By Kent Olson
The simplest guide at the analysis and therapy of poisoning and drug overdose. completely up to date, this reference gains wide tables summarizing toxicity and office publicity directions for over 500 commercial chemical substances, an index containing the components of over a hundred and fifty universal advertisement items, and tabs for fast reference.
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Administer glucose-containing intravenous fluids, and give concentrated glucose bolus (pp 19 and 450) if the patient is hypoglycemic. 3. Rapidly gain control of seizures (see below), agitation (p 24), or muscular rigidity (p 25). 4. Begin external cooling with tepid (lukewarm) sponging and fanning. This evaporative method is the most efficient method of cooling. 5. Shivering often occurs with rapid external cooling, and shivering may generate yet more heat. Some physicians recommend chlorpromazine to abolish shivering, but this agent can lower the seizure threshold, inhibit sweating, and cause hypotension.
An osmolar gap accompanied by anion gap acidosis should immediately suggest poisoning by methanol or ethylene glycol. Note: A falsely normal osmolar gap despite the presence of alcohols may result from TABLE I–22. CAUSES OF ELEVATED OSMOLAR GAPa Acetone Dimethyl sulfoxide (DMSO) Ethanol Ethyl ether Ethylene glycol and other low-molecular-weight glycols Isopropyl alcohol Magnesium Mannitol Metaldehyde Methanol Osmotic contrast dyes Propylene glycol Renal failure without dialysis Severe alcoholic ketoacidosis, diabetic ketoacidosis, or lactic acidosis Osmolar gap = measured − calculated osmolality.
E. 5–3 mg/kg/h titrated to effect (p 485). f. 5 mg/kg), given in increments (40 mg at a time in adults) IV every 10–20 seconds until desired effect (see p 494). g. Phenytoin, 15–20 mg/kg IV; slow infusion over 25–30 minutes (see p 488). Note: Phenytoin is ineffective for convulsions caused by theophylline and is considered the anticonvulsant of last choice for most drug-induced seizures. 5. Immediately check the rectal or tympanic temperature and cool the patient rapidly (see p 22) if the temperature is above 40°C (104°F).
Poisoning and Drug Overdose by Kent Olson