Editor
Kent R. Olson, MD, FACEP, FACMT, FAACT Clinical Professor of
Medicine 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
Susan Y.
Kim-Katz, PharmD Clinical Professor of Pharmacy, University of
California, San Francisco; Senior Toxicology Management Specialist,
California Poison Control System, San Francisco Division
Alan H. B. Wu, PhD Professor of Laboratory
Medicine, University of California, San Francisco; Chief, Clinical Chemistry
Laboratory, San Francisco General Hospital
Contributors
Timothy E. Albertson, MD, MPH, PhD Professor of Medicine,
Medical Pharmacology and Toxicology, University of California Medical
Center, Davis; Medical Director, California Poison Control System,
Sacramento Division
tealbertson@ucdavis.eduSection II: Amphetamines; Barbiturates; Chloroquine; Dextromethorphan;
Opiates and OpioidsJudith A. Alsop,
PharmD, DABAT Health Sciences Clinical Professor, School of
Pharmacy, University of California, San Francisco; Clinical Professor of
Medicine, School of Medicine, University of California, Davis
jalsop@calpoison.orgSection
II: Plants; Section III: Metoclopramide; Ondansetron; Potassium; PropofolIlene B. Anderson, PharmD Clinical
Professor, School of Pharmacy, University of California, San Francisco;
Senior Toxicology Management Specialist, California Poison Control System,
San Francisco Division
iba@calpoison.orgSection II: Botulism; Camphor and Other Essential Oils; Dextromethrophan;
Ethylene Glycol and Other Glycols; Lomotil and Other Antidiarrheals;
Methanol; Warfarin and Related RodenticidesPatil Armenian, MD Medical Toxicology Fellow, California Poison
Control System, San Francisco Division, University of California, San
Francisco
Section II: Phencyclidine and KetamineJohn Balmes, MD Professor, Department of
Medicine, University of California, San Francisco; Chief, Division of
Occupational and Environmental Medicine, San Francisco General Hospital
jbalmes@medsfgh.ucsf.eduSection II: Asbestos; Formaldehyde; Gases, Irritant; Molds; Phosgene;
Sulfur DioxideNeal 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
nbenowitz@medsfgh.ucsf.eduSection II: Anesthetics, Local; Antiarrhythmic Drugs; Antidepressants,
General (Noncyclic); Antidepressants, Tricyclic; Beta-Adrenergic Blockers;
Cardiac Glycosides; 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; NorepinephrineKathleen
Birnbaum, PharmD Toxicology Management Specialist, Department of
Clinical Pharmacy, University of California, San Francisco
kbirnbaum@calpoison.orgSection
III: Insulin; Leucovorin CalciumPaul D.
Blanc, MD, MSPH Professor of Medicine, and Chief, Division of
Occupational and Environmental Medicine, University of California, San
Francisco
Paul.blanc@ucsf.eduSection 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 ChemicalsStephen C.
Born, MD, MPH Associate Clinical Professor, Division of
Occupational and Environmental Medicine, University of California, San
Francisco
sborn@sfghoem.ucsf.eduSection II: Dioxins, Ethylene OxideAlan
Buchwald, MD Consultant in Medical Toxicology and Medical Director,
Occupational Health Center, Dominican Santa Cruz Hospital, Santa Cruz
albuchwald955@pol.netSection
II: CopperChris Camilleri, DO
Volunteer Clinical Faculty, Internal Medicine, University of California,
Davis Medical Center, Shingle Springs
Section II: BenzeneF. 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
fcantrel@ucsd.eduSection II: Thyroid Hormone; Section III: Cyproheptadine; Deferoxamine;
Folic Acid; Inamrinone (formerly Amrinone)Shaun
D. Carstairs, MD Assistant Professor, Department of Emergency
Medicine, Uniformed Services University of the Health Sciences, San Diego
Section II: Polychlorinated Biphenyls (PCBs); Trichloroethane,
Trichloroethylene and TetrachloroethyleneRichard
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
rfclark@ucsd.eduSection II: Hymenoptera; Lionfish and Other Scorpaenoidea; Scorpions;
Snakebite; Section III: Antivenom, Crotalinae (Rattlesnake); Antivenom,
Latrodectus Mactans (Black Widow Spider); Antivenom, Micrurus Fulvius (Coral
Snake)G. Patrick Daubert, MD, FACEP
Associate Medical Director, Sacramento Division, California Poison Control
System; Division of Emergency Medicine, Kaiser Permanente, South Sacramento
Medical Center, Sacramento
Section II: AconiteDelia 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
ddempsey@medsfgh.ucsf.eduSection I: Special Considerations in Pediatric Patients; Section II:
Bromides; Methyl Bromide; Pentachlorophenol and DinitrophenolCharlene Doss School of Pharmacy, University
of California, San Francisco
Section II: AntisepticsJo Ellen Dyer, PharmD Clinical Professor,
Department of Pharmacy, University of California, San Francisco; Senior
Toxicology Management Specialist, California Poison Control System, San
Francisco Division
jdyer@calpoison.orgSection I: Special Considerations in the Evaluation of Drug-Facilitated
Assault; Section II: Azide, Sodium; Gamma-Hydroxybutyrate (GHB)Gary W. Everson, PharmD Toxicology
Management Specialist, California Poison Control System, Fresno/Madera
Division
geverson@calpoison.orgSection II: Phenol and Related Compounds; Section III: MannitolJeffrey Fay, PharmD Assistant Clinical
Professor, Department of Pharmacy, University of California, San Francisco;
Toxicology Management Specialist, California Poison Control System,
Fresno/Madera Division
jfay@calpoison.orgSection II: VasodilatorsThomas J.
Ferguson, MD, PhD Associate Clinical Professor of Internal
Medicine, University of California, Davis; Medical Director, Cowell Student
Health Center, University of California, Davis
tjferguson@ucdavis.eduSection
II: Chromium; ThalliumFrederick 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
fred.fung@sharp.comSection
II: Carbon Tetrachloride and Chloroform; RadiationMark J. Galbo, MS Environmental Toxicologist,
School of Pharmacy, University of California, San Francisco; Poison
Information Specialist, California Poison Control System, San Francisco
Division
mjgalbo@calpoison.orgSection II: Naphthalene and Paradichlorobenzene; Warfare Agents—ChemicalFabian Garza, PharmD School of Pharmacy,
University of California, San Francisco; Toxicology Management Specialist,
California Poison Control System, Fresno/Madera Division
fgarza@calpoison.orgSection
III: Methylene BlueRichard 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 OximesJoanne M.
Goralka Toxicology Management Specialist, Department of Clinical
Pharmacy, University of California, Sacramento
Section III:
Ondansetron; PropofolChristine 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
dchaller@worldnet.att.netSection II: Herbal and Alternative ProductsSandra Hayashi, PharmD Assistant Clinical Professor, School of
Pharmacy, University of California, San Francisco; Toxicology Management
Specialist, California Poison Control System, San Francisco Division
shayashi@calpoison.orgSection
II: Angiotensin Blockers and ACE Inhibitors; Section III: Prussian BluePatricia Hess Hiatt, BS Administrative
Operations Manager, California Poison Control System, San Francisco Division
phiatt@calpoison.orgSection
IV: The Toxic Hazards of Industrial and Occupational ChemicalsRaymond Ho, PharmD Toxicology Management
Specialist, California Poison Control System, San Francisco Division
rho@calpoison.orgSection III:
Botulinum Antitoxin; Flumazenil; Thiosulfate, SodiumYao-Min Hung, MD, MPH Attending Physician,
Department of Internal Medicine, Long Cyuan Veterans Hospital, Kaohsiung
City, Taiwan
Section II: Oxalic AcidLeslie M. Israel, DO, MPH Associate Clinical Professor of
Occupational Medicine, University of California, Irvine
lisrael@uci.eduSection II:
CadmiumSam Jackson, MD, MBA
Global Safety Officer, Amgen Global Safety, Biotechnology Company, San
Francisco, California
Section III: Neuromuscular BlockersThanjira Jiranantakan, MD Medical
Toxicology Fellow, California Poison Control System, University of
California, San Francisco, USA; Instructor, Preventive and Social Medicine
Department, Siriraj Hospital Faculty of Medicine, Mahidol University,
Thailand
Section II: Ethylene Glycol and Other Glycols;
Methotrexate; LithiumThomas E. Kearney,
PharmD, DABAT Professor of Clinical Pharmacy, University of
California, San Francisco; Managing Director, California Poison Control
System, San Francisco Division
pcctk@calpoison.orgSection II: Carbamazepine and Oxcarbazepine; Valproic Acid; Section III:
Introduction; Acetylcysteine (N-Acetylcysteine [NAC]); Benzodiazepines
(Diazepam, Lorazepam, and Midazolam); Benztropine; Bicarbonate, Sodium;
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);
Nifedipine; Nitroprusside; Octreotide; Penicillamine; Pentobarbital;
Phenobarbital; Phentolamine; Physostigmine and Neostigmine; Propranolol;
Protamine; Pyridoxine (Vitamin B6); Thiamine (Vitamin B1); Vitamin K1
(Phytonadione)Paul A. Khasigian, PharmD
Toxicology Management Specialist, California Poison Control System,
University of California, San Francisco, Madera
Section II:
Phosphine and Phosphides; Pyrethrins and PyrethroidsSusan Y. Kim-Katz, PharmD Professor of
Clinical Pharmacy, University of California, San Francisco; Senior
Toxicology Management Specialist, California Poison Control System, San
Francisco Division
susank@calpoison.orgSection II: Antidiabetic Agents; Antineoplastic Agents; Beta-2 Adrenergic
Stimulants; Food Poisoning: Bacterial; Food Poisoning: Fish and Shellfish;
Jellyfish and Other Cnidaria; Salicylates; Skeletal Muscle RelaxantsLada Kokan, MD Assistant Clinical
Professor, Department of Pharmacology, University of California, San
Francisco
lada.kokan@telus.netSection II: Monoamine Oxidase InhibitorsMichael J. Kosnett, MD, MPH Associate Clinical Professor of
Medicine, Department of Clinical Pharmacology and Toxicology, University of
Colorado Health Sciences Center, Denver
michael.kosnett@uchsc.eduSection II: Arsenic; Arsine; Lead; Mercury; Section III: BAL
(Dimercaprol); EDTA, Calcium (Calcium Disodium EDTA, Calcium Disodium
Edetate, Calcium Disodium Versenate); Succimer (DMSA); Unithiol (DMPS)Allyson Kreshak, MD Medical Toxicology
Fellow, Emergency Medicine, Division of Medical Toxicology, University of
California, San Diego
Section II: Ethanol; PhosphorusGrant 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
glackey@calpoison.orgSection II: Antipsychotic Drugs, Including Phenothiazines; Section III:
Phenytoin and FosphenytoinChi-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
clai@calpoison.orgSection II:
Boric Acid, Borates, and BoronDarren H.
Lew, PharmD Toxicology Management Specialist, California Poison
Control System, Fresno/Madera Division
dlew@calpoison.orgSection II:
Chlorinated Hydrocarbon PesticidesJon
Lorett, PharmD Toxicology Management Specialist, Department of
Clinical Pharmacy, University of California, San Francisco
jlorett@calpoison.orgSection
II: Ipecac Syrup; Section III: Ipecac SyrupDerrick Lung, MD, MPH Medical Toxicology Fellow, California
Poison Control System, San Francisco Division; University of California, San
Francisco
Section II: Caustic & Corrosive Agents; Hydrocarbons;
Section III: CarnitineBinh T. Ly, MD,
FACMT, FACEP Professor of Emergency Medicine; Director, Medical
Toxicology Fellowship Program, Division of Medical Toxicology; Director,
Emergency Medicine Residency Program; Department of Emergency Medicine,
University of California, San Diego; California Poison Control System
bly@ucsd.eduSection II: Hydrogen
Fluoride and Hydrofluoric Acid; Methylene Chloride; Section III: CalciumTatiana M. Mamantov, MD Medical Toxicology
Fellow, Department of Medicine, University of California, San Francisco
Section II: Freons & Halons; Section III: DTPABeth H. Manning, PharmD Assistant Clinical
Professor, School of Pharmacy, University of California, San Francisco;
Toxicology Management Specialist, California Poison Control System, San
Francisco Division
bmanning@calpoison.orgSection II: Anticholinergics; AntihistaminesAnthony S. Manoguerra, PharmD Professor of Clinical Pharmacy and
Associate Dean, Skaggs School of Pharmacy and Pharmaceutical Sciences,
University of California, San Diego
amanoguerra@ucsd.eduSection
II: IronKathy 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
kmarquardt@calpoison.orgSection
II: Mushrooms; Mushrooms, Amatoxin-TypeMichael
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
mmatteucci@ucsd.eduSection
II: Isopropyl AlcoholKathryn H. Meier,
PharmD Assistant Clinical Professor, School of Pharmacy, University
of California, San Francisco; Toxicology Management Specialist, California
Poison Control System, San Francisco Division
kmeier@calpoison.orgSection
II: Dapsone; Fluoride; Magnesium; Section III: HydroxocobalaminAlicia Minns, MD Assistant Clinical
Professor of Medicine, Department of Emergency Medicine, University of
California, San Diego
Section II: Barium; IsoniazidS. Todd Mitchell, MD, MPH Dominican Hospital,
Watsonville, California
Section III: Silymarin or Milk ThistleEileen Morentz Poison Information
Provider, California Poison Control System, San Francisco Division
morentz@calpoison.orgSection
II: Nontoxic or Minimally Toxic Household ProductsStephen W. Munday, MD, MPH, MS Assistant
Clinical Professor, Department of Family and Preventive Medicine, University
of California, San Diego; Assistant Director of Outpatient Medicine, Medical
Toxicologist, Sharp Rees-Stealy Medical Group, San Diego
stephen.munday@sharp.comSection
II: Hydrogen SulfideJoshua Nogar, MD
Medical Toxicology Fellow, Emergency Medicine, Division of Medical
Toxicology, University of California, San Diego
Section II: Hydrogen
Fluoride and Hydrofluoric Acid; Methylene Chloride; Section III: CalciumSean Patrick Nordt, MD, PharmD, DABAT
Assistant Professor of Clinical Emergency Medicine and Director, Section of
Toxicology, Department of Emergency Medicine, University of Southern
California, Keck School of Medicine, Los Angeles
Section II:
StrychnineSteve Offerman, MD
Assistant Professor, Department of Emergency Medicine, University of
California, Davis
steve.offerman@gmail.comSection II: FluoroacetateKent R.
Olson, MD, FACEP, FACMT, FAACT Clinical Professor of Medicine and
Pharmacy, University of California, San Francisco; Medical Director,
California Poison Control System, San Francisco Division
olson@calpoison.orgSection I:
Emergency Evaluation and Treatment; Section II: Acetaminophen; Carbon
Monoxide; Smoke Inhalation; Theophylline; Section III: Oxygen &
Hyperbaric Oxygen; Section IV: Emergency Medical Response to Hazardous
Materials Incidents; The Toxic Hazards of Industrial and Occupational
ChemicalsMichael A. O'Malley, MD, MPH
Associate Clinical Professor, School of Medicine, University of California,
Davis
maomalley@ucdavis.eduSection II: Chlorophenoxy HerbicidesKelly
P. Owen, MD Fellow, Department of Emergency Medicine, University of
California, Davis, Sacramento
Section II: IodineCyrus 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
crangan@calpoison.orgSection
II: Clonidine and Related DrugsFreda M.
Rowley, PharmD Assistant Clinical Professor of Pharmacy, University
of California, San Francisco; Toxicology Management Specialist, California
Poison Control System, San Francisco Division
frowley@calpoison.orgSection
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
tsands@calpoison.orgSection II: Bromates; ChloratesAaron
Schneir, MD Assistant Professor, Division of Medical Toxicology,
Department of Emergency Medicine, University of California Medical Center,
San Diego
aschneir@ucsd.eduSection II: Nitrous OxideJay Schrader,
CPhT Poison Information Provider, California Poison Control System,
San Francisco Division
jschrader@calpoison.orgSection II: Nontoxic or Minimally Toxic Household ProductsCraig Smollin, MD Assistant Professor of
Emergency Medicine, Associate Director, California Poison Control System,
San Francisco Division
Section II: Glysophate; PhenytoinKarl A. Sporer, MD Associate Clinical
Professor, University of California, San Francisco; Attending Physician, San
Francisco General Hospital
ksporer@sfghed.ucsf.eduSection II: Tetanus; Section III: Tetanus Toxoid and Immune GlobulinJeffrey R. Suchard, MD, FACEP Assistant
Clinical Professor, Director of Medical Toxicology, Department of Emergency
Medicine, University of California Medical Center, Irvine
jsuchard@uci.eduSection II:
SpidersMark E. Sutter, MD
Assistant Professor, Department of Emergency Medicine, University of
California, Davis, Sacramento
Section II: ColchicineWinnie W. Tai, PharmD Assistant Clinical
Professor of Pharmacy, University of California, San Francisco; Toxicology
Management Specialist, California Poison Control System, San Francisco
Division
tai@calpoison.orgSection II: Metaldehyde; Nonsteroidal Anti-Inflammatory DrugsDavid A. Tanen, MD Assistant Program
Director and Research Director, Emergency Medicine Department, Naval Medical
Center, San Diego
dtanen@yahoo.comSection II: Warfare Agents–Biological; Warfare Agents–ChemicalR. Steven Tharratt, MD, MPVM Professor of
Medicine and Anesthesiology, Chief, Division of Pulmonary, Critical Care and
Sleep Medicine, University of California, Davis, Sacramento
rstharratt@ucdavis.eduSection
II: Ammonia; Chlorine; Section IV: Emergency Medical Response to Hazardous
Materials IncidentsChristian Tomaszewski,
MD Professor of Clinical Medicine, Department of Emergency
Medicine, University of California, San Diego
Section II: Calcium
Antagonists; Section III: Lipid EmulsionBen
T. Tsutaoka, PharmD Assistant Clinical Professor, School of
Pharmacy, University of California, San Francisco; Toxicology Management
Specialist, California Poison Control System, San Francisco Division
btsutaoka@calpoison.orgSection
II: Benzodiazepines; Sedative-Hypnotic Agents; Section III: Nitrite, Sodium
& Amyl; VasopressinRais Vohra, MD
Assistant Professor, Department of Emergency Medicine, University of
California, San Francisco–Fresno
raisvohra@hotmail.comSection
II: Antimony and Stibine; Organophosphates and CarbamatesMichael J. Walsh, PharmD Assistant Clinical
Professor, School of Pharmacy, University of California, San Francisco;
Toxicology Management Specialist, California Poison Control System,
Sacramento Division
mwalsh@calpoison.orgSection II: DetergentsJanet Weiss, MD
Director of Toxicology, TheToxDoc, Berkeley, California
toxdoc@yahoo.comSection II:
Ethylene Dibromide; Toluene and XyleneR.
David West, PharmD Toxicology Management Specialist, California
Poison Control System, Fresno/Madera Division
dwest@calpoison.orgSection
III: MagnesiumJoyce Wong, PharmD
Emergency Medicine Clinical Pharmacist, Pharmaceutical Services, San
Francisco General Hospital
Section II: Diuretics; Vitamins; Section
III: Naloxone & NalmefeneOlga F. Woo,
PharmD Associate Clinical Professor of Pharmacy, University of
California, San Francisco
2tao.olga@gmail.comSection II: Antibacterial Agents; Antiviral and Antiretroviral AgentsAlan H. B. Wu, PhD Professor, Department
of Laboratory Medicine, University of California, San Francisco
wualan@labmed2.ucsf.eduSection
I: Toxicology ScreeningLisa Wu, MD
Clinical Instructor, Department of Emergency Medicine, University of
California, San Francisco
lisawu5@hotmail.comSection II: Amantadine; Lysergic Acid Diethylamide (LSD) and Other
Hallucinogens