Toxicology
There are 2 types of oral hypoglycemic, Biguanide and Sulphonylurea

Biguanides (eg, metformin) do not cause hypoglycemia but can on occasion cause a severe
lactic acidosis. They may cause abdominal pain, nausea, vomiting, and diarrhea. If severe
then lactic acidosis, altered mental status, tachycardia, tachypnea, and hypotension

Sulfonylurea can induce severe and delayed hypoglycemia in a young child.

If multiple rounds of dextrose are needed, use octreotide or diazoxide as they inhibit insulin
release.
Opioid withdrawal causes insomnia, mydriasis, piloerection, diaphoresis, lacrimation,
rhinorrhea, and myalgia. Rx Clonidine, Methadone and Buprenorphine.

Cocaine and methamphetamine withdrawal include fatigue, vivid dreams, increased
appetite, and psychomotor retardation or agitation.

Ethanol withdrawal causes tachycardia, hypertension, tremors, and seizures.
Hypoglycemia
Withdrawal
Acidosis
Toluene causes a non–anion-gap metabolic acidosis associated with renal tubular acidosis
that  can cause severe hypokalemia-induced muscle weakness.

Salicylate and Methanol poisoning causes metabolic acidosis but will exhibit an increased
anion gap.

Digoxin poisoning is associated with hyperkalemia without metabolic acidosis.
B Blockers Overdose
β-blocker overdose can cause bradycardia, arrythmia, hypotension, hypothermia,
hypoglycemia and seizures.

Medication of choice -  glucagon therapy.  
MDMA, Molly, Ecstacy
Causes acute sympathomimetic toxicity with hyperthermia, tachycardia, hypertension,
diaphoresis, mydriasis, agitation, altered mental status,  seizure, hyponatremia, cerebral
Edema, myocarditis and death

Midazolam, helps with seizure and agitation. IV Fluid boluses x 2.

Haldol would be inappropriate, as it would further decrease seizure threshold.

Propranolol should be avoided,  β-blockade will create unopposed α-agonist effect and
worsen the tachycardia and hypertension.

Nitroprusside and Phentolamine can be used for hypertension.

Restraints and Tasers are counter productive.

Computed tomographic scan for patients with any altered mental status, focal neurological
symptoms to rule out intracranial hemorrhage, stroke, or cerebral edema.
“One Pill Can Kill”
Alpha 2 agonist - Clonidine - Rx IV Naloxone

B - Blocker - propranolol - Rx IV Glucagon

Calcium channel blockers - amlodipine - Rx High-dose insulin/dextrose

Camphor

Ethylene glycol - Rx Fomepizole, Hemodialysis

Methanol - Rx Fomepizole, Hemodialysis

Sulfonylureas - glyburide, glipizide - Rx Octreotide

If a child ingests as little as 1 tsp or 1 tablet of these substances, it’s important to admit for treatment and observation
Lethal and Non Lethal species.

Magic mushroom, A psilocybin mushroom, also known as a psychedelic mushroom.

Local nonlethal toxic mushroom ( several Species)  that contains toxins (ie, arabitol) that
irritate the gastrointestinal system cause immediate onset of symptoms of vomiting, gastritis,
and diarrhea. Require supportive care.

Amanita phalloides (death cap) that contain α-amantin. These mushrooms cause toxicity
similar to acetaminophen toxicity and usually have a delay in onset of symptoms of at least
12 hours and can progress to liver failure. Although there is no antidote for A phalloides, N-
acetylcysteine has been reported to help. The A phalloides is the most deadly mushroom in
the United States.

The Cortinarius species contain the toxin orellanine, which causes delayed renal failure
and has no antidote.

The Gyromitra species (false morel) contain the toxin gyromitrin, which has a similar
toxicity to isoniazid. This causes the patient to have intractable seizures, which can be
controlled with pyridoxine administration.
Mushrooms