Summary
The rapid diagnosis and immediate intervention required in patients with serious drug overdose or poisoning makes toxicological screening of limited value to the emergency department physician. Instead, a careful clinical evaluation using the history, physical examination, and the more readily available laboratory tests may allow a tentative diagnosis and the initiation of life-saving treatment. Laboratory tests should include serum osmolality, electrolytes, glucose, BUN and an estimation of the anion and osmolar gaps. The ECG can also provide useful information.
Clinical findings of important include altered blood pressure, pulse, respiration and body temperature, the presence of coma, agitation, delirium or psychosis, and muscular weakness. An ophthalmological examination is also of importance in the acutely poisoned patient. Oral burns or dysphagia may occur following ingestion of any strongly reactive substance, but the absence of oral burns does not preclude the possibility of oesophageal or stomach injury. Odours and skin colour may also contribute to the diagnosis.
Comprehensive toxicology screening may not be immediately available, or may be inaccurate, thus adding little to the information obtained during the initial evaluation of the poisoned patient.
Similar content being viewed by others
References
Ackerman AB, Mandy S, Alexander G, et al. Skin lesions in barbiturate poisoning. Correspondence. New England Journal of Medicine 282: 764, 1970
Adams CR, Ziegler DK, Lin JT. Mercury intoxication simulating amyotrophic lateral sclerosis. Journal of the American Medical Association 250: 642–643, 1983
Adler R, Boxstein D, Schaff P, et al. Metallic mercury vapor poisoning simulating mucocutaneous lymph node syndrome. Journal of Pediatrics 101: 967–968, 1982
Allred RJ, Ewer S. Fatal pulmonary edema following intravenous ‘freebase’ cocaine use. Annals of Emergency Medicine 10: 441–442, 1981
Amitai Y, Whitesell L, Lovejoy FH, et al. Death following accidental lidocaine overdose in a child. New England Journal of Medicine 314: 182–183, 1986
Anas N, Namasonthi V, Ginsberg CM. Criteria for hospitalizing children who have ingested products containing hydrocarbons. Journal of the American Medical Association 246: 840–843, 1981
Andersen PK, Christensen KN, Hole P, et al. Sodium nitroprusside and epidural blockade in the treatment of ergotism. New England Journal of Medicine 296: 1271–1273, 1977
Anderson RJ, Potts DE, Rumack BH, et al. Unrecognized adult salicylate intoxication. Annals of Internal Medicine 85: 745–748, 1976
Anderson RJ, Hart GR, Crumpler CP, et al. Clonidine overdose: report of six cases and review of the literature. Annals of Emergency Medicine 10: 107–112, 1981
Appenzeller O. The normal pupil and some pupillary abnormalities. In Appenzeller O (Ed.) The autonomic nervous system, 3rd ed., pp. 319–338, Elsevier Biomedical Press, New York, 1982
Armen R, Kanel G, Reynolds T. Phencyclidine-induced malignant hyperthermia causing submassive liver necrosis. American Journal of Medicine 77: 167–172, 1984
Aronow R, Fleischmann LE. Mercury poisoning in children: the value of N-acetyl-D,L-penicillamine. Clinical Pediatrics 15: 936–945, 1976
Bailey DN. Comprehensive toxicology screening: the frequency of finding other drugs in addition to ethanol. Journal of Toxicology — Clinical Toxicology 22: 463–471, 1984
Baker EL, Smith TJ, Landrigan PJ. The neurotoxicity of industrial solvents: a review of the literature. American Journal of Industrial Medicine 8: 207–217, 1985
Ballard PA, Tetrud JW, Langston JW. Permanent human parkinsonism due to 1-methyl 4-phenyl-l,2,3,6-tetrahydropyridine (MPTP). Neurology 35: 949–956, 1985
Bangs CC. Hypothermia and frostbite. Emergency Medical Clinics of North America 2(3): 475–487, 1984
Beamer WC, Shealy RM, Prough DS. Acute cyanide poisoning from laetrile ingestion. Annals of Emergency Medicine 12: 449–451, 1983
Becker CE. Methanol poisoning. Journal of Emergency Medicine 1: 51–58, 1983
Benitz WE, Tatro DS. Disulfiram intoxication in a child. Journal of Pediatrics, 105: 487–488, 1984
Benowitz NL. Nitrites and nitrates. In Haddad et al. (Eds) Clinical management of poisoning & drug overdose, pp. 882–886, WB Saunders Co., Philadelphia, 1983a
Benowitz NL. Propranolol (Inderal) and beta-blocker toxicity. In Haddad et al. (Eds) Clinical management of poisoning & drug overdose, pp. 846–852, WB Saunders Co., Philadelphia, 1983b
Benowitz NL, Osterloh J, Goldschlager N, et al. Massive catecholamine release from caffeine poisoning. Journal of the American Medical Association 248: 1097–1098, 1982
Benowitz NL, Goldschlager N. Cardiac disturbances in the toxicologic patient. In Haddad et al. (Eds) Clinical management of poisoning & drug overdose, pp. 65–98, WB Saunders Co., Philadelphia, 1983
Bergman RN, Watson WA. Cardiac toxicity associated with acute maprotiline self-poisoning. American Journal of Emergency Medicine 2: 144–146, 1985
Berlinger WG, Spector R, Flanigan MJ, et al. Hemoperfusion for phenylbutazone poisoning. Annals of Internal Medicine 96: 334–335, 1982
Berwick P. 2,4-Dichlorophenoxyacetic acid poisoning in man: some interesting clinical and laboratory findings. Journal of the American Medical Association 214: 1114–1117, 1970
Bianchine JR: Drugs for parkinson’s disease, spasticity, and acute muscle spasms. In Gilman et al. (Eds) The pharmacological basis of therapeutics, 7th ed, pp. 473–490, MacMillan Co., New York 1985
Biberstein MP, Ziegler MG, Ward DM. Use of beta-blockade and hemoperfusion for acute theophylline poisoning. Western Journal of Medicine 141: 485–490, 1984
Blain PG, Nightingale S, Stoddart JC: Strychnine poisoning: abnormal eye movements. Journal of Toxicology — Clinical Toxicology 19: 215–217, 1982
Bodnar T, Nowak R, Tomlanovich MC, et al. Massive intravenous bolus of bretylium tosylate. Annals of Emergency Medicine 9: 630–633, 1980
Boehnert MT, Lovejoy FH. Value of the QRS duration versus the serum drug level in predicting seizures and ventricular arrhthymias after an acute overdose of tricyclic antidepressants. New England Journal of Medicine 313: 474–479, 1985
Boland ME, Roper SMB, Henry JA. Complications of quinine poisoning. Lancet 1: 384–385, 1985
Brown GR. Nonsteroidal anti-inflammatory drugs. Clinical Toxicology Review 6(7): 1–2, 1984
Brown MJ. Hypokalemia from beta-2-receptor stimulation by circulating epinephrine. American Journal of Cardiology 56: 3D-9D, 1985
Buiumsohn A, Eisenberg ES, Jacob H, et al. Seizures and intraventricular conduction defect in propranolol poisoning. Annals of Internal Medicine 91: 860–862, 1979
Cadnapaphornchai P, Taher S, Bhathena D, et al. Ethylene glycol poisoning: diagnosis based on high osmolal and anion gaps and crystalluria. Annals of Emergency Medicine 10: 94–97, 1981
Caldwell J, Sever PS. The biochemical pharmacology of abused drugs. I Amphetamines, cocaine and LSD. Clinical Pharmacology and Therapeutics 16: 625–638, 1974
Callaham M: Tricyclic antidepressant overdose. Journal of the American College of Emergency Physicians 8: 413–425, 1979
Callaham M, Kassel D. Epidemiology of fatal tricyclic anti-depressant ingestion: implications for management. Annals of Emergency Medicine 14: 1–9, 1985
Caruana DS, Weinbach B, Goerg D et al: Cocaine-packet ingestion: diagnosis, management, and natural history. Annals of Internal Medicine 100: 73–74, 1984
Catravas JD, Waters IW. Acute cocaine intoxication in the conscious dog: studies on the mechanism of lethality. Journal of Pharmacology and Experimental Therapeutics 217: 350–356, 1985
Cohan SL. Central nervous system disturbances. In Haddad et al. (Eds) Clinical management of poisoning & drug overdose, pp. 51–64, WB Saunders Co., Philadelphia, 1983
Coleman DL. Smoke inhalation — Medical Staff Conference, University of California, San Francisco. Western Journal of Medicine 135: 300–309, 1981
Coleman DL, Ross TF, Naughton JL. Myocardial infarction and ischemia related to recreational cocaine use. Western Journal of Medicine 136: 444–446, 1982
Conner CS, Watanabe AS. Clonidine overdose: a review. American Journal of Hospital Pharmacy 36: 906–911, 1979
Corre KA, Niemann JT, Bessen H, et al. Extended therapy for acute dystonic reactions. Annals of Emergency Medicine 13: 194–197, 1984
Craig DH, Rosen P. Abuse of antiparkinsonian drugs. Annals of Emergency Medicine 10: 98–100, 1981
Crain EF, Gershel JC, Mezey AP. Caustic ingestions: symptoms as predictors of esophageal injury. American Journal of Diseases of Children 138: 863–865, 1984
Curry SC. Methemoglobinemia. Annals of Emergency Medicine 11: 214–221, 1982
Curtis JA, Goel KM. Lomotil poisoning in children. Archives of Disease in Childhood 54: 222–225, 1979
Davidson CS, Gabuzda GJ. Hepatic coma. In Schiff (Ed.) Diseases of the liver, 4th ed., pp. 466–499, JB Lippincott Co., Philadelphia, 1975
Davies JE, Dedhia HV, Morgade C, et al. Lindane poisonings. Archives of Dermatology 119: 142–144, 1983
Davis JP, Chesney PJ, Wand PJ, et al. Toxic shock syndrome. New England Journal of Medicine 303: 1429–1435, 1980
Davis SA. Dermatologic emergencies. In Mills et al. (Eds) Current emergency diagnosis and treatment, 2nd ed., pp. 695–708. Lange Medical Publications, Los Altos, 1985
DeGroot G, VanHeijst ANP, Maes RAA. Charcoal hemoperfusion in the treatment of acute carbamazepine poisoning. Clinical Toxicology, 22: 349–362, 1984
Dingledine R. Opiate receptors; central nervous system. In Rogawski (Ed.) Neurotransmitter actions in the vertebrate nervous system, pp. 359, Plenum Press, New York, 1985
Dittrich K, Bayer MJ, Wanke LA. A case of fatal strychnine poisoning. Journal of Emergency Medicine 1: 327–330, 1984
Dole VP, Fishman J, Goldfrank L, et al. Arousal of ethanol-intoxicated comatose patients with naloxone. Alcoholism: Clinical & Experimental Research 6: 275–279, 1982
Dove DJ, Jones T. Delayed coma associated with salicylate intoxication. Journal of Pediatrics 100: 493–496, 1982
Dudley AW, Thapar NT. Fatal human ingestion of 2,4-D, a common herbicide. Archives of Pathology 94: 270–275, 1972
Dupre LJ, Stieglitz P. Extrapyramidal syndromes after premedication with droperidol in children. British Journal of Anaesthesiology 52: 831–833, 1980
Eckstein JW, Abboud FM. Circulatory effects of sympathomimetic amines. American Heart Journal 63: 119–135, 1962
Edell TA, Sullivan CP, Osborn KM, et al. Wound botulism associated with a positive tensilon test. Western Journal of Medicine 139: 218–219, 1983
Eells JT, McMartin KE, Black K, et al. Formaldehyde poisoning — rapid metabolism to formic acid. Journal of the American Medical Association 246: 1237–1238, 1981
Elbaum DJ, Wood C, Abuabara F, et al. Bullae in a patient with toxic shock syndrome. Journal of the American Academy of Dermatology 10: 267–272, 1984
Escobar JI, Karno M. Chronic hallucinosis from nasal drops. Journal of the American Medical Association 247: 1859–1860, 1982
Espelin DE, Done AK. Amphetamine poisoning — effectiveness of chlorpromazine. New England Journal of Medicine 278: 1361–1365, 1968
Fahn S, Craddock G, Kumin G. Acute toxic psychosis from suicidal overdosage of amantidine. Archives of Neurology 25: 45–48, 1971
Fazen LE, Lovejoy FH, Crone RK. Acute poisoning in a children’s hospital: a 2-year experience. Pediatrics 77: 144–151, 1986
Fein A, Left A, Hopewell PC. Pathophysiology and management of the complications resulting from fire and the inhaled products of combusion: review of the literature. Critical Care Medicine 8: 94–98, 1980
Felser JM, Orban DJ. Dystonic reaction after ketamine abuse. Annals of Emergency Medicine 11: 673–675, 1982
Finkelstein FN, Bayne LH, Rangno RE. Nonspecific arousal with naloxone. Canadian Medical Association Journal 123: 33–35, 1980
Fishbain DA, Wetli CV. Cocaine intoxication, delirium, and death in a body packer. Annals of Emergency Medicine 10: 531–532, 1981
Fisher CJ, Albertson TE, Foulke GE. Salicylate-induced pulmonary edema: clinical characteristics in children. American Journal of Emergency Medicine 3: 33–37, 1985
Fligner CL, Jack R, Twiggs GA et al. Hyperosmolality induced by propylene glycol — a complication of silver sulfidiazine therapy. Journal of the American Medical Association 253: 1606–1609, 1985
Foley RJ. Inhaled industrial acetylene — a diabetic ketoacidosis mimic. Journal of the American Medical Association 254: 1066–1067, 1985
Fruncillo RJ, Gibbons W, Bowman SM, et al. CNS toxicity after ingestion of topical lidocaine. New England Journal of Medicine 306: 426–427, 1982
Gapany-Gapanavicius M, Yellin A, Almog S et al. Pneumomediastinum: a complication of chlorine exposure from mixing household cleaning agents. Journal of the American Medical Association 248: 349–350 aiGarcia-Estrada H, Fischman CM. An unusual case of nicotine poisoning. Clinical Toxicology 10: 391–393, 1977
Gaudreault P, Parent M, McGuigan MA, et al. Predictability of esophageal injury from signs and symptoms: a study of caustic ingestion in 378 children. Pediatrics 71: 767–770, 1983
Gaudreault P, Temple AR, Lovejoy FH. The relative severity of acute vschronic salicylate poisoning in children. Pediatrics 70: 566–569, 1982
Gennari FJ. Serum osmolality — uses and limitations. New England Journal of Medicine 310: 102–105, 1984
Gershank J, Boecler B, Ensley H, et al. The gasping syndrome and benzyl alcohol poisoning. New England Journal of Medicine 307: 1384–1388, 1982
Ginsberg MD, Hertzman M, Schmidt-Nowara WW. Amphetamine intoxication with coagulopathy, hyperthermia, and reversible renal failure. Annals of Internal Medicine 73: 81–85, 1970
Goetting MG. Acute lithium poisoning in a child with dystonia. Pediatrics 76: 978–980, 1985
Goggans FC. Acute hyperkalemia during lithium treatment of manic illness. American Journal of Psychiatry 137: 860–861, 1980
Goldberg LH. Supraventricular tachycardia in association with the Chinese restaurant syndrome. Annals of Emergency Medicine 11: 333, 1982
Goldberg M, Ishak S, Garcia C, et al. Postoperative rigidity following sufentanil administration. Anesthesiology 63: 199–201, 1985
Goldfrank L (Ed). Toxicologic emergencies, 3rd ed., Appleton-Century Crofts, New York, 1985
Goldfrank L, Weisman R, Flomenbaum N, et al: Teaching the recognition of odors. Annals of Emergency Medicine 11: 684–686, 19
Goldsmith S, From AHL. Arsenic-induced atypical ventricular tachycardia. New England Journal of Medicine 303: 1096–1098, 1980
Gonzalez ER. Cyanide evades some noses, overpowers others (Medical News). Journal of the American Medical Association 248: 2211, 1982
Gowdy JM. Stramonium intoxication: review of symptomatology in 212 cases. Journal of the American Medical Association 221: 585–587, 1972
Graham DL, Laman D, Theodore J, et al. Acute cyanide poisoning complicated by lactic acidosis and pulmonary edema. Archives of Internal Medicine 137: 1051–1055, 1977
Greer JE. Adolescent abuse of typewriter correction fluid. Southern Medical Journal 77: 297–298, 1984
Guyton AC. Body temperature, temperature regulation, and fever. In Medical physiology, 6th ed., pp. 889, WB Saunders, Philadelphia, 1981c
Guyton AC. The autonomic nervous system: the adrenal medulla. In Medical physiology, 6th ed., pp. 710–722, WB Saunders, Philadelphia, 1981b
Guyton AC. Regulation of acid-based balance. In Medical physiology, 6th Ed., pp. 448–462, W.B. Saunders Co., Philadelphia, 1981a
Haddad LM. Phenol, dinitrophenol, and pentachlorophenol. In Haddad et al. (Eds) Clinical management of poisoning & drug overdose, pp. 810–812, WB Saunders Co., Philadelphia, 1983
Haddad LM, Dimond KA, Schweistris JE. Phenol poisoning. Journal of the American College of Emergency Physicians 8: 267–269, 1979
Haddad LM, Winchester JF. Clinical management of poisoning and drug overdose, WB Saunders Co., Philadelphia, 1983
Hall KW, Dobson KE, Dalton JG, et al. Metabolic abnormalities associated with intentional theophylline overdose. Annals of Internal Medicine 101: 457–462, 1984
Handy CA. Radio-opacity of oral nonliquid medications. Radiology 98: 525–533, 1971
Hansen HE, Amdisen A. Lithium intoxication. Quarterly Journal of Medicine 47: 123–144, 1978
Hata S, Bernstein E, Davis LE. Atypical ocular bobbing in acute organophosphate poisoning. Archives of Neurology 43: 185–186, 1986
Haynes BE, Bessen HA, Wightman WD. Oleander tea: herbal draught of death. Annals of Emergency Medicine 14: 350–353, 1985
Heaney RM. Left bundle branch block associated with propoxyphene hydrochloride poisoning. Annals of Emergency Medicine 12: 780–782, 1983
Heffner JE, Sahn SA. Salicylate-induced pulmonary edema: clinical features and prognosis. Annals of Internal Medicine 95: 405–409, 1981
Helper BR, Sutheimer CA, Sunshine I. The role of the toxicology laboratory in emergency medicine. Journal of Toxicology — Clinical Toxicology 19: 353–365, 1982
Hestand HE, Teske DW. Diphenhydramine hydrochloride intoxication. Journal of Pediatrics 90: 1017–1018, 1977
Hodges M, Salerno DM, Granrud G, et al. Flecainide versus quinidine: results of a multicenter trial. American Journal of Cardiology 53: 66B-71B, 1984
Hoehn MM, Rutledge CO. Acute overdose with levodopa. Neurology 25: 792–794, 1975
Hossack KF. Conduction abnormalities due to diltiazem. New England Journal of Medicine 307: 953–954, 1982
Hotson JR, Langston JW. Disulfiram-induced encephalopathy. Archives of Neurology 33: 141–142, 1976
Howrie DL, Wolfson JH. Phenylpropanolamine-induced hypertensive seizures. Journal of Pediatrics 102: 143–145, 1983
Hughes JM, Merson MH. Fish and shellfish poisoning. New England Journal of Medicine 295: 1117–1120, 1976
Hughes JM, Blumenthal JR, Merson MH et al. Clinical features of types A and B food-borne botulism. Annals of Internal Medicine 95: 442–445, 1981
Iberti TJ, Patterson BK, Fisher CJ. Prolonged bromide intoxication resulting from a gastric bezoar. Archives of Internal Medicine 144: 402–403, 1984
Indo T, Ando K. Metoclopramide-induced parkinsonism: clinical characteristics of ten cases. Archives of Neurology 39: 494–496, 1982
Ingelfinger JA, Isakson G, Shine D, et al. Reliability of the toxic screen in drug overdose. Clinical Pharmacology and Therapeutics 29: 570–575, 1981
Jacobsen D, McMartin KE. Methanol and ethylene glycol poisonings: mechanism of toxicity, clinical course, diagnosis and treatment. Medical Toxicology 1: 309–334, 1986
Jaeger RW, deCastro FJ, Barry RC, et al. Radiopacity of drugs and plants in vivo: limited usefulness. Veterinary and Human Toxicology 23: 2–4, 1981
James MB, Leonard JC, Fraser JJ et al. Hypervitaminosis A: a case report. Pediatrics 69: 112–115, 1982
Jameson HD. Pyridoxine and levodopa-induced dystonia. Journal of the American Medical Association 221: 1700, 1970
Jung RC, Aaronson J. Death following inhalation of mercury vapor at home. Western Journal of Medicine 132: 539–543, 1980
Jonsson S, O’Meara M, Young JB: Acute cocaine poisoning: importance of treating seizures and acidosis. American Journal of Medicine 75: 1061–1064, 1983
Kalant H, Kalant OJ. Death in amphetamine users: causes and rates. Canadian Medical Association Journal 112: 299–304, 1975
Kaplan RF, Feinglass NG, Webster W, et al. Phenelzine overdose treated with dantrolene sodium. Journal of the American Medical Association 255: 642–644, 1986
Karp HN, Kaufman ND, Anand SK. Phencyclidine poisoning in young children. Journal of Pediatrics 97: 1006–1009, 1980
Kemper AJ, Dunlap R, Pietro DA. Thioridazine-induced torsade de pointe. Journal of the American Medical Association 249: 2931–2934, 1983
King GS, Smialek JE, Troutman WG. Sudden death in adolescents resulting from the inhalation of typewriter correction fluid. Journal of the American Medical Association 253: 1604–1606, 1985
Kitson TM. The disulfiram-ethanol reaction: a review. Journal of Studies on Alcohol 38: 96–113, 1977
Klein-Schwartz W, Gorman R, Oderda GM. Central nervous system depression from ingestion of nonprescription eyedrops. American Journal of Emergency Medicine 2: 217–218, 1984
Klock JC, Boerner U, Becker CE. Coma, hyperthermia and bleeding associated with massive LSD overdose: a report of eight cases. Western Journal of Medicine 120: 183–188, 1973
Kopelman R, Miller S, Kelly R, et al. Camphor intoxication treated by resin hemoperfusion. Journal of the American Medical Association 241: 727–728, 1979
Koren G, Butt W, Pape K, et al. Morphine-induced seizures in newborn infants. Veterinary and Human Toxicology 27: 519–520, 1985
Kovanen J, Somer H, Schroeder P. Acute myopathy associated with gasoline sniffing. Neurology 33: 629–631, 1983
Krantz T, Thisted B, Strom J, et al. Severe, acute propoxyphene overdose treated with dopamine. Clinical Toxicology 23: 347–352, 1985
Krenzelok EP, Anderson GM, Mirick M. Massive diphenhydramine overdose resulting in death. Annals of Emergency Medicine 11: 212–213, 1982
Krishnamoorthy KS, Zalneraitis EL, Young RS, et al. Phenytoininduced choreoathetosis in infancy: case reports and a review. Pediatrics 72: 831–834, 1983
Kulig K, Golightly LK, Rumack BH. Levothyroxine overdose associated with seizures in a young child. Journal of the American Medical Association 254: 2109–2110, 1985
Kulig K, Rumack BH. Anticholinergic poisoning. In Haddad et al. (Eds) Clinical management of poisoning & drug overdose, pp. 482–487, WB Saunders Co., Philadelphia, 1983
Kulig K, Rumack BH, Sullivan JB, et al. Amoxapine overdose: coma and seizures without cardiotoxic effects. Journal of the American Medical Association 248: 1092–1094, 1982
Kunkel DB. Poisonous plants. In Haddad et al. (Eds) Clinical management of poisoning & drug overdose, pp. 317–335, WB Saunders Co., Philadelphia, 1983
Kuracheck SC, Rockoff MA. Inadvertent intravenous administration of racemic epinephrine. Journal of the American Medical Association 253: 1441–1442, 1985
Lacoutre PG, Wason S, Temple AR, et al. Emergency assessment of severity in iron overdose by clinical and laboratory methods. Journal of Pediatrics 99: 89–91, 1981
Lacoutre PG, Wason S, Abrams A, et al. Acute isopropyl alcohol intoxication: diagnosis and management. American Journal of Medicine 75: 680–686, 1983
Landers D, Seppi K, Blauer W. Seizures and death on a white river float trip: report of water hemlock poisoning. Western Journal of Medicine 142: 637–640, 1985
Lankin DL, Jewell GM, Grinvalsky HJ, et al. Psychotic-like reaction to procaine penicillin G. Annals of Emergency Medicine 12: 507–509, 1983
Larner J. Insulin and oral hypoglycemic drugs. In Gilman AG et al. (Eds) The pharmacological basis of therapeutics, 7th ed., pp. 1490–1510, MacMillan Co., New York, 1985
Lazar RB, Ho SU, Melen O, et al. Multifocal central nervous system damage caused by toluene abuse. Neurology 33: 1337–1340, 1983
Lesko LM, Fischman MW, Javaid JI et al. Iatrogenous cocaine psychosis. New England Journal of Medicine 307: 1153, 1982
Leung FW, Guze PA. Diazepam withdrawal. Western Journal of Medicine 138: 98–100, 1983
Lichtenfeld PJ, Rubin DB, Feldman RS. Subarachnoid hemorrhage precipitated by cocaine snorting. Archives of Neurology 41: 223–224, 1984
Linden CH, Rumack BH, Strehlke C. Monoamine oxidase inhibitor overdose. Annals of Emergency Medicine 13: 1137–1144, 1984
Litovitz TL. Amphetamines. In Haddad et al. (Eds) Clinical management of poisoning & drug overdose, pp. 469–475, W.B. Saunders Co., Philadelphia, 1983a
Litovitz TL. Button battery ingestions: a review of 56 cases. Journal of the American Medical Association 249: 2495–2500, 1983b
Litovitz TL. The ‘sniffing bar’. Annals of Emergency Medicine 12: 332, 1983c
Litovitz TL, Larkin RF, Myers RAM. Cyanide poisoning treated with hyperbaric oxygen. American Journal of Emergency Medicine 1: 94–101, 1983
Litovitz TL, Troutman WG. Amoxapine overdose: seizures and fatalities. Journal of the American Medical Association 250: 1069–1071, 1983
Litovitz TL, White JD. Levothyroxine ingestions in children: an analysis of 78 cases. American Journal of Emergency Medicine 3: 297–300, 1985
Longstreth WT, Pierson DJ. Metaldehyde poisoning from slug bait ingestion. Western Journal of Medicine 137: 134–137, 1982
Lowe TL, Cohen DJ, Detlor J, et al. Stimulant medications precipitate Tourette’s syndrome. Journal of the American Medical Association 247: 1168–1169, 1982
Ludbrook J, Wynn V. Citrate intoxication: a clinical and experimental study. British Medical Journal 1: 525–528, 1958
Ludomirsky A, Klein HO, Sarelli P, et al. QT prolongation and polymorphous ventricular arrhythmias associated with organophosphate poisoning. American Journal of Cardiology 49: 1654–1658, 1982
Lumpkin J, Watanabe AS, Rumack BH, et al. Phenothiazine-induced ventricular tachycardia following acute overdose. Journal of the American College of Emergency Physicians 8: 476–478, 1979a
Lumpkin JR, Baker FJ, Franaszek JB. Alcoholic ketoacidosis in a pregnant woman. Journal of the American College of Emergency Physicians 8: 21–23, 1979b
Madison LL. Ethanol-induced hypoglycemia. Advances in Metabolic Disorders 3: 85–109, 1968
Magera BE, Betlach CJ, Sweatt AP, et al. Hydroxyzine intoxication in a 13-month-old child. Pediatrics 67: 280–283, 1981
Mahieu P, Hassoun A, Van Binst R, et al. Severe and prolonged poisoning by fenthion. Significance of the anticholinesterase of plasma. Journal of Toxicology — Clinical Toxicology 19: 425–432, 1982
Mallampalli R, Pentel PR, Anderson DC. Nonreactive pupils due to monoamine oxidase inhibitor overdose. Submitted for publication, 1986
Marshall AJ. Cardiac arrhythmias caused by chloral hydrate. British Medical Journal 2: 994, 1977
Martin WE. Adverse reactions during treatment of parkinson’s disease with levodopa. Journal of the American Medical Association 216: 1979–1983, 1971
Mateer JR, Clark MR. Lithium toxicity with rarely reported ECG manifestations. Annals of Emergency Medicine 11: 208–211, 1982
Mayer TG, Gross PL. Fatal systemic fluorosis due to hydrofluoric acid burns. Annals of Emergency Medicine 14: 149–153, 1985
McCarron MM, Schulze BW, Thompson GA, et al. Acute phencyclidine intoxication: incidence of clinical findings in 1000cases. Annals of Emergency Medicine 10: 237–242, 1981
McCarron MM, Schulze BW, Walberg CB, et al. Short-acting barbiturate overdosage: correlation of intoxication score with serum concentration. Journal of the American Medical Association 248: 55–61, 1982
McCarron MM, Wood JD. The cocaine ‘body packer’ syndrome: diagnosis and treatment. Journal of the American Medical Association 250: 1417–1420, 1983
McDowell JR, LeBlanc HJ. Phenylpropanolamine and cerebral hemorrhage. Western Journal of Medicine 142: 688–691, 1985
McGuigan MA. Nicotine. Clinical Toxicology Review 4(6): 1–2, 1982
Messing RO, Closson RG, Simon RP. Drug-induced seizures: a 10-year experience. Neurology 34: 1582–1586, 1984
Mitchell AA, Lovejoy FH, Goldman P. Drug ingestions associated with miosis in comatose children. Journal of Pediatrics 89: 303–305, 1976
Mofenson HC, Caraccio TR, Greensher J. Iodine. In Haddad et al. (Eds) Clinical management of poisoning & drug overdose, pp. 697–703, WB Saunders Co., Philadelphia, 1983
Mofenson HC, Caraccio TR, Brody GM. Carbon monoxide poisoning. American Journal of Emergency Medicine 2: 254–261, 1984
Mordes D, Kreutner K, Metzger W, et al. Dangers of intravenous ritodrine in diabetic patients. Journal of the American Medical Association 248: 973–975, 1982
Morisy L, Platt D. Hazards of high-dose meperidine. Journal of the American Medical Association 255: 467–468, 1986
Moylan JA. Smoke inhalation and burn injury. Surgical Clinics of North America 60: 1533–1540, 1980
Mudge GH. Agents affecting volume and composition of body fluids. In Gilman et al. (Eds) The pharmacological basis of therapeutics, 7th ed, pp. 846–878, MacMillan Co., New York, 1985
Mueller EJ, Seger DL. Metal fume fever: a review. Journal of Emergency Medicine 2: 271–274, 1985
Mullally WJ. Carbamazepine-induced ophthalmoplegia. Archives of Neurology 39: 64, 1982
Murray RB, Adler MW, Korczyn AD. Mini-review: the pupillary effects of opioids. Life Sciences 33: 495–509, 1983
Myers RA, Linberg SE, Crowley RA, et al. Carbon monoxide poisoning: the injury and its treatment. Journal of the American College of Emergency Physicians 8: 479–483, 1979
Namba T, Greenfield M, Grob D. Malathion poisoning: a fatal case with cardiac manifestations. Archives of Environmental Health 21: 533–541, 1970
Namba T, Nolte CT, Jackrel J, et al. Poisoning due to organophosphate insecticides: acute and chronic manifestations. American Journal of Medicine 50: 475–492, 1971
O’Brien RP, McGeehan PA, Helmeczi AW, et al. Detectability of drug tablets and capsules by plain radiography. American Journal of Emergency Medicine 4: 302–312, 1986
O’Neill S, Tipton KF, Prichard JS, et al. Survival after high blood alcohol levels: association with first-order elimination kinetics. Archives of Internal Medicine 144: 641–642, 1984
Oberst BB, Mclntyre RA. Acute nicotine poisoning: case report. Pediatrics 11: 338–340, 1953
Olson KR. Carbon monoxide poisoning: mechanisms, presentation and controversies in management. Journal of Emergency Medicine 1: 233–243, 1984
Olson KR, Benowitz NL, Pentel PR. Survey of the causes and consequences of seizures during drug intoxication. (Abstract.) Veterinary and Human Toxicology 24: 268, 1982
Olson KR, Benowitz NL. Environmental and drug-induced hyperthermia, pathophysiology, recognition, and management. Emergency Medical Clinics of North America 2: 459–474, 1984
Olson KR, Becker CE. Poisoning. In Mills et al. (Eds) Current emergency diagnosis and treatment, 2nd ed., pp. 451–482, Lange Medical Publications, Los Altos, 1985
Olson KR, Benowitz NL, Woo OF, et al. Theophylline overdose: acute single ingestion versus chronic repeated overmedication. American Journal of Emergency Medicine 3: 386–394, 1985a
Olson KR, Yin L, Osterloh J, et al. Coma caused by trivial triazolam overdose. American Journal of Emergency Medicine 3: 210–211, 1985b
Ong GL, Bruning HA. Dilated fixed pupils due to administration of high does of dopamine hydrochloride. Critical Care Medicine 9: 658–659, 1981
Osbern LN, Crapo RO. Dung lung: a report of toxic exposure to liquid manure. Annals of Internal Medicine 95: 312–314, 1981
Osterholm RK, Caoriano JK. Transdermal scopolamine psychosis. Journal of the American Medical Association 247: 3081, 1982
Osterman J, Zmyslinski RW, Hopkins CB, et al. Full recovery from severe orthostatic hypotension after vacor rodenticide ingestion. Archives of Internal Medicine 141: 1505–1507, 1981
Park CM, Nagel RL. Sulfhemoglobinemia: clinical and molecular aspects. New England Journal of Medicine 310: 1579–1584, 1984
Parry MF, Wallach R. Ethylene glycol poisoning. American Jouranl of Medicine 57: 143–150, 1974
Pasternack PF, Colvin SB, Baumann FG. Cocaine-induced angina pectoris and acute myocardial infarction in patients younger than 40 years. American Journal of Cardiology 55: 847, 1985
Pentel P. Toxicity of over-the-counter stimulants. Journal of the American Medical Association 252: 1898–1903, 1984
Pentel PR, Benowitz NL. Tricyclic antidepressant poisoning: management of arrhythmias. Medical Toxicology 1: 101–121, 1986
Peters HA, Croft WA, Woolson EA, et al. Arsenic, chromium, and copper poisoning from burning treated wood. New England Journal of Medicine 308: 1360–1361, 1983
Petersen CD, Fifield GC. Emergency gastrotomy for acute iron poisoning. Annals of Emergency Medicine 9: 262–264, 1980
Petersen RG, Rumack BH. D-penicillamine therapy of acute arsenic poisoning. Journal of Pediatrics 91: 661–666. 1977
Plum F, Posner JB. The diagnosis of stupor and coma, 3rd ed., pp. 45–47, FA Davis Co., Philadelphia, 1980b
Plum F, Posner JB. The diagnosis of stupor and coma, 3rd ed., pp. 189–190, FA Davis Co., Philadelphia, 1980c
Plum F, Posner JB. The diagnosis of stupor and coma, 3rd ed., pp. 260, FA Davis Co., Philadelphia, 1980d
Plum F, Posner JB. The diagnosis of stupor and coma, 3rd ed. pp. 189–190, FA Davis Co., Philadelphia, 1980c
Powers JM. Decongestant-induced blepharospasm and orofacial dystonia. Journal of the American Medical Association 247: 3244–3245, 1982
Prough DS, Roy R, Bumgarner J, et al. Acute pulmonary edema in healthy teenagers following conservative doses of intravenous naloxone. Anesthesiology 60: 485–486, 1984
Raheja R, Puri VK, Schaeffer Jr RJ. Shock due to profound hypothermia and alcohol ingestion: report of 2 cases. Critical Care Medicine 9: 644–646, 1981
Rajput AH, Rozdilsky B, Hornykiewitz O, et al. Reversible drug-induced parkinsonism: clinicopathological study of two cases. Archives of Neurology 39: 644–646, 1982
Rees Jr JB. Skin and appendages. In Krupp et al. (Eds) Current medical diagnosis and treatment, pp. 47–89, Lange Medical Publications, Los Altos, 1985
Reuler JB. Hypothermia: pathophysiology, clinical settings, and management. Annals of Internal Medicine 89: 519–527, 1978
Rimsza ME, Zimmerman DR, Bergeson PS. Scorpion envenomation. Pediatrics 66: 298–302, 1980
Robertson WO. Arsenic and other heavy metals. In Haddad et al. (Eds) Clinical management of poisoning and drug overdose, pp. 656–663, WB Saunders Co., Philadelphia, 1983
Robinson AG, Loeb JN. Ethanol ingestion: commonest cause of elevated plasma osmolality? New England Journal of Medicine 284: 1253–1255, 1971
Roby DS, Fein AM, Bennett RH, et al. Cardiopulmonary effects of acute thallium poisoning. Chest 85: 236–240, 1984
Rogawski MA. Norepinephrine. In Rogawski (Ed.) Neurotransmitter actions in the vertebrate nervous system, pp. 241–284, Plenum Press, New York, 1985
Roland EH, Jan JE, Rigg JM. Toxic encephalopathy in a child after brief exposure to insect repellents. Canadian Medical Association Journal 132: 155–156, 1985
Rolnick MA, Szara S. Marijuana. In Haddad et al. (Eds) Clinical management of poisoning and drug overdose, pp. 434–443, WB Saunders Co., Philadelphia, 1983
Roza O, Berman LB. The pathophysiology of barium: hypokalemic and cardiovascular effects. Journal of Pharmacology and Experimental Therapeutics 177: 433–439, 1971
Rudd P, Blaschke TF. Antihypertensive agents and the drug therapy of hypertension. In Gilman et al. (Eds) The pharmacological basis of therapeutics, 7th ed, pp. 784–805, MacMillan Co., New York, 1985
Ruprah M, Mant TG, Slade RJ. Acute carbon tetrachloride poisoning in 19 patients: implications for diagnosis and treatment. Lancet 1: 1027–1029, 1985
Rygnestad T, Berg KJ. Evaluation of benefits of drug analysis in the routine clinical management of acute self poisoning. Journal of Toxicology — Clinical Toxicology 22: 51–61, 1984
Sankey RJ, Nunn AJ, Silla JA. Visual hallucinations in children receiving decongestants. British Medical Journal 288: 1369, 1984
Sartori M, Pratt CM, Young JB. Torsade de pointe — malignant cardiac arrhythmia induced by amantidine poisoning. American Journal of Medicine 77: 388–391, 1984
Savitt DL, Hawkins HH, Roberts JR. Radiopacity of ingested medications. (Abstract.) Annals of Emergency Medicine 15: 658, 1980
Schillinger BM, Berstein M, Goldberg LA, et al. Boric acid poisoning. Journal of the American Academy of Dermatology 7: 667–673, 1982
Schipior PG. An unusual case of antihistamine intoxication. Journal of Pediatrics 71: 589–591, 1967
Schottstaedt MW, Nicotrs MB, Rivera M. Placidyl abuse: a dimorphic picture. Critical Care Medicine 9: 677–679, 1981
Selbst SM, Henretig FM, Pearce J. Lead encephalopathy: a case report and review of management. Clinical Pediatrics 24: 280–285, 1985
Sellers EM, Kalant H. Alcohol intoxication and withdrawal. New England Journal of Medicine 294: 757–762, 1976
Shannon M. Fluoride. Clinical Toxicology Review 8 (2): 1985
Shaul PW, Farrell MK, Maloney MJ. Caffeine toxicity as a cause of acute psychosis in anorexia nervosa. Journal of Pediatrics 105: 493–495, 1984
Shesser R, Davis C, Edelstein S. Pneumomediastinum and pneumothorax after inhaling alkaloidal cocaine. Annals of Emergency Medicine 10: 213–215, 1981
Siegel RK. Herbal intoxication: psychoactive effects from herbal cigarettes, tea, and capsules. Journal of the American Medical Association 236: 473–476, 1976
Sklar AH, Linas SL. The osmolar gap in renal failure. Annals of Internal Medicine 98: 481–482, 1983
Sloth Madsen P, Strom J, Reiz S, et al. Acute propoxyphene self-poisoning in 222 consecutive patients. Acta Anesthesiologica Scandinavica 28: 661–665, 1984
Smith TW, Antman EM, Friedman PL, et al. Digitalis glycosides: mechanisms and manifestations of toxicity. Progress in Cardiovascular Diseases 27: 21–56, 1984
Soderman P, Sahlberg D, Wiholm BE. CNS reactions to nose drops in small children. Lancet 1: 573, 1984
Spiker DG, Weiss AN, Chang SS, et al. Tricyclic antidepressant overdose: clinical presentation and plasma levels. Clinical Pharmacology and Therapeutics 18: 539–546, 1973
Springer M, Olson KR, Feaster W. Acute massive digoxin overdose: survival without use of digitalis-specific antibodies. American Journal of Emergency Medicine 4: 364–368, 1986
Stapczynski JS, Rothstein RJ, Gaye WA, et al. Colchicine overdose: report of two cases and review of the literature. Annals of Emergency Medicine 10: 364–369, 1981
Stephens DS, Walker DH, Schaffner W, et al. Pseudodiphtheria: prominent pharyngeal membrane associated with paraquat ingestion. Annals of Internal Medicine 94: 202–204, 1981
Steuven H, Aprahamian C, Thompson B, et al. Cobra envenomation: an uncommon emergency. Annals of Emergency Medicine 12: 636–638, 1983
Streicher HZ, Gabow PA, Moss AH, et al. Syndromes of toluene sniffing in adults. Annals of Internal Medicine 94: 758–762, 1981
Strom J, Sloth Madsen P, Nielson N, et al. Acute self-poisoning with tricyclic antidepressants in 295 consecutive patients treated in an ICU. Acta Anesthesiologica Scandinavica 28: 666–670, 1984
Sunderland T, Orsulak PJ, Cohen BM. Amoxapine and neuroleptic side effects: a case report. American Journal of Psychiatry 140: 1233–1235, 1983
Sznajder IJ, Bentur Y, Taitelman U. First and second degree atrioventricular block in oxpentifylline overdose. British Medical Journal 288: 26, 1984
Taviera Da, Silva AM. Principles of respiratory therapy. In Haddad et al. (Eds) Clinical management of poisoning and drug overdose, pp. 198–220, WB Saunders Co., Philadelphia, 1983
Temple AR. Acute and chronic effects of aspirin toxicity and their treatment. Archives of Internal Medicine 141: 364–369, 1981
Tenckhoff H, Sherrard DJ. Acute diphenylhydantoin intoxication. American Journal of Diseases of Children 116: 422, 1968
Tenny SM, Miller RM. Respiratory and circulatory actions of salicylate. American Journal of Medicine 19: 498–508, 1955
Timms PK, Gibbons RB. Latrodectism: effects of the black widow spider bite. Western Journal of Medicine 144: 315–317, 1986
Tse RL, Bockman AA. Nitrogen dioxide toxicity: report of four cases in firemen. Journal of the American Medical Association 212: 1341–1344, 1970
Uden DL, Huska DR, Kellenberger TA, et al. Antihistamines: a study of pediatric usage and incidence of toxicity. Veterinary and Human Toxicology 26: 469–472, 1981
Umez-Eronini EM, Eronini EA. Choloroquine induced involuntary movements. British Medical Journal 1: 945–946, 1977
Valpey R, Sumi SM, Copass MK, et al. Acute and chronic progressive encephalopathy due to gasoline sniffing. Neurology 28: 507–510, 1978
Vanholder R, Colardyn F, DeReuck J, et al. Diquat intoxication: report of two cases and review of the literature. American Journal of Medicine 70: 1267–1271, 1981
Wason S, Lacoutre PG, Lovejoy FH. Single high-dose pyridoxine treatment for isoniazid overdose. Journal of the American Medical Association 246: 1102–1104, 1981
Weddington WW, Muelling AE, Moosa HH, et al. Cimetidine toxic reactions masquerading as delirium tremens. Journal of the American Medical Association 245: 1058–1059, 1981
Weiner N, Taylor P. Neurohumoral transmission: the autonomic and somatic motor nervous systems. In Gilman et al. (Eds) The pharmacological basis of therapeutics, pp. 66–99, MacMillan Co., New York, 1985
Weiner N. Atropine, scopolamine, and related antimuscarinic drugs. In Gilman et al. (Eds) The pharmacological basis of therapeutics, 7th ed, pp. 130–144, MacMillan Co., New York, 1985b
Weiner N. Norepinephrine, epinephrine, and the sympathomimetic amines. In Gilman et al. (Eds) The pharmacological basis of therapeutics, 7th ed, pp. 145–180, MacMillan Co., New York, 1985a
Weinstein RS. Recognition and management of poisoning with beta-adrenergic blocking agents. Annals of Emergency Medicine 13: 1123–1131, 1984
Westveer DC, Gadowski DO, Gordon S, et al. Amiodarone-induced ventricular tachycardia. Annals of Internal Medicine 97: 561–562, 1982
Wetherill SF, Guarino MJ, Cox RW. Acute renal failure associated with barium chloride poisoning. Annals of Internal Medicine 95: 185–188, 1981
Weyman AE, Greenbaum DM, Grace WJ. Accidental hypothermia in an alcoholic population. American Journal of Medicine 56: 13–21, 1974
Wheeler-Usher DH, Wanke LA, Bayer MJ. Gastric emptying: risk versus benefit in the treatment of acute poisoning. Medical Toxicology 1: 142–153, 1986
Whitwam JG, Russell WJ. The acute cardiovascular changes and adrenergic blockade by droperidol in man. British Journal of Anaesthesiology 43: 581–590, 1970
Williams ME, Rosa RM, Silva P, et al. Impairment of extrarenal potassium disposal by alpha-adrenergic stimulation. New England Journal of Medicine 311: 145–149, 1984
Williams ME, Gervino EV, Rosa RM, et al. Catecholamine modulation of rapid potassium shifts during exercise. New England Journal of Medicine 312: 823–827, 1985
Winchester JF. Lithium. In Haddad et al. (Eds) Clinical management of poisoning and drug overdose, pp. 372–379, WB Saunders Co., Philadelphia, 1983
Wong LC, Heimbach MD, Truscott DR, et al. Boric acid poisoning: report of 11 cases. Canadian Medical Association Journal 90: 1018–1023, 1964
Wong P, Bottorff MB, Heritage RW, et al. Acute rifampin overdose: a pharmacokinetic study and review of the literature. Journal of Pediatrics 104: 781–783, 1984
Woo OF. Acute intoxication with nonprescription antihistamines. Contemporary Pharmacy Practice 4: 257–259, 1981
Woo OF, Benowitz NL, Bialy FW, et al. Atrioventricular conduction block caused by phenylpropanolamine. Journal of the American Medical Association 253: 2646–2647, 1985
Woodle ES, Moody RR, Cox KL, et al. Orthotopic liver transplantation in a patient with amanita poisoning. Journal of the American Medical Association 253: 69–70, 1985
Wright N. An assessment of the unreliability of the history given by self-poisoned patients. Clinical Toxicology 16: 381–384, 1980
Yolken R, Konecny P, McCarthy P. Acute fluoride poisoning. Pediatrics 58: 90–93, 1979
Zimmerman PM, Pulliam J, Schwengels J, et al. Caffeine intoxication: a near fatality. Annals of Emergency Medicine 14: 1227–1229, 1985
Zoghbi W, Schwartz JB. Verapamil overdose: report of a case and review of the literature. Cardiovascular Reviews & Reports 5: 356–359, 1984
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Olson, K.R., Pentel, P.R. & Kelley, M.T. Physical Assessment and Differential Diagnosis of the Poisoned Patient. Drugs 2, 52–81 (1987). https://doi.org/10.1007/BF03259860
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03259860