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By Kent Olson
The easiest guide at the analysis and therapy of poisoning and drug overdose. completely up-to-date, this reference gains broad tables summarizing toxicity and office publicity directions for over 500 commercial chemical compounds, an index containing the elements of over one hundred fifty universal advertisement items, and tabs for fast reference.
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Qxd_cc 9/9/03 1:18 PM Page 35 I: COMPREHENSIVE EVALUATION AND TREATMENT 35 TABLE I–25. SELECTED CAUSES OF ALTERATIONS IN SERUM GLUCOSE Hyperglycemia Beta-2-adrenergic drugs Caffeine intoxication Corticosteroids Dextrose administration Diabetes mellitus Diazoxide Excessive circulating epinephrine Glucagon Theophylline intoxication Thiazide diuretics Vacor Hypoglycemia Akee fruit Endocrine disorders (hypopituitarism, Addison’s disease, myxedema) Ethanol intoxication (especially pediatric) Fasting Hepatic failure Insulin Oral sulfonylurea hypoglycemic agents Pentamidine Propranolol intoxication Renal failure Salicylate intoxication Streptozocin Valproic acid intoxication a.
SELECTED DRUGS AND TOXINS CAUSING SEIZURESa Adrenergic-sympathomimetic agents Amphetamines and derivatives (including MDMA) Caffeine Cocaine Ephedrine Phencyclidine Phenylpropanolamine Theophylline Others Antihistamines (diphenhydramine, hydroxyzine) Beta blockers (primarily propranolol; not reported for atenolol, metoprolol, pindolol, or practolol) Boric acid Camphor Carbamazepine Cellular hypoxia (eg, carbon monoxide, cyanide, hydrogen sulfide) Chlorinated hydrocarbons Cholinergic agents (carbamates, nicotine, organophosphates) Cicutoxin and other plant toxins Citrate DEET (diethyltoluamide) Ethylene glycol Fipronil Fluoride Antidepressants and antipsychotics Amoxapine Bupropion Haloperidol and butyrophenones Loxapine, clozapine, and olanzapine Phenothiazines Tricyclic antidepressants Venlafaxine, other newer serotonin reuptake inhibitors (SSRIs) GHB (gamma hydroxybutyrate) Isoniazid (INH) Lead and other heavy metals Lidocaine and other local anesthetics Lithium Mefenamic acid Meperidine (normeperidine metabolite) Metaldehyde Methanol Methyl bromide Phenols Phenylbutazone Piroxicam Salicylates Strychnine (opisthotonos and rigidity) Withdrawal from ethanol or sedative-hypnotic drugs a Adapted, in part, with permission, from Olson KR et al: Med Toxicol 1987;2:63.
In malnourished or alcoholic patients, also give thiamine, 100 mg IM or IV, to prevent acute Wernicke’s syndrome. e. For hypoglycemia caused by oral sulfonylurea drug overdose (see p 93), consider antidotal therapy with diazoxide (p 433) or octreotide (p 480). E. Hypernatremia and hyponatremia. Sodium disorders occur infrequently in poisoned patients (see Table I–26). More commonly they are associated with underlying disease states. Antidiuretic hormone (ADH) is responsible for concentrating the urine and preventing excess water loss.