24t anabolic, 216t See also herbal and alternative products, 215–218 warfarin interaction and, 379t psychosis caused by, 24t Stibine, 98–100 hazard summary for, 613t odor caused by, 32t, 99 toxicity of, 98–100 Stimulants (CNS) amphetamines, 72–74 as chemical weapons, 373, 376, 377 See also warfare agents, chemical, 372–378 neuromuscular blocking agents for overdose of, 472–475 in toxicology screens, 41t St John’s Wort (Hypericum perforatum), 217t, 269–271, 317t See also herbal and alternative products, 215–218; monoamine oxidase inhibitors, 269–271; plants, 309–319 Stoddard solvent, hazard summary for, 613t Stonefish (Australian) envenomation, 243–244 Stools, smoking, in phosphorus poisoning, 308 STP (2,5-dimethoxy-4-methyl-amphetamine/DOM), 248t See also hallucinogens, 247–249 toxicity of, 248t, 249 Streptomycin See also antibacterial agents, 81–84 pharmacokinetics of, 400t toxicity of, 82t Streptozocin See also antineoplastic agents, 100–107 hypoglycemia caused by, 35t toxicity of, 105t String of pearls/beads, 317t See also plants, 309–319 Strontium-90 See also radiation (ionizing), 327–331 chelating/blocking agents for exposure to, 330t Structural paint refurbishing, toxic exposures and, 521t Strychnine, 317t, 348–350 diazepam for poisoning caused by, 349, 415–418 hazard summary for, 613t methocarbamol for poisoning caused by, 465–466 neuromuscular blocking agents for poisoning caused by, 472–475 pancuronium for poisoning caused by, 350, 472–475 pharmacokinetics of, 349, 400t renal failure caused by, 39t, 349 rhabdomyolysis caused by, 27t, 39t, 349 rigidity caused by, 26t seizure-like activity caused by, 23t, 349 toxicity of, 317t, 348–350 in toxicology screens, 41t ventilatory failure caused by, 6t, 349 Strychnos nux-vomica, 317t, 348 See also strychnine, 348–350 Stupor, 19–20, 19t benzodiazepines causing, 19t, 20, 130 flumazenil for treatment of, 20, 131, 416, 446–447 drugs and toxins causing, 19t treatment of, 19–20 glucose for, 450–451 707 nalmefene for, 469–472 naloxone for, 20, 469–472 thiamine for, 20, 505 Styrene monomer, hazard summary for, 613t Styrofoam See also nontoxic products, 286 accidental exposure to, 287t Subarachnoid hemorrhage, miosis caused by, 30t Substance abuse, toxicology screening for, 42t Subtilisins, hazard summary for, 614t Succimer (DMSA/meso-2,3-dimercaptosuccinic acid), 501–503 for arsenic poisoning, 118, 501–503 for arsine gas poisoning, 121 for lead poisoning, 241, 501–503 for mercury poisoning, 256, 257, 501–503 pharmacology/use of, 501–503 Succinonitrile, tetramethyl, hazard summary for, 618t Succinylcholine See also neuromuscular blocking agents, 472–475 adverse effects of, 474 in children, for orotracheal intubation, 5, 472–475 pharmacology/use of, 472, 473t, 474–475 Sucol B See 1,4-butanediol, 210–213, 211t Suction devices, for snakebites, 345 Suctioning, for clearing airway, Sudafed See pseudoephedrine, 320–322 Suicide/suicide attempts in adolescents, 60 antipsychotic drugs in, 107 ethanol in, 191, 192 psychiatric consultation for patients at risk for, 58 tricyclic antidepressants in, 90 Sular See nisoldipine, 145t Sulfa drugs, old, odor caused by, 32t Sulfamethoxazole, pharmacokinetics of, 400t Sulfhemoglobinemia dapsone causing, 179, 180 hypoxia in, 7t in sulfur dioxide poisoning, 350 Sulfites anaphylactic/anaphylactoid reaction caused by, 28t bronchospasm caused by, 9t Sulfonamides See also antibacterial agents, 81–84 toxicity of, 83t warfarin interaction and, 379t Sulfonylureas, 93–96 See also antidiabetic (hypoglycemic) agents, 93–96 hypoglycemia caused by, 35, 35t, 93–94, 95 octreotide for overdose of, 480–481 pharmacokinetics of, 94t toxicity of, 93–96, 94t in children, 60t Sulfotepp (tetraethyl-di-thionopyrophosphate) See also organophosphates and carbamates, 291–295 hazard summary for, 617t toxicity of, 292t Sulfoton, pralidoxime (2-PAM)/oximes for poisoning with, 492–494 Sulfur dioxide, 350–351 See also gases, irritant, 213–215 exposure limits for, 214t, 350, 614t hazard summary for, 614t job processes associated with exposure to, 521t toxicity of, 214t, 350–351 Sulfur hexafluoride, hazard summary for, 614t Sulfuric acid, hazard summary for, 614t Sulfur monochloride, hazard summary for, 614t Sulfur mustard as chemical weapon, 372, 374t See also warfare agents, chemical, 372–378 toxicity of, 372, 374t Sulfur pentafluoride, hazard summary for, 615t Sulfur tetrafluoride, hazard summary for, 615t Sulfuryl fluoride (Vikane) hazard summary for, 615t job processes associated with exposure to, 521t Sulindac See also nonsteroidal anti-inflammatory drugs, 283–286 pharmacokinetics of, 400t toxicity of, 284t 5607indx.qxd_mg 9/9/03 1:52 PM Page 708 708 Sulprofos See also organophosphates and carbamates, 291–295 hazard summary for, 615t toxicity of, 292t Sumac (poison), 316t See also plants, 309–319 Sumatriptan, ventricular arrhythmias caused by, 14t Summer sausage, monoamine oxidase inhibitor interaction and, 270t Sunscreens See also low-toxicity products, 286 accidental exposure to, 287t Suntan lotions See also low-toxicity products, 286 accidental exposure to, 287t “Super C” (slang) See ketamine, 300–302 Superglue See also nontoxic products, 286 accidental exposure to, 287t Supermethrin See also pyrethrins/pyrethroids, 322–324 toxicity of, 323t Superwarfarins in rodenticides, 378–380 toxicity of, 378–380 Support Zone (cold or green zone), at hazardous materials incident site, 510, 511f victim management in, 516 Supraventricular tachycardia, 12 esmolol for, 443–444 Surface decontamination, 46–47, 47t, 48f eyes, 47, 48f inhalation, 47 skin, 46, 47t Surgery, for gastrointestinal decontamination, 54 Surmontil See trimipramine, 88t Sustained-release preparations, abdominal x-ray showing, 46t Sustiva See efavirenz, 113t, 114 “Swamp gas” See hydrogen sulfide, 224–225 Sweating, in diagnosis of poisoning, 31 Sweet clover, 317t See also plants, 309–319 Sweet pea, 317t See also plants, 309–319 Sweet William, 317t See also plants, 309–319 Swimming pool disinfection, toxic exposures and, 521t Swiss cheese plant, 317t See also plants, 309–319 Symmetrel See amantadine, 69–70 Sympatholytic agents atrioventricular (AV) block caused by, 10t bradycardia caused by, 10t coma caused by, 19t hypotension caused by, 16t miosis caused by, 30t stupor caused by, 19t ventilatory failure caused by, 6t Sympatholytic syndrome, 29, 29t Sympathomimetics, 320–322, 321t hypertension caused by, 18t mydriasis caused by, 30t propranolol for overdose of, 496–497 seizures caused by, 23t tachycardia caused by, 13, 13t ventricular arrhythmias caused by, 14t Symphoricarpos spp, 216t, 312t, 314t, 317t See also herbal and alternative products, 215–218; plants, 309–319 Symphytum officinale, 216t, 312t See also herbal and alternative products, 215–218; plants, 309–319 Symplocarpus foetidus, 317t See also plants, 309–319 Synanceja (Australian stonefish) envenomation, 242–243 Syndrome of inappropriate ADH secretion (SIADH), 37 drugs and toxins causing, 36t Syngenta Agricultural Products Emergency Information Network, 298 Syngonium podophyllum, 311t, 315t See also plants, 309–319 Synthroid See thyroxine, 356–357 Syrian rue, 314t See also plants, 309–319 Syrup of ipecac, 228–229, 457–458 for emesis in gastrointestinal decontamination, 48–49, 457–458 in pediatric patient, 49, 458 in pregnant patient, 59, 458 toxicity of, 228–229, 457–458 INDEX Systemic illness in lead poisoning, 239 occupational causes of, 522t, 524 Systemic vascular resistance, in hypotension, 17 Systox (demeton) See also organophosphates and carbamates, 291–295 hazard summary for, 557t pralidoxime (2-PAM)/oximes for poisoning with, 492–494 toxicity of, 292t 2,4,5-T (2,4,5-trichlorophenoxyacetic acid) in Agent Orange, 164 hazard summary for, 623t toxicity of, 164–165 T1/2 (half life), effectiveness of enhanced elimination and, 55 T-2 mycotoxins, as biological weapons, 370t See also warfare agents, biological, 367–372 T3 (triiodothyronine/liothyronine) See also thyroid hormone, 356–357 pharmacokinetics of, 392t toxicity of, 356–357, 356t T4 (thyroxine/levothyroxine) See also thyroid hormone, 354–356 pharmacokinetics of, 392t toxicity of, 356–357, 356t T-piece, for mechanical ventilation, Tabun (GA) See also organophosphates and carbamates, 291–295 as chemical weapon, 372, 373, 374t See also warfare agents, chemical, 372–378 oximes for poisoning with, 492–494 toxicity of, 372, 373, 374t Tachycardia/tachyarrhythmias, 12–13, 12f, 13t in amantadine overdose, 70 amphetamines causing, 13t, 14t, 74 beta-agonists causing, 134 drugs and toxins causing, 13t hypertension with, 18, 18t hypotension with, 16t treatment of, 13 esmolol for, 13, 443–444 hypertension and, 18 propranolol for, 13, 496–497 ventricular, 14, 15f See also ventricular arrhythmias, 12f, 13–15, 14t, 15f drugs and toxins causing, 14, 14t with pulse, 15 without pulse, 15 treatment of, 15 bretylium in, 421–422 magnesium in, 463–464 Tacrolimus, ventricular arrhythmias caused by, 14t Tagamet See cimetidine, 428–430 Talacen See acetaminophen, 66–69 pentazocine, 289t Talc in baby powder See also nontoxic products, 286 accidental exposure to, 288t hazard summary for, 615t Talwin See pentazocine, 289t Talwin NX See naloxone, 469–472 pentazocine, 289t Tambocor See flecainide, 79t, 80 Tamoxifen See also antineoplastic agents, 100–107 toxicity of, 103t ventricular arrhythmias caused by, 14t Tamsulosin pharmacokinetics of, 400t toxicity of, 365–366 Tanacetum parthenium, 216t, 317t See also herbal and alternative products, 215–218; plants, 309–319 Tanafed See chlorpheniramine, 97t pseudoephedrine, 320–322 Tannic acid See also caustic and corrosive agents, 157–159 toxicity of, 158t Tannin See also plants, 309–319 toxicity of, 310t 5607indx.qxd_mg 9/9/03 1:52 PM Page 709 INDEX Tansy, 316t, 317t See also plants, 309–319 Tantalum compounds, hazard summary for, 615t “Tap test,” in scorpion stings, 334 Tarantula envenomation, 346–348 Tarka See trandolapril, 402t verapamil, 144, 145, 145t, 146 Taro, 317t See also plants, 309–319 Tartrazine dye, anaphylactic/anaphylactoid reaction caused by, 28t Taxol See paclitaxel, 103t, 106 Taxotere See docetaxel, 103t Taxus, 318t See also plants, 309–319 3TC (lamivudine) See also antiviral and antiretroviral agents, 111–115 pharmacokinetics of, 391t toxicity of, 112t TCA (1,1,1-trichloroethane/methyl chloroform) exposure limits for, 359–360, 622t hazard summary for, 622t toxicity of, 359–361 TCDD (2,3,7,8-tetrachlorodibenzo-p-dioxin) See also dioxins, 184–186 in Agent Orange, 164, 184 toxicity of, 164–165, 184–186 TCE (trichloroethylene), 359–361 exposure limits for, 360, 622t hazard summary for, 622t toxicity of, 359–361 TCP (1-[1-cyclohexyl]piperidine) See also phencyclidine, 300–302 toxicity of, 300 Td (tetanus toxoid), 352, 503–505 pharmacology/use of, 503–505 TDI (toluene 2,4-diisocyanate), 232–233 asthma caused by, 520 exposure limits for, 232, 621t hazard summary for, 621t toxicity of, 232–233 Tea See also plants, 309–319 bush, 316t Mormon, 315t Paraguay, 315t Tear gas α-chloroacetophenone, hazard summary for, 549t o-chlorobenzylidene malonitrile (CS) as chemical weapon, 375t See also warfare agents, chemical, 372–378 hazard summary for, 549t toxicity of, 375t Tea tree oil, 217t See also herbal and alternative products, 215–218 TEDP (tetraethyl-di-thionopyrophosphate/sulfotepp) See also organophosphates and carbamates, 291–295 hazard summary for, 617t toxicity of, 292t Teething rings See also nontoxic products, 286 accidental exposure to, 287t Tegretol See carbamazepine, 148–150 Tellurium, hazard summary for, 616t Tellurium hexafluoride, hazard summary for, 616t Telmisartan, pharmacokinetics of, 400t Telone (1,3-dichloropropene), hazard summary for, 561t Temazepam See also benzodiazepines, 129–131, 415–418 pharmacokinetics of, 400t toxicity of, 130t Temephos See also organophosphates and carbamates, 291–295 hazard summary for, 616t toxicity of, 292t Temozolomide See also antineoplastic agents, 100–107 toxicity of, 101t Temperature (body) in hyperthermia, 21 in hypothermia, 20 in seizures, 24 Tempra See acetaminophen, 66–69 Tenex See guanfacine, 169–171 Teniposide See also antineoplastic agents, 100–107 toxicity of, 104t 709 Tenofovir See also antiviral and antiretroviral agents, 111–115 pharmacokinetics of, 400t toxicity of, 113t Tenoretic See atenolol, 132t chlorthalidone, 188t Tenormin See atenolol, 132t “Tentacle tracks,” in cnidarian envenomations, 347 TEPP (tetraethylpyrophosphate) See also organophosphates and carbamates, 291–295 hazard summary for, 618t toxicity of, 292t Teratogens, 59, 59t FDA pregnancy categories for, 404, 405t Terazosin hypotension caused by, 16t pharmacokinetics of, 400t toxicity of, 365–366 Terbufos See also organophosphates and carbamates, 291–295 toxicity of, 292t Terbutaline See also beta-adrenergic agents, 131–133 pharmacokinetics of, 400t toxicity of, 134, 134t Terfenadine See also antihistamines, 96–98 pharmacokinetics of, 400t QT prolongation/torsade de pointes caused by, 14t, 98 toxicity of, 97t, 98 withdrawal of from market, 98 Terphenyls, hazard summary for, 616t Terrorism biological warfare agents and, 367–372, 369–370t chemical warfare agents and, 372–378, 374–375t “dirty bomb” used in, 327 Teslac See testolactone, 103t Tessalon See benzonatate, 75t Testolactone See also antineoplastic agents, 100–107 toxicity of, 103t Tetanospasmin See also tetanus, 351–352 toxicity of, 351–352, 503 Tetanus, 351–352 methocarbamol for, 465–466 neuromuscular blocking agents for, 352, 472–475 pancuronium for, 352, 472–475 rhabdomyolysis in, 27t, 351 rigidity in, 26t, 351 ventilatory failure caused by, 6t Tetanus immune globulin, 352, 503–505 pharmacology/use of, 503–505 Tetanus toxoid, 352, 503–505 pharmacology/use of, 503–505 Tetrabromoethane (acetylene tetrabromide), hazard summary for, 533t Tetrabromomethane (carbon tetrabromide), hazard summary for, 547t Tetracaine See also anesthetics, local, 74–77 toxicity of, 75t 2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) See also dioxins, 184–186 in Agent Orange, 164, 184 toxicity of, 164–165, 184–186 1,1,1,2-Tetrachloro-2,2-difluoroethane, hazard summary for, 616t 1,1,2,2-Tetrachloro-1,2-difluoroethane, hazard summary for, 617t 1,1,2,2-Tetrachloroethane, hazard summary for, 617t Tetrachloroethylene, hazard summary for, 617t Tetrachloromethane (carbon tetrachloride), 154–155 acetylcysteine for poisoning caused by, 155, 405–407 exposure limits for, 154, 547t hazard summary for, 547t hepatic failure caused by, 40t, 154 toxicity of, 154–155 Tetrachloronaphthalene, hazard summary for, 617t Tetrachlorosilane (silicon tetrachloride), hazard summary for, 612t Tetrachlorvinphos See also organophosphates and carbamates, 291–295 toxicity of, 292t 5607indx.qxd_mg 9/9/03 1:52 PM Page 710 710 Tetracyclines See also antibacterial agents, 81–84 pharmacokinetics of, 401t teratogenic effects of, 59t toxicity of, 83t Tetraethoxysilane (ethyl silicate), hazard summary for, 573t Tetraethyl-di-thionopyrophosphate (TEDP/sulfotepp) See also organophosphates and carbamates, 291–295 hazard summary for, 617t toxicity of, 292t Tetraethyl lead hazard summary for, 618t neurotoxicity of, 523 Tetraethyl orthosilicate (ethyl silicate), hazard summary for, 573t Tetraethylpyrophosphate See also organophosphates and carbamates, 291–295 hazard summary for, 618t toxicity of, 292t Tetraethylthiuram disulfide (disulfiram), 186–187 carbon disulfide as metabolite of, 150, 186 atherosclerotic disease and, 523 chemical coexposures and, 524 coma caused by, 19t, 186 confusion caused by, 24t, 186 delirium caused by, 24t ethanol interaction and, 186, 187, 445 hazard summary for, 567t mushroom intoxication and, 272t neuropathy caused by, 31t pharmacokinetics of, 186, 387t stupor caused by, 19t, 186 teratogenic effects of, 59t toxicity of, 186–187 warfarin interaction and, 379t 1,2,3,4-Tetrahydrobenzene (cyclohexene), hazard summary for, 556t ∆-9-Tetrahydrocannabinol (THC), 252 See also marijuana, 252–254 in “drugs of abuse” panel, 42t toxicity of, 252, 253 Tetrahydrofuran, hazard summary for, 618t Tetrahydro-1,4-oxazine (morpholine), hazard summary for, 595t Tetrahydropalmatine, 216t See also herbal and alternative products, 215–218 Tetrahydrozoline, 169–171 coma caused by, 19t hypertension caused by, 18t hypotension caused by, 16t miosis caused by, 30t pharmacokinetics of, 401t stupor caused by, 19t toxicity of, 169–171 Tetraiodothyronine (thyroxine/levothyroxine) See also thyroid hormone, 356–357 pharmacokinetics of, 392t toxicity of, 356–357, 356t Tetramethrin See also pyrethrins/pyrethroids, 322–324 toxicity of, 323t Tetramethyl lead, hazard summary for, 618t Tetramethyl succinonitrile, hazard summary for, 618t O,O,O′,O′-Tetramethyl O,O-thiodi-p-phenylene phosphorothioate (temephos) See also organophosphates and carbamates, 291–295 hazard summary for, 616t toxicity of, 292t Tetramethylthiuram disulfide (thiram), hazard summary for, 619t Tetranitromethane, hazard summary for, 619t Tetrasodium pyrophosphate, hazard summary for, 619t Tetrodotoxin, food poisoning caused by, 205–207, 206t Tetryl, hazard summary for, 619t Texas umbrella tree, 317t See also plants, 309–319 Thalidomide, teratogenic effects of, 59t Thallium, 352–354 binding agent for, 53t, 353 hazard summary for, 619t hepatic failure caused by, 40t neuropathy caused by, 31t INDEX odor caused by, 32t Prussian blue (ferric hexocyanoferrate) for poisoning caused by, 353, 499 toxicity of, 352–354 ventricular arrhythmias caused by, 14t Thallium acetate, hazard summary for, 619t Thallium nitrate, hazard summary for, 619t Thallium sulfate, hazard summary for, 619t Thalomid See thalidomide, 59t THC (∆-9-tetrahydrocannabinol), 252 See also marijuana, 252–254 in “drugs of abuse” panel, 42t toxicity of, 252, 253 Thenyldiamine See also antihistamines, 96–98 toxicity of, 97t Theo-24 See theophylline, 354–356 Theobid See theophylline, 354–356 Theo-Dur See theophylline, 354–356 Theolair See theophylline, 354–356 Theophylline, 354–356 agitation caused by, 24t anion gap/lactic acidosis caused by, 34t, 354 elimination of, 56t, 354 esmolol for overdose of, 355, 443–444 hyperglycemia caused by, 35t, 354 hypokalemia caused by, 38, 38t, 354, 355 hypotension caused by, 16t, 354, 355 metoclopramide for vomiting caused by, 467–468 pharmacokinetics of, 354, 401t propranolol for overdose of, 355, 496–497 psychosis caused by, 24t quantitative levels/potential interventions and, 45t, 355 repeat-dose activated charcoal for overdose of, 58t, 356 seizures caused by, 23t, 354, 355 tachycardia caused by, 13t, 354, 355 toxicity of, 354–356 in children, 60t in toxicology screens, interferences and, 44t ventricular arrhythmias caused by, 14t, 354, 355 volume of distribution of, 55t, 56t, 354, 355 Theo-X See theophylline, 354–356 Thermal-breakdown products, 531 Thermal injury, smoke inhalation and, 341, 342 “Thermogenic” dietary supplements, toxicity of, caffeine and, 143 Thermometers See also nontoxic products, 286 accidental exposure to, 287t, 288t Thevetia peruviana, 311t, 315t, 318t See also plants, 309–319 THF (tetrahydrofuran), hazard summary for, 618t Thiamine (vitamin B1), 505 abdominal x-ray showing, 46t for alcohol-related disorders, 192 for coma and stupor, 20, 505 for ethylene glycol poisoning, 198, 505 for hypoglycemia, 35 pharmacology/use of, 505 Thiazide diuretics See also diuretics, 187–189 hyperglycemia caused by, 35t toxicity of, 188t Thiazolidinediones (glitazones) See also antidiabetic (hypoglycemic) agents, 93–96 pharmacokinetics of, 94t toxicity of, 93, 94t Thimet (phorate) See also organophosphates and carbamates, 291–295 hazard summary for, 603t toxicity of, 292t Thiocyanate toxicity elimination and, 56t from nitroprusside infusion, 281–282, 478 Thiodicarb See also organophosphates and carbamates, 291–295 toxicity of, 293t Thioglycolic acid, hazard summary for, 619t 6-Thioguanine See also antineoplastic agents, 100–107 toxicity of, 102t Thiometon See also organophosphates and carbamates, 291–295 toxicity of, 292t 5607indx.qxd_mg 9/9/03 1:52 PM Page 711 INDEX Thiopental See also barbiturates, 124–126 pharmacokinetics of, 125t, 401t toxicity of, 125t Thioplex See thiotepa, 101t Thioridazine See also antipsychotic drugs, 107–109 pharmacokinetics of, 401t QRS interval prolongation caused by, 11t toxicity of, 107t in children, 60t ventricular arrhythmias caused by, 14t Thiosulfate, sodium, 505–506 for antineoplastic infusion extravasation, 106, 505–506 for bromate poisoning, 139, 505–506 for chlorate poisoning, 160 for cyanide poisoning, 178, 377, 505–506 nitroprusside-induced, 478, 505–506 in smoke inhalation, 342, 505–506 for iodine poisoning, 227 pharmacology/use of, 505–506 Thiotepa See also antineoplastic agents, 100–107 toxicity of, 101t Thiothixene See also antipsychotic drugs, 107–109 pharmacokinetics of, 401t toxicity of, 107t Thiram, hazard summary for, 619t Third spacing, hypotension caused by, 16t Thisilyn See milk thistle, 500–501 Thompson’s Water Seal See aliphatic hydrocarbons, 219 Thorazine See chlorpromazine, 107t Thornapple, 317t See also plants, 309–319 Threshold Limit Value (TLV), 528–529 Threshold Limit Value Ceiling (TLV-C), 528 Threshold Limit Value Time-Weighted Average (TLV-TWA), 528 Thrombocytopenia, antineoplastic agents causing, 100 Thuja spp, 312t See also plants, 309–319 Thunder See 1,4-butanediol/gamma-butyrolactone, 210–213, 211t Thunder Nectar See 1,4-butanediol, 210–213, 211t Thymol See also essential oils, 147–148 toxicity of, 147t Thyro-Block See potassium iodide, 456–457 Thyroid hormone, 356–357, 356t desiccated pharmacokinetics of, 401t toxicity of, 356–357, 356t hyperthermia caused by, 21t, 356 tachycardia caused by, 13t, 356, 357 toxicity of, 356–357, 356t Thyrolar See triiodothyronine, 356–357 Thyroxine (levothyroxine) See also thyroid hormone, 354–356 pharmacokinetics of, 392t toxicity of, 356–357, 356t Tiagabine See also anticonvulsants, 86–87 pharmacokinetics of, 401t toxicity of, 86t, 87 Tiazac See diltiazem, 144, 145t Ticar See ticarcillin, 83t Ticarcillin See also antibacterial agents, 81–84 pharmacokinetics of, 401t toxicity of, 83t Tick paralysis, neuropathy associated with, 31t Tidal volume, for mechanical ventilation, TIG (human tetanus immune globulin), 352, 503–505 pharmacology/use of, 503–505 Tigan See trimethobenzamide/trimethobenzamine, 107t Tilex Instant Mildew Stain Remover See caustic and corrosive agents, 157–159 hypochlorite, 162–164 sodium hydroxide, 313 Timet (phorate) See also organophosphates and carbamates, 291–295 hazard summary for, 603t toxicity of, 292t Timolide See hydrochlorothiazide, 188t timolol, 132t Timolol See also beta-adrenergic blockers, 131–133 pharmacokinetics of, 401t toxicity of, 132t 711 Timoptic See timolol, 132t Tin metal and inorganic compounds of, hazard summary for, 620t organic compounds of, hazard summary for, 620t Tinazaparin, protamine for overdose of, 497–498 Tincture of iodine See iodine, 226–228 Titanium dioxide, hazard summary for, 620t Tityus spp scorpion envenomation, 334–335 Tizanidine See also clonidine, 169–171 pharmacokinetics of, 401t toxicity of, 169–171, 340 ventricular arrhythmias caused by, 14t TLV (Threshold Limit Value), 528–529 TLV-C (Threshold Limit Value Ceiling), 528 TLV-TWA (Threshold Limit Value Time-Weighted Average), 528 TMAN (trimellitic anhydride) hazard summary for, 623t job processes associated with exposure to, 521t TMB4, 492, 493 See also oximes, 492–494 TMSN (tetramethyl succinonitrile), hazard summary for, 618t TNT (trinitrotoluene), hazard summary for, 624t Toad venom, cardiac glycosides in, 155, 216t See also cardiac (digitalis) glycosides, 155–157; herbal and alternative products, 215–218 Tobacco See also nicotine, 277–278; plants, 309–319 environmental smoke from, hazard summary for, 568t Indian, 317t toxicity of, 277–278, 317t Tobramycin See also antibacterial agents, 81–84 pharmacokinetics of, 401t toxicity of, 82t Tocainide See also antiarrhythmic drugs, 78–81 pharmacokinetics of, 79, 401t toxicity of, 79–80, 79t TOCP (triorthocresyl phosphate) See also organophosphates and carbamates, 291–295 hazard summary for, 624t toxicity of, 292t Toddlers See also children, poisoning in, 59–60 poisoning in, 59–60, 60t Tofranil See imipramine, 88t Tolazamide See also antidiabetic (hypoglycemic) agents, 93–96 pharmacokinetics of, 401t toxicity of, 94t Tolazoline contraindications to for clonidine overdose, 170 pharmacokinetics of, 401t toxicity of, 365–366 Tolbutamide See also antidiabetic (hypoglycemic) agents, 93–96 pharmacokinetics of, 401t toxicity of, 94t Tolectin See tolmetin, 284t Tolidine (o-tolidine), hazard summary for, 620t Tolmetin See also nonsteroidal anti-inflammatory drugs, 283–286 pharmacokinetics of, 401t toxicity of, 284t Tolterodine See also anticholinergic agents, 84–86 pharmacokinetics of, 401t toxicity of, 85t Toluene, 357–359 exposure limits for, 358, 620t hazard summary for, 620t hypokalemia caused by, 38t kinetics of, 358 toxicity of, 357–359 Toluene 2,4-diisocyanate (TDI), 232–233 asthma caused by, 520 exposure limits for, 232, 621t hazard summary for, 621t toxicity of, 232–233 m-Toluidine, hazard summary for, 621t o-Toluidine, hazard summary for, 621t p-Toluidine, hazard summary for, 621t 5607indx.qxd_mg 9/9/03 1:52 PM Page 712 712 Toluol (toluene), 357–359 exposure limits for, 358, 620t hazard summary for, 620t hypokalemia caused by, 38t kinetics of, 358 toxicity of, 357–359 Tomato leaves, 317t See also plants, 309–319 Tonka bean, 317t See also plants, 309–319 Tonocard See tocainide, 79–80, 79t Toothpaste with fluoride See fluoride, 200–201 without fluoride, 287t See also low-toxicity products, 286 Topamax See topiramate, 86t, 87 Topiramate See also anticonvulsants, 86–87 pharmacokinetics of, 401t toxicity of, 86t, 87 Topoisomerase inhibitors See also antineoplastic agents, 100–107 toxicity of, 100, 104t Topotecan See also antineoplastic agents, 100–107 toxicity of, 104t Toprol See metoprolol, 132t Toradol See ketorolac, 284t Toremifene See also antineoplastic agents, 100–107 toxicity of, 103t Torsade de pointes, 14, 15f droperidol and haloperidol causing, 14t, 25, 452 drugs and toxins causing, 14, 14t terfenadine or astemizole causing, 14t, 96 treatment of, 15 isoproterenol for, 15, 458–459 magnesium for, 463–464 tricyclic antidepressants causing, 14t, 91, 92 type Ia antiarrhythmic drugs causing, 324, 325 Torsemide pharmacokinetics of, 401t toxicity of, 188t Total clearance, effectiveness of enhanced elimination and, 55, 56t Toxalbumin See also plants, 309–319 toxicity of, 310t Toxaphene (chlorinated camphene) See also chlorinated hydrocarbons, 161–162 hazard summary for, 548t toxicity of, 161t Toxicodendron spp, 315t, 316t See also plants, 309–319 Toxicology screening, 40–45 agents commonly included in, 41t, 42t agents not included in, 42t approach to, 45, 45t in drug-assisted assault, 64–65, 64t interferences in, 43–44t limitations of, 40–42 uses for, 42–45 Toxogonin See obidoxime, 492 Toyon leaves, 317t See also plants, 309–319 Tracrium See atracurium, 473t, 475 Tramadol, 287–289, 289t See also opiates/opioids, 286–291 monoamine oxidase inhibitor interaction and, 270t pharmacokinetics of, 402t toxicity of, 287–289, 289t Trandate See labetalol, 459–460 Trandolapril, pharmacokinetics of, 402t Transdermal nicotine patches See also nicotine, 277–278 toxicity of, 277 Transderm Scop See scopolamine, 85t, 373, 376 Transfusion exchange for arsine gas poisoning, 120, 121 for iron poisoning, 231 for methemoglobinemia, 263 for nitrate/nitrite overdose, 280 for warfarin overdose, 380 Transport, for victims of hazardous materials incident, 516 Tranxene See clorazepate, 130t Tranylcypromine See also monoamine oxidase inhibitors, 269–271 abdominal x-ray showing, 46t pharmacokinetics of, 402t toxicity of, 269–271 INDEX Trastuzumab See also antineoplastic agents, 100–107 toxicity of, 104t Trauma occupational causes of, 522t rhabdomyolysis associated with, 27t Trazodone, 88 See also antidepressants, noncyclic, 88–90 monoamine oxidase inhibitor interaction and, 89, 270t pharmacokinetics of, 89, 402t toxicity of, 88, 88t, 89 Tremolite (asbestos), 121–122 exposure limits for, 121, 538t hazard summary for, 538t toxicity of, 121–122 Tretinoin (retinoic acid) See also antineoplastic agents, 100–107 teratogenic effects of, 59t toxicity of, 105t Triaminic Cold Syrup See chlorpheniramine, 97t phenylpropanolamine, 320–322 Triaminic DM See dextromethorphan, 183–184 phenylpropanolamine, 320–322 Triaminic Expectorant See guaifenesin, 287t phenylpropanolamine, 320–322 Triaminic Nite Lite See chlorpheniramine, 97t dextromethorphan, 183–184 pseudoephedrine, 320–322 Triaminicol Multisymptom Cold Syrup See chlorpheniramine, 97t dextromethorphan, 183–184 phenylpropanolamine 320–322 Triamterene See also diuretics, 187–189 pharmacokinetics of, 402t toxicity of, 188t Triatomic oxygen (ozone) See also gases, irritant, 213–215 exposure limits for, 214t, 600t hazard summary for, 600t job processes associated with exposure to, 521t toxicity of, 214t Triavil (amitriptyline with perphenazine) See amitriptyline, 88t, 90 perphenazine, 107t Triazolam See also benzodiazepines, 129–131, 415–418 pharmacokinetics of, 402t toxicity of, 129, 130, 130t 3-amino-1,2,4-Triazole (amitrole), hazard summary for, 536t Triazophos See also organophosphates and carbamates, 291–295 toxicity of, 292t Tribromomethane (bromoform), hazard summary for, 542t Tribufos See also organophosphates and carbamates, 291–295 toxicity of, 292t Tributyl phosphate, hazard summary for, 621t Trichlorfon See also organophosphates and carbamates, 291–295 toxicity of, 292t Trichlormethiazide See also diuretics, 187–189 pharmacokinetics of, 402t toxicity of, 188t Trichloroacetic acid, hazard summary for, 621t 1,2,4-Trichlorobenzene, hazard summary for, 621t Trichloroethane, 359–361 exposure limits for, 359–360 toxicity of, 359–361 1,1,1-Trichloroethane (methyl chloroform) exposure limits for, 359–360, 622t hazard summary for, 622t toxicity of, 359–361 1,1,2-Trichloroethane exposure limits for, 359–360, 622t hazard summary for, 622t toxicity of, 359–361 2,2-bis(p-methoxyphenol)-1,1,1-Trichloroethane (methoxychlor) See also chlorinated hydrocarbons, 161–162 hazard summary for, 587t toxicity of, 161t 5607indx.qxd_mg 9/9/03 1:52 PM Page 713 INDEX Trichloroethanol (chloral hydrate) See also sedative-hypnotics, 335–337 abdominal x-ray showing, 46t in drug-assisted assault, 64t elimination of, 56t esmolol for overdose of, 336, 443–444 odor caused by, 32t pharmacokinetics of, 384t propranolol for overdose of, 336, 496–497 toxicity of, 335t, 336 in toxicology screens, 41t ventricular arrhythmias caused by, 14t, 15, 336 volume of distribution of, 56t, 384t warfarin interaction and, 379t Trichloroethylene (trichloroethene), 359–361 exposure limits for, 360, 622t hazard summary for, 622t toxicity of, 359–361 Trichlorofluoromethane (Freon 11) hazard summary for, 622t toxicity of, 209–210 Trichloromethane (chloroform), 154–155 acetylcysteine for poisoning caused by, 155, 405–407 exposure limits for, 154, 550t hazard summary for, 550t methyl (1,1,1-trichloroethane) exposure limits for, 359–360, 622t hazard summary for, 622t toxicity of, 359–361 toxicity of, 154–155 Trichloronaphthalene, hazard summary for, 622t Trichloronitromethane (chloropicrin), hazard summary for, 551t 2,4,5-Trichlorophenoxyacetic acid (2,4,5-T) in Agent Orange, 164 hazard summary for, 623t toxicity of, 164–165 4-amino-3,5,6-Trichloropicolinic acid (picloram), hazard summary for, 605t 1,1,2-Trichloro-1,2,2-trifluoroethane (Freon 113) hazard summary for, 623t toxicity of, 209–210 Trichoderma spp See also molds, 267–269 toxicity of, 267 Trichothecene mycotoxins, as biological weapons, 370t See also warfare agents, biological, 367–372 Tricyclic antidepressants, 88t, 90–93 atrioventricular (AV) block caused by, 10t, 91 bicarbonate for overdose of, 15, 92, 419–420 bradycardia caused by, 10t, 91 coma caused by, 19t, 90, 91 dyskinesias caused by, 26t hypertension caused by, 18t, 90 hyperthermia caused by, 21t, 91 hypotension caused by, 16t, 90, 91 hypothermia caused by, 20t hypoxia caused by, 7t mydriasis caused by, 30t pharmacokinetics of, 90 physostigmine contraindicated in overdose of, 13, 92, 490 QRS interval prolongation caused by, 11, 11t, 12f, 91 rhabdomyolysis caused by, 27t, 91 seizures caused by, 23t, 90, 91, 92 stupor caused by, 19t tachycardia caused by, 13, 13t, 14t, 15, 90, 91 toxicity of, 88t, 90–93 in toxicology screens, 41t, 91–92 interferences and, 44t ventilatory failure caused by, 6t ventricular arrhythmias caused by, 14t, 15, 90 Tridihexethyl See also anticholinergic agents, 84–86 toxicity of, 85t Tridymite (silica), hazard summary for, 611t Trien See triethyl tetramine dihydrochloride, 176 Triethylamine, hazard summary for, 623t Triethylene glycol See also glycols, 194–198 toxicity of, 196t Triethyl tetramine dihydrochloride, for copper poisoning, 176 Trifluoperazine See also antipsychotic drugs, 107–109 abdominal x-ray showing, 46t 713 pharmacokinetics of, 402t toxicity of, 107t in toxicology screens, 41t Trifluorobromomethane, hazard summary for, 623t Trifluoromethane (Freon 23), hazard summary for, 623t Trifluridine See also antiviral and antiretroviral agents, 111–115 toxicity of, 112t Trihexyphenidyl See also anticholinergic agents, 84–86 pharmacokinetics of, 402t toxicity of, 85t in toxicology screens, 41t 1,2,3-Trihydroxybenzene (pyrogallol), hazard summary for, 609t Triiodothyronine (liothyronine/T3) See also thyroid hormone, 354–356 pharmacokinetics of, 392t toxicity of, 356–357, 356t Trilafon See perphenazine, 107t Trileptal See oxcarbazine, 396t Trimazosin pharmacokinetics of, 402t toxicity of, 365–366 Trimellitic anhydride hazard summary for, 623t job processes associated with exposure to, 521t Trimeprazine See also antihistamines, 96–98 abdominal x-ray showing, 46t pharmacokinetics of, 402t toxicity of, 97t Trimethacarb See also organophosphates and carbamates, 291–295 toxicity of, 293t Trimethadione, teratogenic effects of, 59t Trimethobenzamide/trimethobenzmine See also antipsychotic drugs, 107–109 pharmacokinetics of, 402t toxicity of, 107t Trimethoprim See also antibacterial agents, 81–84 leucovorin calcium for overdose of, 81, 460–461 pharmacokinetics of, 402t toxicity of, 81, 84t 3,4,5-Trimethoxyphenethylamine (mescaline), 248t See also hallucinogens, 247–249 toxicity of, 248t Trimethoxy silane (methyl silicate), hazard summary for, 593t Trimethylamine, hazard summary for, 624t Trimethylcyclohexenone (isophorone), hazard summary for, 582t Trimethyl phosphite, hazard summary for, 624t Trimipramine See also tricyclic antidepressants, 90–93 pharmacokinetics of, 402t toxicity of, 88t Trinalin (azatidine and pseudoephedrine) See azatidine, 97t pseudoephedrine, 320–322 2,4,6-Trinitrophenol (picric acid) See also caustic and corrosive agents, 157–159 hazard summary for, 605t toxicity of, 158t 2,4,6-Trinitrophenylmethylnitramine (tetryl), hazard summary for, 619t Trinitrotoluene (2,4,6-trinitrotoluene), hazard summary for, 624t Trinitrotrimethylenetriamine (cyclonite), hazard summary for, 556t Triorthocresyl phosphate See also organophosphates and carbamates, 291–295 hazard summary for, 624t toxicity of, 292t Tripelennamine See also antihistamines, 96–98 pharmacokinetics of, 402t toxicity of, 97t Triphenylphosphate, hazard summary for, 624t Triphenyls (terphenyls), hazard summary for, 616t Triple-X See pyrethrins/pyrethroids, 322–324 Tripoli (silica), hazard summary for, 611t Triprolidine See also antihistamines, 96–98 pharmacokinetics of, 402t toxicity of, 97t 5607indx.qxd_mg 9/9/03 1:52 PM Page 714 714 Triptorelin See also antineoplastic agents, 100–107 toxicity of, 103t Trisenox See arsenic, 115–119 Trisilate (choline magnesium trisalicylate) See salicylates, 331–333 Trismus, in tetanus, 351 Tritium See also radiation (ionizing), 327–331 chelating/blocking agents for exposure to, 330t Trivalent chromium compounds, toxicity of, 167–169 Trizivir See abacavir, 112t lamivudine, 112t zidovudine, 113t, 114 Troglitazone See also antidiabetic (hypoglycemic) agents, 93–96 hepatic failure caused by, 40t, 93 removal of from market, 93 toxicity of, 93 Trovafloxacin See also antibacterial agents, 81–84 pharmacokinetics of, 402t toxicity of, 83t Tryptophan See also herbal and alternative products, 215–218 monoamine oxidase inhibitor interaction and, 270, 270t toxicity of, 217t Tubatoxin (rotenone), hazard summary for, 610t Tuberculosis, isoniazid for, 233 Tubocurarine, anaphylactoid reaction caused by, 28t Tubular necrosis, acute occupational causes of, 524 in rhabdomyolysis, 27 Tuinal See amobarbital, 125t Tularemia, as biological weapon, 367, 368, 369t, 371 See also warfare agents, biological, 367–372 Tulip bulbs/Tulipa, 317t See also plants, 309–319 Tums antacids (calcium carbonate) abdominal x-ray showing, 46t for oxalic acid poisoning, 296 Tung nut/tung tree, 317t See also plants, 309–319 Tungsten, hazard summary for, 625t Turbina/Turbina corymbosa, 317t See also plants, 309–319 Turkeyfish envenomation, 243–244 Turpentine/turpentine oil See also essential oils, 147–148; hydrocarbons, 219–221 hazard summary for, 625t toxicity of, 147t, 219t T’u-san-chi, 317t See also plants, 309–319 Tussi-Organidin DM-S See dextromethorphan, 183–184, 287 guaifenesin, 287t Tussi-Organidin-S See codeine, 289t guaifenesin, 287t Two-part glues/paints/coatings, occupational exposure to, 519, 521t Tylenol See acetaminophen, 66–69 Tylenol Arthritis Pain Extended Relief tablets See also acetaminophen, 66–69 treatment of overdose of, 68 Tylenol with codeine See acetaminophen, 66–69 codeine, 289t Tylenol Multi-Symptom See acetaminophen, 66–69 chlorpheniramine, 97t dextromethorphan, 183–184, 287 pseudoephedrine, 320–322 Tylenol PM (acetaminophen plus diphenhydramine) See acetaminophen, 66–69 diphenhydramine, 97t, 98, 436–437 Tylox See acetaminophen, 66–69 oxycodone, 289t Tympagesic Otic See antipyrine, 285 benzocaine, 75, 75t, 76 phenylephrine, 320–322 Typewriter correction fluid See trichloroethane, 359–361 INDEX UDMH (1,1-dimethylhydrazine), hazard summary for, 565t Ulmus parvifolia, 313t See also plants, 309–319 Ultracet (tramadol plus acetaminophen) See acetaminophen, 66–69 tramadol, 287–289 Ultradiol See 1,4-butanediol, 210–213, 211t Ultralente insulin (extended zinc insulin) See also insulin, 93–96, 455–456 pharmacokinetics of, 391t toxicity of, 94t Ultram See tramadol, 287–289, 289t Umbrella plant, 317t See also plants, 309–319 Uni-Dur See theophylline, 354–356 Unipen See nafcillin, 83t Uniphyl See theophylline, 354–356 Uniretic See hydrochlorothiazide, 188t moexipril, 395t Unisom See, doxylamine, 97t Unisom Dual Relief Formula See acetaminophen, 66–69 diphenhydramine, 97t, 98, 436–437 United States Department of Transportation (DOT) identification of substance in occupational exposure and, 520 labeling system for hazardous chemicals of, 512, 514f Unithiol (DMPS/2,3-dimercaptopropanol-sulfonic acid), 506–508 for arsenic poisoning, 118, 506–508 for arsine gas poisoning, 121 for lead poisoning, 241, 506–508 for mercury poisoning, 256, 506–508 pharmacology/use of, 506–508 Uranium, hazard summary for, 625t Uranium-233/235/238 See also radiation (ionizing), 327–331 chelating/blocking agents for exposure to, 330t bicarbonate, 330t, 419–420 Urapidil pharmacokinetics of, 402t toxicity of, 365–366 Urginea maritima, 317t See also plants, 309–319 Urinary acidification, for phencyclidine overdose, 302 Urinary alkalinization for barbiturate overdose, 126 bicarbonate for, 419–420 potassium as supplement to, 491–492 for chlorophenoxy herbicide poisoning, 165 for chlorpropamide overdose, 96 for formaldehyde poisoning, 209 for rhabdomyolysis, 27 for salicylate overdose, 55, 333 Urinary manipulation, for enhanced elimination, 55 Urine adulteration, toxicology screening and, 41–42 Urine screen, for drugs, 41t Urine testing in drug-assisted assault, 64 for toxicology screening, 41t, 45 Urispas See flavoxate, 85t Uva-ursi, 317t See also plants, 309–319 V-3 See gamma-butyrolactone, 210–213, 211t Vaccines, anaphylactic reaction caused by, 28t Vacor, 361–362 hyperglycemia caused by, 35t, 361 nicotinamide for poisoning caused by, 362, 475–476 toxicity of, 361–362 Vagotonic agents, bradycardia/atrioventricular (AV) block caused by, 10t Valacyclovir See also antiviral and antiretroviral agents, 111–115 pharmacokinetics of, 402t toxicity of, 112t Valdecoxib See also nonsteroidal anti-inflammatory drugs, 283–286 pharmacokinetics of, 402t toxicity of, 284t Valeraldehyde, hazard summary for, 625t 5607indx.qxd_mg 9/9/03 1:52 PM Page 715 INDEX Valerian (Valeriana officinalis/Valeriana edulis), 217t, 317t See also herbal and alternative products, 215–218; plants, 309–319 Valium See diazepam, 129, 130, 130t, 415–418 Valone See also warfarin, 378–380 in rodenticides, 378–380 toxicity of, 378–380 Valproic acid, 362–364 anion gap acidosis caused by, 34t, 363 L-carnitine for overdose/toxicity of, 364, 426 coma caused by, 19t, 363 elimination of, 56t, 362 hepatic failure caused by, 40t, 363 hypernatremia caused by, 36t, 363 hypoglycemia caused by, 35t miosis caused by, 30t, 363 naloxone for overdose of, 364, 469–472 pharmacokinetics of, 362, 403t quantitative levels/potential interventions and, 45t, 363 stupor caused by, 19t, 363 teratogenic effects of, 59t, 363 toxicity of, 362–364 volume of distribution of, 56t, 362, 403t Valrubicin See also antineoplastic agents, 100–107 toxicity of, 102t Valsartan, pharmacokinetics of, 403t Valtrex See valacyclovir, 112t Vanadium/vanadyl sulfate, 217t See also herbal and alternative products, 215–218 Vanadium pentoxide, hazard summary for, 625t Vancocin See vancomycin, 81, 84t Vancomycin See also antibacterial agents, 81–84 pharmacokinetics of, 403t toxicity of, 81, 84t Vapor pressure, toxicity and, 530 Variola major (smallpox), as biological weapon, 367, 368, 369t, 371 See also warfare agents, biological, 367–372 Varnish makers’ and printers’ naphtha (VM&P naphtha), hazard summary for, 626t Varnish removers, methylene chloride in See methylene chloride, 265–267 Vascor See bepridil, 144, 145, 145t Vaseretic See enalapril, 77 hydrochlorothiazide, 188t Vasoconstriction/vasoconstrictors ergot derivatives and, 189 for nasotracheal intubation, Vasocort See bepridil, 144, 145, 145t Vasodilators, 365–366 hypotension caused by, 16t, 365–366 hypothermia caused by, 20t nitrates/nitrites as, 279–280 tachycardia caused by, 13t, 365 toxicity of, 365–366 Vasospasm amphetamines causing, 73, 74 ergot derivatives causing, 189, 190 Vasotec See enalapril, 77 Vd (volume of distribution), accessibility to removal by enhanced elimination and, 54, 55t, 56t Vectrin See minocycline, 83t Vecuronium See also neuromuscular blocking agents, 472–475 for hyperthermia, 22, 472–475 for orotracheal intubation, 472–475 pharmacology/use of, 473t, 475 Velban See vinblastine, 104t, 106 Venlafaxine, 88 See also antidepressants, noncyclic, 88–90 monoamine oxidase inhibitor interaction and, 89, 270, 270t pharmacokinetics of, 403t seizures caused by, 23t toxicity of, 88, 88t, 89 ventricular arrhythmias caused by, 14t Venous access, in assessment/management of circulatory problems, 10 Venous dilation, hypotension caused by, 16t Venous oxygen saturation, in cyanide poisoning, 178 715 Venovenous hemodiafiltration for metformin overdose, 96 for salicylate overdose, 333 Ventilator settings, for ventilatory failure, Ventilatory failure, 6–7, 6t botulin toxin causing, 6t, 136, 137 drugs and toxins causing, 6t neuromuscular blocking agents causing, 6t, 474 treatment of, Ventimask, for oxygen therapy, 483 Ventolin See albuterol, 134t Ventricular arrhythmias, 12f, 13–15, 14t, 15f arsenic causing, 14t, 116 drugs and toxins causing, 13–14, 14t hydrocarbons causing, 14t, 15, 526–527 treatment of, 15 lidocaine for, 15, 462–463 propranolol for, 496–497 Ventricular fibrillation drugs and toxins causing, 14t hypothermia causing, 21 treatment of, 15 bretylium for, 421–422 magnesium in, 463–464 Ventricular tachycardia, 14, 15f drugs and toxins causing, 14, 14t with pulse, 15 without pulse, 15 treatment of, 15 bretylium in, 421–422 esmolol in, 443–444 magnesium in, 463–464 Verapamil See also calcium antagonists, 144–147 hypotension caused by, 16t hypoxia caused by, 7t pharmacokinetics of, 145, 403t toxicity of, 144, 145, 145t, 146 in children, 60t in toxicology screens, 41t, 146 Veratrum alkaloids/ Veratrum spp, 310t, 313t, 317t See also plants, 309–319 Verbena (Verbena officinalis/Verbena hastata), 317t See also plants, 309–319 Verelan See verapamil, 144, 145, 145t, 146 Versed See midazolam, 129, 130, 130t, 415–418 Versenate See calcium EDTA, 440–442 Verve See gamma-butyrolactone, 210–213, 211t Vesanoid See tretinoin (retinoic acid), 105t Vesicants (blister agents), as chemical weapons, 372, 373, 374t, 376, 377 See also warfare agents, chemical, 372–378 Vespidae envenomation, 225–226 Viagra See sildenafil, 279 Vibrio parahemolyticus, food poisoning caused by, 204t See also food poisoning, bacterial, 203–205 Vicia faba (fava bean), 313t See also plants, 309–319 monoamine oxidase inhibitor interaction and, 270t Vicks Formula 44-D See acetaminophen, 66–69 Vicks Vaporub See camphor, 147–148 eucalyptus oil, 147t menthol, 147t turpentine/turpentine oil, 147t Vicodin See acetaminophen, 66–69 hydrocodone, 289t Vicoprofen See hydrocodone, 289t ibuprofen, 284t, 285 Victim management, in hazardous materials incident, 515–516 Vidarabine See also antiviral and antiretroviral agents, 111–115 pharmacokinetics of, 403t toxicity of, 112t Videx See didanosine, 112t Vigabatrin See also anticonvulsants, 86–87 pharmacokinetics of, 403t toxicity of, 86t, 87 5607indx.qxd_mg 9/9/03 1:52 PM Page 716 716 Vikane (sulfuryl fluoride) hazard summary for, 615t job processes associated with exposure to, 521t Vinblastine See also antineoplastic agents, 100–107 extravasation of, 106 toxicity of, 104t, 106 Vinca, 316t See also plants, 309–319 Vincristine See also antineoplastic agents, 100–107 extravasation of, 106 toxicity of, 104t, 106 Vinegar (acetic acid) for cnidarian envenomation, 237 hazard summary for, 532t tert-butyl ester of (tert-butyl acetate), hazard summary for, 543t Vinorelbine See also antineoplastic agents, 100–107 toxicity of, 104t Vinyl acetate, hazard summary for, 625t Vinylbenzene (styrene monomer), hazard summary for, 613t Vinyl bromide, hazard summary for, 626t Vinyl chloride, hazard summary for, 626t Vinyl cyanide (acrylonitrile) See also cyanide, 177–179 acetylcysteine for poisoning caused by, 405–407 hazard summary for, 534t toxicity of, 177 Vinyl cyclohexene dioxide, hazard summary for, 626t Vinylhexane dioxide (vinyl cyclohexene dioxide), hazard summary for, 626t Vinylidine chloride (1,1-dichloroethylene), hazard summary for, 560t Vinylstyrene (divinylbenzene), hazard summary for, 567t Vinyl toluene, hazard summary for, 626t Vioxx See rofecoxib, 284t, 285 Viperidae-subfamily Crotalidae envenomation, 343t See also snakebites, 343–346 Viperidae-subfamily Viperinae envenomation, 343t See also snakebites, 343–346 Viracept See nelfinavir, 113t Viral hemorrhagic fevers, as biological weapons, 369t See also warfare agents, biological, 367–372 Virginia creeper, 317t See also plants, 309–319 Viscum album, 315t See also plants, 309–319 Visine Eye Drops See tetrahydrozoline, 169–171 Vistaril See hydroxyzine, 97t “Vita G” (slang) See gamma-hydroxybutyrate (GHB), 210–213, 211t Vital signs, in infants and children, 61–62, 61t Vitamin A See also vitamins, 366–367 toxicity of, 366–367 pseudotumor cerebri associated with, mannitol for, 464–465 Vitamin B1 (thiamine), 505 abdominal x-ray showing, 46t for coma and stupor, 20, 505 for ethylene glycol poisoning, 198, 505 for hypoglycemia, 35 pharmacology/use of, 505 Vitamin B3 (nicotinamide), 475–476 pharmacology/use of, 475–476 for Vacor (PNU) poisoning, 362, 475–476 Vitamin B6 (pyridoxine), 499–500 See also vitamins, 366–367 for ethylene glycol poisoning, 198, 499–500 for isoniazid overdose, 234, 499–500 for monomethylhydrazine poisoning, 273, 499–500 neuropathy caused by, 31t, 500 pharmacokinetics of, 399t pharmacology/use of, 499–500 toxicity of, 366–367, 500 Vitamin B12 (hydroxocobalamin), 453–454 for cyanide poisoning, 178, 453–454 nitroprusside-induced, 282, 453–454, 478 in smoke inhalation, 342 pharmacology/use of, 453–454 Vitamin C (ascorbic acid) See also vitamins, 366–367 for chromium poisoning, 168 for methemoglobinemia, 263 for selenium poisoning, 339 toxicity of, 366–367 INDEX Vitamin D See also vitamins, 366–367 toxicity of, 366–367 Vitamin E See also vitamins, 366–367 toxicity of, 366 Vitamin K See also vitamins, 366–367 toxicity of, 366 Vitamin K1 (phytonadione), 508–509 for coumarin/warfarin overdose, 380, 508–509 for nonsteroidal anti-inflammatory drug overdose, 285 pharmacology/use of, 508–509 Vitamin K3 (menadione), vitamin K1 (phytonadione) differentiated from, 508, 509 “Vitamin K” (slang) See ketamine, 300–302 Vitamins, toxicity of, 366–367 Vitriol (sulfuric acid), hazard summary for, 614t Vivactil See protriptyline, 88t VM&P naphtha, hazard summary for, 626t VOCs (volatile organic compounds), molds generating, 268 Volatile oils, toxicity of, 147–148, 147t Volatile organic compounds (VOCs), molds generating, 268 Volume of distribution (Vd), accessibility to removal by enhanced elimination and, 54, 55t, 56t Volume overload hypernatremia with, treatment of, 36 hyponatremia with, 36–37 treatment of, 37 Vomiting See also emesis, 48–49 in acetaminophen overdose, 68 in diagnosis of poisoning, 31 metoclopramide for, 467–468 ondansetron for, 481–482 transport of patients with toxic ingestion and, 516 Vomitus, blue green in boric acid poisoning, 135–136 in copper poisoning, 176 Vumon See teniposide, 104t VX See also organophosphates and carbamates, 291–295 as chemical weapon, 372, 373, 374t See also warfare agents, chemical, 372–378 pralidoxime (2-PAM)/oximes for poisoning with, 377, 492–494 toxicity of, 372, 373, 374t Wall board See also nontoxic products, 286 accidental exposure to, 287t Walnut shells (green), 317t See also plants, 309–319 Warfare agents biological, 367–372, 369–370t chemical, 291, 372–378, 374–375t See also organophosphates and carbamates, 291–295 pralidoxime (2-PAM)/oximes for poisoning with, 377, 492–494 Warfarin drug interactions and, 379, 379t hazard summary for, 627t in rodenticides, 378–380 teratogenic effects of, 59t toxicity of, 378–380 Warm zone (Contamination Reduction Zone), at hazardous materials incident site, 510, 511f victim decontamination in, 516 Wasp envenomation, 225–226 sea wasp (Australian box jellyfish), 236–237 Watercolor paints See also nontoxic products, 286 accidental exposure to, 287t Water drinking, compulsive (psychogenic polydipsia), hyponatremia caused by, 37 Water hemlock (cicutoxin), 314t, 317t See also plants, 309–319 odor caused by, 32t seizures caused by, 23t Water restriction, for hyponatremia, 37 Water treatment/purification, toxic exposures and, 521t Wax See also nontoxic products, 286 accidental exposure to, 287t WD-40 See hydrocarbons (petroleum distillate, petroleum base oil, 219–221 Weeping fig sap, 317t See also plants, 309–319 Weeping willow, 317t See also plants, 309–319 5607indx.qxd_mg 9/9/03 1:52 PM Page 717 INDEX Weight belt cleaner (slang) See 1,4-butanediol, 210–213, 211t Welding galvanized steel, toxic exposures and, 521t Welding solvent-contaminated metal, toxic exposures and, 521t Wellbutrin See bupropion, 88, 88t, 89 Wellcovorin See leucovorin, 460–461 Wernicke-Korsakoff syndrome, thiamine for, 505 Whink Rust Stain Remover See hydrofluoric acid, 221–224 “Whippets” (slang) See nitrous oxide, 282–283 White cedar, 317t See also plants, 309–319 White Magic See 1,4-butanediol, 210–213, 211t “White-out” correction fluid See titanium dioxide, 620t trichloroethane, 359–361 White/yellow phosphorus See also phosphorus, 307–309 hazard summary for, 603t topical treatment for exposure to, 47t, 308 toxicity of, 307–309 Whole blood exchange transfusion, for arsine gas poisoning, 120, 121 Whole bowel irrigation, for gastrointestinal decontamination, 52–53 in iron poisoning, 231 in lithium overdose, 245 in valproic acid overdose, 364 Wigraine See caffeine, 142–144 ergotamine, 189–190 Wild calla, 317t See also plants, 309–319 Wild cotton, 317t See also plants, 309–319 Wild crocus, 312t See also plants, 309–319 Wild hops, 314t See also plants, 309–319 Wild licorice, 314t See also plants, 309–319 Wild onion, 317t See also plants, 309–319 Wild tobacco, 317t See also plants, 309–319 Windflower, 317t See also plants, 309–319 Wine (red), monoamine oxidase inhibitor interaction and, 270t Wintergreen drugs or toxins causing odor of, 32t oil of See also essential oils, 147–148; salicylates, 331–333 toxicity of, 147t, 331 Wisteria/Wisteria, 317t See also plants, 309–319 Withdrawal, drug/alcohol confusion caused by, 24t delirium caused by, 24t diazepam and lorazepam in management of, 415–418 hypertension caused by, 18t hyperthermia caused by, 21t in neonates, 62–63 pentobarbital in management of, 485–486 phenobarbital in management of, 486–487 propofol in management of, 494–496 seizures caused by, 23t tachycardia caused by, 13t Wood alcohol See methanol, 260–261 Wood ashes See also nontoxic products, 286 accidental exposure to, 287t Woodbind, 318t See also plants, 309–319 Wood preservatives, arsenic in, 115 Woodrose, 318t See also plants, 309–319 Hawaiian, 314t Woodruff, 318t See also plants, 309–319 Workplace See also occupational toxicology, 510–531 exposure guidelines for, 528–530, 532–628t See also specific substance Wormwood, 318t See also plants, 309–319 Wound botulism, 136–138 Wound injuries, tetanus toxoid/immune globulin for, 352, 503–505 Wycillin See penicillins, 83t Wygesic See acetaminophen, 66–69 propoxyphene, 289, 289t Wymox See amoxicillin, 83t Wytensin See guanabenz, 169–171 717 X-12 See 1,4-butanediol, 210–213, 211t X 14 Instant Mildew Stain Remover See, hypochlorite, 162–164 Xanax See alprazolam, 129, 130t Xanthosoma spp, 312t See also plants, 309–319 XDopenex (levalbuterol) See albuterol, 134t XMC (cosban) See also organophosphates and carbamates, 291–295 toxicity of, 293t X-rays, occupational exposure limits and, 328 Xylene (dimethylbenzene/xylol), 357–359 exposure limits for, 358, 627t hazard summary for, 627t toxicity of, 357–359 Xylidine, hazard summary for, 627t Xylocaine See lidocaine, 74, 75t, 76, 462–463 Xyrem See gamma-hydroxybutyrate (GHB), 210–213 Yage (harmaline), 248t, 314t See also hallucinogens, 247–249; plants, 309–319 Yarrow, 318t See also plants, 309–319 Yeast, monoamine oxidase inhibitor interaction and, 270t Yellow jacket envenomation, 225–226 Yellow jessamine, 314t See also plants, 309–319 Yellow oleander, 315t, 318t See also plants, 309–319 Yellow/white phosphorus See also phosphorus, 307–309 hazard summary for, 603t topical treatment for exposure to, 47t, 308 toxicity of, 307–309 Yellow rain (T-2 mycotoxins), as biological weapon, 370t See also warfare agents, biological, 367–372 Yellow zone (Contamination Reduction Zone), at hazardous materials incident site, 510, 511f victim decontamination in, 516 Yerba mate, toxicity of, 143 Yersinia enterocolitica, food poisoning caused by, 204t See also food poisoning, bacterial, 203–205 Yersinia pestis (plague), as biological weapon, 367, 368, 369t, 371 See also warfare agents, biological, 367–372 Yew, 318t See also plants, 309–319 Yohimbine, 217t, 318t See also herbal and alternative products, 215–218; plants, 309–319 Yttrium, hazard summary for, 627t Yttrium chloride, hazard summary for, 627t Yttrium nitrate hexahydrate, hazard summary for, 627t Yttrium oxide, hazard summary for, 627t Yutopar See ritodrine, 134t Zalcitabine See also antiviral and antiretroviral agents, 111–115 pharmacokinetics of, 403t toxicity of, 113t Zaleplon pharmacokinetics of, 403t toxicity of, 129, 130t Zanaflex See tizanidine, 169–171, 340 Zantac See ranitidine, 428–430 Zantedeschia spp, 312t See also plants, 309–319 Zantryl See phentermine, 72, 73t Zaroxolyn See metolazone, 188t Zebeta See bisoprolol, 132t Zemuron See rocuronium, 473t, 475 Zen See 1,4-butanediol, 210–213, 211t Zerit See stavudine, 400t Zestril See lisinopril, 77 Ziac See bisoprolol, 132t hydrochlorothiazide, 188t Ziagen See abacavir, 112t Zidovudine (AZT), 111 See also antiviral and antiretroviral agents, 111–115 pharmacokinetics of, 403t toxicity of, 113t, 114 Zigadenus spp, 311t, 313t, 317t See also plants, 309–319 Zilactin-B See benzocaine, 75, 75t, 76 Zilactin-L See lidocaine, 74, 75t, 76, 462–463 Zinc, 217t See also herbal and alternative products, 215–218 5607indx.qxd_mg 9/9/03 1:52 PM Page 718 718 Zinc chloride hazard summary for, 627t in “smoke bomb,” 341 Zinc chromates, hazard summary for, 627t Zinc oxide exposure limits for, 259, 628t hazard summary for, 628t job processes associated with exposure to, 521t metal fume fever caused by, 259 Zinc oxide ointment See also nontoxic products, 286 accidental exposure to, 287t Zinc phosphide, toxicity of, 306–307 Zinc potassium chromate, hazard summary for, 627t Zinc protoporphyrin (ZPP), in lead poisoning, 240 Zinc sulfate, abdominal x-ray showing, 46t Zinc yellow, hazard summary for, 627t Ziprasidone See also antipsychotic drugs, 107–109 pharmacokinetics of, 403t toxicity of, 107t ventricular arrhythmias caused by, 14t Zirconium, hazard summary for, 628t Zirconium oxide, hazard summary for, 628t Zirconium oxychloride, hazard summary for, 628t Zirconium tetrachloride, hazard summary for, 628t Zithromax See azithromycin, 382t INDEX ZnCrO4 (zinc chromate), hazard summary for, 627t Zn-DTPA, pharmacology/use of, 439–440 Zofran See ondansetron, 481–482 Zolmitriptan, ventricular arrhythmias caused by, 14t Zoloft See sertraline, 88, 88t, 89 Zolpidem pharmacokinetics of, 403t toxicity of, 129, 130t Zonalon cream See doxepin, 88t Zonisamide See also anticonvulsants, 86–87 pharmacokinetics of, 403t toxicity of, 86t, 87 Zoto-HC See pramoxine, 75t Zovirax See acyclovir, 111, 112t, 114 ZPP (zinc protoporphyrin), in lead poisoning, 240 ZrCl4 (zirconium tetrachloride), hazard summary for, 628t ZrO2 (zirconium oxide), hazard summary for, 628t ZrOCl (zirconium oxychloride), hazard summary for, 628t Zyban See bupropion, 88, 88t, 89 Zydone See acetaminophen, 66–69 hydrocodone, 289t Zyprexa See olanzapine, 107t Zyrtec See cetirizine, 97t ... 5607fm01.qxd_cs 9/9/03 1:11 PM Page xv Preface Poisoning & Drug Overdose provides practical advice for the diagnosis and management of poisoning and drug overdose and concise information about common industrial... evaluation and treatment of coma, seizures, shock, and other common complications of poisoning and to the proper use of gastric decontamination and dialysis procedures Section II Specific Poisons & Drugs:... chemical names and numerous brand name drugs and commercial products v 5607ch01.qxd_cc 9/9/03 1:18 PM Page SECTION I Comprehensive Evaluation and Treatment ᭤ EMERGENCY EVALUATION AND TREATMENT