Acetaminophen OD
Opioid reversal
Benzo reversal (caution)
TCA OD with QRS widening
CCB/HF OD, hyperK+, hypoCa
Cyanide / smoke inhalation
Roc/Vec reversal
16 mg/kg for immediate reversal; 4 mg/kg deep block; 2 mg/kg routine. Vecuronium reversal: 4 mg/kg.
| Toxin | Antidote | Dose |
|---|---|---|
| Acetaminophen | 150 mg/kg load → 50 → 100 | |
| Opioids | 0.1 mg/kg IV/IN/IM (max 2 mg) | |
| 0.01 mg/kg IV (caution) | ||
| β-blocker / CCB | / Ca / | 50 mg/kg ; 1 U/kg |
| (wide QRS) | 1-2 mEq/kg IV bolus | |
| Iron | 15 mg/kg/hr IV | |
| Methemoglobin | 1-2 mg/kg IV | |
| Cyanide | 70 mg/kg (max 5 g) IV | |
| + | 0.05 mg/kg , double q5 | |
| Sulfonylurea | 1-2 mcg/kg SQ q6h | |
| Salicylate () | + dialysis | Alkalinize urine pH >7.5; HD if >100 mg/dL or AMS |
| Digoxin | () | Acute: 10-20 vials; chronic: 3-6 vials empiric |
| Methanol / Ethylene glycol | 15 mg/kg IV load → 10 mg/kg q12h × 4 | |
| Warfarin / sup-warfarin | + | 10 mg IV K1; 25-50 U/kg if major bleed |
| Heparin | 1 mg per 100 U (max 50 mg) | |
| Isoniazid (INH) | () | 1 g per g INH (empiric 5 g IV) for seizures |
| Carbon monoxide | 100% O2 ± HBO | NRB until COHb <5%; HBO if AMS / COHb >25% |
| Local anesthetic (LAST) | 20% | 1.5 mL/kg bolus → 0.25 mL/kg/min |
| Anticholinergic | 1-2 mg IV slow (pure anticholinergic only) | |
| Lead / arsenic / mercury | / / | Chelation per heavy-metal protocol |
| Substance | Key concern | ER action |
|---|---|---|
| Acetaminophen (Tylenol) | Hepatotoxicity (>150 mg/kg or >7.5 g) | 4-h level → Rumack-Matthew nomogram → |
| Ibuprofen / NSAIDs | GI bleed, AKI, AG acidosis at >400 mg/kg | Supportive; activated charcoal if <1 h |
| / salicylates | Tachypnea, tinnitus, mixed acid-base | Serial salicylate, K+ repletion, alkalinize, HD |
| () | Anticholinergic, wide QRS, seizures | if QRS >100; for seizures |
| () | Serotonin syndrome, dissociation | , cooling, supportive |
| / decongestants | HTN, tachy, MI, stroke | , BP control (avoid pure β-block) |
| Loperamide (Imodium) abuse | QT/QRS prolongation, torsades | Mg, for QRS, overdrive pace |
| Caffeine / energy drinks | Tachydysrhythmia, seizures, hypoK | , K+ replete, for SVT |
| Iron supplements | >40 mg/kg elemental → shock, AGMA | AXR, serum Fe @ 4-6 h, |
| Vitamin D / multivitamins | Hypercalcemia (chronic) | IVF, calcitonin, bisphosphonate |
| Melatonin (peds) | Sedation, usually mild | Observe; airway support if large dose |
| () | CNS depression, hypoglycemia (peds) | Glucose, thiamine, airway |
| Marijuana / THC edibles | Peds: lethargy, ataxia; adults: anxiety, vomiting | Supportive, , |
| Cannabinoid hyperemesis | Cyclic vomiting in chronic users | or , capsaicin cream |
| Bleach / household cleaners | Mucosal irritation; mixing → chlorine gas | Dilute with water/milk; humidified O2 |
| Drain / oven cleaner (alkali) | Caustic burns, esophageal injury | NPO, no charcoal/no induced emesis, GI consult |
| Button battery | Esophageal necrosis <2 h | Honey if <12 y & <12 h; emergent endoscopy |
| Magnets (multiple) | Bowel perforation | XR; surgical/GI consult if >1 or with metal |
| Laundry pods | Caustic burns, CNS depression, aspiration | Airway, dilute, observe |
| Hand sanitizer (/methanol) | Intoxication; methanol blindness | Check /methanol levels, if MeOH |
| Antifreeze (ethylene glycol) | AGMA, Ca-oxalate crystals, AKI | + HD; Ca repletion |
| Windshield washer (methanol) | Blindness, AGMA | + HD; folinic acid |
| Rat poison (superwarfarin) | Delayed coagulopathy (days-weeks) | (high-dose, prolonged); if bleeding |
| pesticides | SLUDGE, , fasciculations | to dry secretions; |
| Mushrooms (Amanita) | Delayed hepatic failure (>6 h sx) | , , transplant center |
| Plants (oleander, foxglove) | Cardiac glycoside toxicity | Treat as digoxin; |
| Essential oils (eucalyptus, camphor) | Seizures, CNS depression | , airway |
| Nicotine (vape liquid, gum) | N/V, seizures, | , , supportive |
| ADHD stimulants () | Sympathomimetic, hyperthermia | , cooling, IVF |
| / | Serotonin syndrome, seizures | , , cooling |
| Bupropion | Seizures, wide QRS, status | , , for refractory |
| / | Sedation, hypotension, QT | IVF, pressors, ECG monitoring |
| Lithium | Tremor, AMS, renal failure | IVF, hold drug, HD if level >4 or symptomatic |
| Metformin | Lactic acidosis | HD if pH <7.1 or lactate >20 |
| / sulfonylurea | Prolonged hypoglycemia | D10 infusion, for sulfonylurea |
| Statins / fibrates | Rhabdomyolysis | IVF, monitor CK, renal |
| Kratom | Opioid-like + stimulant; seizures, QTc | partial response, supportive |
| Synthetic cannabinoids (K2/Spice) | Agitation, seizures, AKI | , cooling, IVF |