Close Window Contributors Editor 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 Clinical Professor of Pharmacy, University of California, San Francisco; Senior Toxicology Management Specialist, California Poison Control System, San Francisco 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 Paul D. Blanc, MD, MSPH Professor of Medicine and Chief, Division of Occupational and Environmental Medicine, University of California, San Francisco Richard F. Clark, MD, FACEP Professor of Medicine, University of California, San Diego; Director, Division of Medical Toxicology and Medical Director, California Poison Control System, San Diego Division Thomas E. Kearney, PharmD, ABAT Professor of Clinical Pharmacy, University of California, San Francisco; Managing Director, California Poison Control System, San Francisco Division 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 Contributors Timothy E. Albertson, MD, PhD Professor of Medicine, Medical Pharmacology and Toxicology, University of California Medical Center, Davis; Medical Director, California Poison Control System, Sacramento Division [email protected] Section II: Amphetamines; Barbiturates; Dextromethorphan; Opiates and Opioids Judith A. Alsop, PharmD, DABAT Associate Clinical Professor, School of Pharmacy, University of California, San Francisco; Clinical Professor of Medicine, School of Medicine, University of California, Davis [email protected] Section II: Plants; Section III: Metoclopramide; Ondansetron; Potassium Ilene B. Anderson, PharmD Clinical Professor, School of Pharmacy, University of California, San Francisco; Senior Toxicology Management Specialist, California Poison Control System, San Francisco Division [email protected] 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 [email protected] Section II: Asbestos; Formaldehyde; Gases, Irritant; Molds; Phosgene; Sulfur Dioxide 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 [email protected] 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; Phencyclidine (PCP) and Ketamine; Pseudoephedrine, Phenylephrine and Other Decongestants; Quinidine and Other Type IA Antiarrhythmic Drugs; Quinine; Vacor (PNU); Section III: Dopamine; Epinephrine; Norepinephrine David P. Betten Assistant Clinical Professor, Department of Emergency Medicine, College of Human Medicine, Michigan State University, East Lansing [email protected] Section II: Colchicine Kathleen Birnbaum, PharmD Toxicology Management Specialist, Department of Clinical Pharmacy, University of California, San Francisco [email protected] Section III: Insulin; Leucovorin Calcium Paul D. Blanc, MD, MSPH Professor of Medicine, and Chief, Division of Occupational and Environmental Medicine, University of California, San Francisco [email protected] Section II: Carbon Disulfide; Cyanide; Isocyanates; Manganese; Metal Fume Fever; Methemoglobinemia; Nitrogen Oxides; Section IV: Evaluation of the Patient with Occupational Chemical Exposure; The Toxic Hazards of Industrial and Occupational Chemicals Stephen C. Born, MD, MPH Associate Clinical Professor, Division of Occupational and Environmental Medicine, University of California, San Francisco [email protected] 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 [email protected] Section II: Copper Cindy Burkardt Toxicology Management Specialist, California Poison Control System, San Francisco Division [email protected] Section III: DTPA; Thiosulfate, Sodium Chris Camilleri, DO Attending Physician, University of California Davis Medical Center, Sacramento. Section II: Benzene F. Lee Cantrell, PharmD Assistant Clinical Professor, School of Pharmacy, University of California, San Diego and San Francisco; Interim Director, California Poison Control System, San Diego Division [email protected] Section II: Thyroid Hormone; Section III: Cyproheptadine; Folic Acid; Inamrinone (formerly Amrinone) Terry Carlson, PharmD Toxicology Management Specialist, California Poison Control System, Fresno/Madera Division [email protected] Section III: Naloxone and Nalmefene Richard F. Clark, MD Professor of Medicine, University of California, San Diego; Director, Division of Medical Toxicology, University of California Medical Center, San Diego; Medical Director, California Poison Control System, San Diego Division [email protected] Section II: Hymenoptera; Lionfish and Other Scorpaenoidea; Scorpions; Snakebite; Section III: Antivenom, Crotalinae (Rattlesnake); Antivenom, Latrodectus Mactans (Black Widow Spider); Antivenom, Micrurus Fulvius (Coral Snake), and Exotic Antivenoms Matthew D. Cook Assistant Clinical Professor, Medical Toxicology Fellow, and Attending Physician, Department of Emergency Medicine, University of California Medical Center, San Diego [email protected] Section II: Phosphorus Delia A. Dempsey, MD, MS Assistant Adjunct Professor of Pediatrics, Medicine, and Clinical Pharmacy, University of California, San Francisco; Assistant Medical Director, California Poison Control System, San Francisco Division [email protected] Section I: Special Considerations in Pediatric Patients; Section II: Bromides; Methyl Bromide; Pentachlorophenol and Dinitrophenol Jo Ellen Dyer, PharmD Clinical Professor, Department of Pharmacy, University of California, San Francisco; Senior Toxicology Management Specialist, California Poison Control System, San Francisco Division [email protected] Section I: Special Considerations in the Evaluation of Drug-Facilitated Assault; Section II: Azide, Sodium; Gamma- Hydroxybutyrate (GHB) Andrew Erdman, MD Clinical Pharmacology Fellow, University of California, San Francisco [email protected] Section II: Isoniazid (INH) Gary W. Everson, PharmD Toxicology Management Specialist, California Poison Control System, Fresno/Madera Division [email protected] Section II: Phenol and Related Compounds; Section III: Mannitol Jeffrey Fay, PharmD Assistant Clinical Professor, Department of Pharmacy, University of California, San Francisco; Toxicology Management Specialist, California Poison Control System, Fresno/Madera Division [email protected] Section II: Vasodilators 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 [email protected] Section II: Chromium; Thallium Frederick Fung, MD, MS Clinical Professor of Occupational Medicine, University of California, Irvine; Medical Director, Occupational Medicine Department and Toxicology Services, Sharp Rees-Stealy Medical Group, San Diego, California [email protected] Section II: Carbon Tetrachloride and Chloroform Mark J. Galbo, MS Environmental Toxicologist, School of Pharmacy, University of California, San Francisco; Poison Information Specialist, California Poison Control System, San Francisco Division [email protected] Section II: Naphthalene and Paradichlorobenzene; Warfare Agents—Chemical Fabian Garza, PharmD School of Pharmacy, University of California, San Francisco; Toxicology Management Specialist, California Poison Control System, Fresno/Madera Division [email protected] Section III: Methylene Blue Richard J. Geller, MD, MPH Associate Clinical Professor of Emergency Medicine, University of California, San Francisco; Medical Director, California Poison Control System, Fresno/Madera Division Section II: Disulfiram; Paraquat and Diquat; Selenium; Section III: Atropine and Glycopyrrolate; Pralidoxime (2- PAM) & Other Oximes Robert L. Goldberg, MD, FACOEM Director, Occupational and Environmental Medicine Residency Program; Health Sciences Associate Clinical Professor of Medicine, Department of Medicine, University of California, San Francisco [email protected] Section II: Polychlorinated Biphenyls (PCBs) Colin S. Goto, MD Assistant Clinical Professor of Pediatrics, University of California, San Diego; Attending Physician, Division of Emergency Medicine, Children's Hospital and Health Center, San Diego, California [email protected] Section II: Hydrocarbons Christine A. Haller, MD Assistant Professor of Medicine and Laboratory Medicine, University of California, San Francisco; California Poison Control System, San Francisco Division; San Francisco General Hospital [email protected] Section II: Caffeine; Herbal and Alternative Products; Section III: L-Carnitine (Levocarnitine); Silymarin or Milk Thistle (Silybum Marianum) Jennifer Hannum, MD Medical Toxicology Fellow, Department of Emergency Medicine, University of California Medical Center, San Diego [email protected] Section II: Hydrogen Fluoride and Hydrofluoric Acid; Methylene Chloride; Section III: Calcium Sandra Hayashi, PharmD Assistant Clinical Professor, School of Pharmacy, University of California, San Francisco; Toxicology Management Specialist, California Poison Control System, San Francisco Division [email protected] Section II: Angiotensin Blockers and ACE Inhibitors; Section III: Prussian Blue Patricia Hess Hiatt, BS Administrative Operations Manager, California Poison Control System, San Francisco Division [email protected] Section IV: The Toxic Hazards of Industrial and Occupational Chemicals Raymond Ho, PharmD Toxicology Management Specialist, California Poison Control System, San Francisco Division [email protected] Section III: Botulinum Antitoxin David L. Irons, PharmD Toxicology Management Specialist, Department of Clinical Pharmacy, University of California, San Francisco [email protected] Section II: Vitamins; Section III: Deferoxamine Leslie M. Israel, DO, MPH Associate Clinical Professor of Occupational Medicine, University of California, Irvine [email protected] 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 [email protected] Section II: Carbamazepine and Oxcarbazepine; 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 Professor of Clinical Pharmacy, University of California, San Francisco; Senior Toxicology Management Specialist, California Poison Control System, San Francisco Division [email protected] 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 Lada Kokan, MD Attending Physician, Emergency Department, Kaiser Permanente, San Francisco, California [email protected] Section II: Monoamine Oxidase Inhibitors Michael J. Kosnett, MD, MPH Associate Clinical Professor of Medicine, Department of Clinical Pharmacology and Toxicology, University of Colorado Health Sciences Center, Denver [email protected] 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) Grant D. Lackey, PharmD, PhD, CSPI, FASCP Assistant Clinical Professor of Medicine, University of California, Davis; Assistant Clinical Professor of Medicine, University of California, San Francisco; Toxicology Management Specialist, California Poison Control System, Sacramento Division [email protected] Section II: Antipsychotic Drugs, Including Phenothiazines; 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 Medical Center, Davis; Toxicology Management Specialist, California Poison Control System, Sacramento Division [email protected] Section II: Boric Acid, Borates, and Boron John P. Lamb, PharmD Clinical Professor of Medicine, University of California, Davis; Assistant Clinical Professor of Pharmacy, University of California, San Francisco; Toxicology Management Specialist, California Poison Control System, Sacramento Division [email protected] Section II: Pyrethrins and Pyrethroids Darren H. Lew, PharmD Toxicology Management Specialist, California Poison Control System, Fresno/Madera Division [email protected] Section II: Chlorinated Hydrocarbon Pesticides Jon Lorett, PharmD Toxicology Management Specialist, Department of Clinical Pharmacy, University of California, San Francisco [email protected] Section II: Ipecac Syrup; Section III: Ipecac Syrup Binh T. Ly, MD Associate Clinical Professor of Medicine; Associate Director, Emergency Medicine Residency Program; Associate Director, Medical Toxicology Fellowship Program, Division of Medical Toxicology, Department of Emergency Medicine, University of California, San Diego [email protected] Section II: Hydrogen Fluoride and Hydrofluoric Acid; Methylene Chloride; Section III: Calcium Richard Lynton, MD Staff Physician, VA Medical Center, Sacramento; Assistant Clinical Professor, University of California, Davis School of Medicine [email protected] 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 [email protected] Section II: Anticholinergics; Antihistamines Anthony S. Manoguerra, PharmD Professor of Clinical Pharmacy and Associate Dean, University of California, San Diego [email protected] Section II: Iron 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 [email protected] Section II: Mushrooms; Mushrooms, Amatoxin-Type Michael J. Matteucci, MD Assistant Clinical Professor and Medical Toxicology Fellow, Department of Medicine, University of California, San Diego; Attending Physician, University of California Medical Center, San Diego; Attending Physician, Naval Medical Center, San Diego [email protected] Section II: Isopropyl Alcohol 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 [email protected] Section II: Dapsone; Fluoride; Magnesium; Section III: Hydroxocobalamin Eileen Morentz Poison Information Provider, California Poison Control System, San Francisco Division [email protected] 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 [email protected] Section II: Caustic and Corrosive Agents; Iodine; Section III: Flumazenil; Nitrite, Sodium and Amyl Stephen W. Munday, MD, MPH, MS Assistant Clinical Professor, Department of Family and Preventative Medicine, University of California, San Diego; Assistant Director of Outpatient Medicine, Medical Toxicologist, Sharp Rees-Stealy Medical Group, San Diego, California [email protected] Section II: Hydrogen Sulfide Nancy G. Murphy, MD Medical Toxicology Fellow, Department of Clinical Pharmacology and Experimental Therapeutics, University of California, San Francisco [email protected] Section II: Anesthetics, Local; Calcium Antagonists; Cocaine Steve Offerman, MD Assistant Professor, Department of Emergency Medicine, University of California, Davis [email protected] 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 [email protected] Section I: Emergency Evaluation and Treatment; Section II: Acetaminophen; Carbon Monoxide; Oxalic Acid; Phosphine and Phosphides; Smoke Inhalation; Theophylline; Section III: Oxygen & Hyperbaric Oxygen; Section IV: Emergency Medical Response to Hazardous Materials Incidents; The Toxic Hazards of Industrial and Occupational Chemicals Michael A. O'Malley, MD, MPH Associate Clinical Professor, School of Medicine, University of California, Davis [email protected] Section II: Chlorophenoxy Herbicides Cyrus Rangan, MD Assistant Medical Director, California Poison Control System, San Francisco Division; Director, Toxics Epidemiology Program, Los Angeles County Department of Health Services; Attending Staff, Children's Hospital, Los Angeles [email protected] Section II: Clonidine and Related Drugs Freda M. Rowley, PharmD Assistant Clinical Professor of Pharmacy, University of California, San Francisco; Toxicology Management Specialist, California Poison Control System, San Francisco Division [email protected] Section II: Anticonvulsants, Newer; Section III: Iodide (Potassium Iodide, KI) 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 [email protected] Section II: Bromates; Chlorates Aaron Schneir, MD Assistant Professor, Division of Medical Toxicology, Department of Emergency Medicine, University of California Medical Center, San Diego [email protected] Section II: Nitrous Oxide Jay Schrader, CPhT Poison Information Provider, California Poison Control System, San Francisco Division [email protected] Section II: Nontoxic or Minimally Toxic Household Products Kerry Schwarz, PharmD Toxicology Management Specialist, California Poison Control System, San Diego Division [email protected] Section II: Antiseptics and Disinfectants Craig Smollin, MD Medical Toxicology Fellow, California Poison Control System, San Francisco Division Section II: Glysophate; Phenytoin Karl A. Sporer, MD Associate Clinical Professor, University of California, San Francisco; Attending Physician, San Francisco General Hospital [email protected] Section II: Tetanus Jeffrey R. Suchard, MD, FACEP Assistant Clinical Professor, Director of Medical Toxicology, Department of Emergency Medicine, University of California Medical Center, Irvine [email protected] 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 [email protected] 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 [email protected] Section II: Organophosphorus and Carbamate Insecticides; Warfare Agents—Biological; Warfare Agents—Chemical John H. Tegzes, VMD Associate Professor, College of Veterinary Medicine, Western University of Health Sciences, Pomona, California [email protected] Section III: Tetanus Toxoid and Immune Globulin R. Steven Tharratt, MD, MPVM Professor of Medicine and Anesthesiology, University of California, Davis; Associate Medical Director, California Poison Control System, Sacramento Division [email protected] Section II: Ammonia; Chlorine; Section IV: Emergency Medical Response to Hazardous Materials Incidents Josef G. Thundiyil, MD, MPH Medical Toxicology Fellow, California Poison Control System, San Francisco Division Section II: Freons and Halons; Trichloroethane, Trichloroethylene, and Tetrachloroethylene Ben T. Tsutaoka, PharmD Assistant Clinical Professor, School of Pharmacy, University of California, San Francisco; Toxicology Management Specialist, California Poison Control System, San Francisco Division [email protected] Section II: Benzodiazepines; Sedative-Hypnotic Agents; Section III: Vasopressin Rais Vohra, MD Toxicology Fellow, Department of Emergency Medicine, University of California Medical Center, San Diego; California Poison Control System, San Diego Division [email protected] Section II: Antimony and Stibine Michael J. Walsh, PharmD Assistant Clinical Professor, School of Pharmacy, University of California, San Francisco; Toxicology Management Specialist, California Poison Control System, Sacramento Division [email protected] Section II: Detergents Janet Weiss, MD Director of Toxicology, TheToxDoc, Berkeley, California [email protected] Section II: Ethylene Dibromide; Toluene and Xylene R. David West, PharmD Toxicology Management Specialist, California Poison Control System, Fresno/Madera Division