Salicylate

Acetaminophen
BZD

(lithium)
(serotonin uptake inhibitor)
(MAO)
(neuroleptics)
Tegretol (carbamazepine)
Depakene (valproic acid)
Dilantin (phenytoin)
Baclofen

Carbamate
Pyrethrin

2, 4 D

SMFA 1080

Phenol

CO

(chlorhexidine)
(sodium hypochlorite)

1 21

(camphor)
(naphthalene)
(p-dichlorobenzene)

Cyanide
Methanol
Hydrocarbon
Toluene & Xylene
H2S

()

Heroin
Amphetamine

2 21

Salicylate
1.
1)
150 mg/kg mild
150300 mg/kg moderate
300-500 mg/kg severe
2)
Tinnitus
Hyperventilation
Anionic gap metabolic acidosis
3)
Salicylate 6hrs 45mg/dl
Methylsalicylate 2hrs 45mg/dl
2.
1)
2)

NaHCO3 5Amp+N/S 500c.c.+15%KCl 5c.c. IV for one hour st

NaHCO3 2Amp+N/S 500c.c.+15%KCl 5c.c. IV q6h
keep PH 7.457.55 or Urine PH 7.58.0

3) HD
Serum level 100mg/dl
Coma
Heart failure or renal failure
Intractable metabolic acidosis
Acetaminophen
1. Acetaminophen
1) 150mg/kg
2) 4hrs 150ug/ml
2.
1) Activated charcoal activated charcoal

2) (N-acetylcysteine)
NAC 140mg/kg loadong70mg/kg q4h17
NAC
a.
b.
c. primperan
3) (N-acetylcysteine)
NAC 140mg/kg loadong70mg/kg q4h12 dose
3 21

4) Acetaminophen HD
BZD
1.
1) Flumazenil 0.5mg IV st
a. clearBZD
b. partial responsemixed drugethanolhepatic
encephalopathy
c. TCA seizures and ventricular
dysrhythmias.epileptic patients BZD
d. BZD level, BZD
BZD

2) complication
a. aspiration pneumonia ()
b. bed sore & bullae ()
c. rhabdomyolysis ()
d. deep vein thrombosis()
2.

1.
1) moderate to serious exposures - 10 to 20 mg/kg PO.
2) QTc prolonged, QRS widening, R on T, Torsade de pointes
3) conscious disturbance
4)
2.
1) NaHCO3 5Amp+N/S 500c.c.+15%KCl 5c.c. IV for one hour st
NaHCO3 2Amp+N/S 500c.c.+15%KCl 5c.c. IV q6h
keep pH 7.457.55 or Urine pH 7.58.0
2) VT ACLS antiarrhythmia Class Ia ( procainamide)
3)
(lithium)
1.
1) (manic-depressive disorder)
2)
2.
1)

4 21

2)
3) ()

4) ST-T QT U
3.
1)
2)
a. 0.6-1.2 mEq/L
b. 1.5-2.5 mEq/L
c. 2.5-3 mEq/L
d. 3-4 mEq/L
e. 3-6 mEq/L
4.
1) 0.9%
2) furosemide thiazides and spironolactone
3)
a. 3.5-4 mEq/L
b.
c. < 3.5-4 mEq/L (+)
(serotonin uptake inhibitor)
1.
1) Fluvoxamine (Luvox ) (>1g)

2) Paroxetine (Seroxat)

3) Fluoxetine (Prozac) (>400-800mg )

2.
1)
2) diazepam, phenobarbital, phenytoin, muscle relaxant
3) lidocaine, inderal, MgSO4
4) , norepinephrine, dopamine
(MAO)
1. (phenelzine, tranylcypromine, pargyline, nialamide, moclobemide and
isocarboxazid)
2.
1) norepinephrine, dopamine and seortonin
5 21

2) >2-3mg/Kg
3) >4-6mg/Kg
3.
1) (< 12 )
2)
3)
4) (fasciculation)

5)
6)
7)
4.
1)
2) diazepam, phenobarbital, phenytoin, muscle relaxant
3) lidocaine, inderal, MgSO4
4) nitroprusside, phentolamine (hydralazine, thiazide, methyldopa )
5) norepinephrine, dopamine
6) acetaminophen, external cooling, dantrolene, but not bromocriptine
7) diazepam, muscle relaxant, but not succinylcholine
8) 24
9) tyramine chocolate, aged cheese, chianti, vermouth,
pickled fish, and concentrated yeast extracts.
5.
1) Interaction: methyldopa, guanethidine, clonidine, reserpine, and meperidine.
2) Serotonin syndrome: clomipramine, fluoxetine, lithium, meperidine, tricyclic antidepressants,
or selective serotonin reuptake inhibitors.
3) Severe life threatening hypertensive crisis : ephedrine, phenylpropanolamine, metaraminol,
phenylephrine, dopamine, amphetamine, and cocaine.
(neuroleptics)
1.
1) dopamine
2) serotonin
3) quinidine
2.
1) phenothiazine :
dimethylamine (chlorpromazine) :
piperazine ( prochlorperazinefluphenazine) : NMS
piperidine ( thioridazine) :
2) butyrophenone ( haloperidoldroperidol ) : NMS
6 21

3) thioxanthine ( chlorprothixene) : phenothiazine

4) loxapine : phenothiazine
3.
1)

2)
(rigidity,bradykinesia, resting tremor) dystonia (
torticollis, oculogyric crisis) tardive dyskinesia
3) NMS (neuroleptic malignant syndrome)
()CPK

5-10
4) dimethylamine, piperidine
5) piperidine >dimethylamine >butyrophenone > loxapine QT PR
( torsade de pointes, ventricular tachycardia)
6) Dimethylamine, butyrophenone, loxapine
7)
8) thioridazine
4.
1) X
2) NMS
5.
1)
2)
3) lidocainephenytoin
4) Torsade de pointes : MgSO4, isoproterenol, overdrive cardiac pacing
5) ( tardive dyskinesia)diphenhydramine, ( biperiden,
trihexyphenidyl )
6) Tardive dyskinesia reserpine, diltiazem
7) NMS dantrolene 1-2mg/Kg,

bromocriptine

7.5-60mg/day
8)
9) diazepam, phenobarbital, phenytoin, muscle relaxant
Tegretol (carbamazepine)
1. Tegretol
1) . Tegretol (carbamazepine)
2) 10,11-epoxide

7 21

2. Tegretol (carbamazepine)
1) < 40g/ml

2) >40g/ml
QRS QTc

3)
(SIADH)
3. Tegretol (carbamazepine)
1)
2)
3)
4) diazepam, lorazepam, phenobarbital and/or phenytoin
5) sodium bicarbonate
6) atropine
7) >.10g/ml
Depakene (valproic acid)
1. Depakene
1) GABA GABA
2)
2. Depakene (valproic acid)
1) 1,800mg 100g/ml
2) 200mg/Kg QTc

3)
3. Depakene (valproic acid)
1)
2)
3)
4)
5)
6)
7)
8) >.100g/ml
Dilantin (phenytoin)
1. Dilantin (phenytoin)
8 21

1)
2)
3) SA node
4)
5) cytochrome P450
6)
7)
8)
9)
10) phenytoin (phenobarbitalcarbamazepine)
2. Dilantin (phenytoin)
1) 20-30g/ml
2) 30-40g/ml

3) 40-50g/ml ()
4) 50-70g/ml
5) ( IV
)
6) megaloblastic anemiaosteomalacia Stevens-Johnson syndrome
3. Dilantin (phenytoin)
1)
2)
3)
4)
5) diazepam, lorazepam or phenobarbital
6) atropine
7)
8)
Baclofen
1. Baclofen
1) substance P dopamine
2) GABA
3)
4)
2. Baclofen
1)
2) 3-5
3) 12-96
4) 8
9 21

3. Baclofen
1)
2)
3)
4) diazepam, lorazepam, phenobarbital and/or phenytoin
5)
6) baclofen

1. :
1) Muscarinic manifestations:
bradycardia, hypotension
increase bronchial secretion, bronchospasma
sweating, salivation, lacrimation
miosis
nausea, vomiting, diarrhea
urinary incontinence
2) Nicotinic manifestations
muscular twitching, fasciculation
tachycardia, hypertension
3) CNS manifestations
drowsiness, coma, convulsion
slurred speech, dizziness
2. :
1) RBC cholinesterase ()
RBC neuromuscular junction, nerve synapse
2) Plasma cholinesterase ()
plasma, liver
3.
1) PAM 1.02.0g IV q4hq6h 12g IVD for 24 hrs
( PAM )
2) atropine keeping HR 80120/min clear
a. atropine 12amp IV q2h prn (bolus)bolus 150/min
VT VF
b. atropine 5mg in N/S 500 cc IVD run 5-10 MD/min (continuous
dripping)continuous dripping
c. atropine 0.5mg IH q1hq6h ()

4.
10 21

1) HR 80120/min
2) BS Clear
3) Consciousness CPR
RBC-CHE
4) CholinesteraseRBC-CHE plasma-CHE
RBC-CHE
5.
1)
2)
3) garlic-like odor
4) cholinergic sign ( carbamate)
5) Check RBC cholinesterase ( carbamate)
6) Pupil size cholinergic sign heroin pontine
hemorrhage ( carbamate)
6. ? ()

1-4

4-18

8-14

6-12

Carbamate
1. Carbamate
1) PAM PAM carbamate
2) atropine OPS intoxication
2. Carbamate
1) carbamate cholinergic sign
2) carbamate fasciculation
3) carbamate PAM
Pyrethrin

11 21

1.
1)
2) 24hr

3) (sodium dithionite)
2.
1)
2) 25003500c.c./day

3) hydrocortisoneVitCVitE
acetylcysteine
4) O2 PaO2 60 mmHg
5) HP paraquat paraquat
34
3.

1.
1)

2)
xylocaine H2-blocker

2, 4-D(chlorophenoxy compounds)
1.
2. - miosis, coma, fever, hypotension, emesis, tachycardia, bradycardia, ECG
abnormalities, muscle rigidity, possible respiratory failure, pulmonary edema, rhabdomyolysis,
LDH, AST (SGOT) , ALT (SGPT) , albuminuria, porphyria, renal failure, hypocalcemia,
hyperkalemia, hypophosphatemia, thrombocytopenia and leukopenia
3. sodium bicarbonate 2, 4-D

1.
2.
12 21

cholinergic sign cholinergic sign cholinesterase

(RBC plasma ) atropine
PAM
(sodium dithionite)

1.
1) Coumadin
Onset time 12 hrs
Peak time 24 hrs
2) Superwarfarin ()
Onset time 24 hr
Peak time 23
2.
1) VitK K1 K3
2) VitK PT
3) onset time PT coumadin q12h PT superwafarin qd
PT peak time PT VitK
4) PT q6h PT PT PT
(qd, qw, qm) 8
5) VitK 10mg IM or IV qd
3. PT
IIVIIIXX
VII PTXI APTTII X PT & APTT VII
half life PTPT APTT
SMFA 1080
1. SMFA 1080 TCA cycle
enzyme systemic
2. ()
() () () ()
() ()

23 5-6 1520

13 21

Phenol
C6H5OH (carbolic acid) ()
Phenol
> 5%
120240 c.c. phenol
phenol dinitrophenol
or hydroquinone methylene blue 12mg/kg/dose IV q4h

CO

CO
1. CO
1)
2)
3)
4) glucosenaloxoneflumazenil VitB1
2. CO

1. silica gel
2. CaO CaCl2CaO 120240 c.c.
24 CaCl2 120
240 c.c.
3. Fe2O3 ageless 120240 c.c.

detergent
120240 c.c.

120240 c.c.
24
14 21

UGI series
(chlorhexidine)
0.2% > 4%> 20%
(parachloroaniline, CLC6H4NH2)
120240 c.c.
methylene blue 12mg/kg/dose IV q4h

(sodium hypochlorite)
1)
PH 9-12H2O2) (NaBO3)
(C3H3N3O3.Na)(C3CL3N3O3.Na)
2NaOCL+H2O+CO2---Na2CO3+2HCLO2HCLO---2HCL+O2NaOCL+HCL---CL2+NaOH
NH3+NaOCL---NH2CL+Na+OH
2)

1)
2)
3)
4)
(camphor)
1. ()
2.
3. 5-20 90
4.

5.
ASA

(naphthalene)
1.
2.

3. G-6-PD deficiency, sickle cell anemia, or sickle trait

4. X-() paradichlorobenzene ()
15 21

5.

ASA
methylene blue 12mg/kg/dose IV q4h

(paradichlorobenzene)
1.
2.
3.

4.

Cyanide
1. Cyanide
1)
2)
3)
4) PaO2-PvO2
5) anionic gap increased metabolic acidosis
6) PaO2
2. Cyanide
1) Cyanide kit
2) Hydroxycobalamine
3)
Methanol
1. Methanol
1) blurred vision papillary edema ( ethanol )
2) anion gap metabolic acidosis
3) osmolarity
4)
2. Methanol
1) 250c.c.st 1ml/kg

2) Leukovorin 50mg IV st Folic acid 50mg IV q4h6

3) Sodium bicarbonate
4) HD
Methanol level50mg/dl
Severe acid-base or electrolyte imbalance
Renal failure
16 21

Hydrocarbon
Hydrocarbon

Toluene & xylene

Toluene xylene thinner
1)
2)
3)
4)
H2S
1. H2S
1)
2)
3)
4)
2. H2S
3. H2S Sodium Nitrite

1. HF
2.
3. HF
4. calcium gluconate calcium gluconate
(10% 20cc IA continuous dripping for 24 hrs)

1.

2.
1)
2)
3)

4)
100 0.1 c.c. 1cm
1015 10 ml

17 21

a. hydrocortisone 200 mg IV stantihistamine 1 Amp IV st

b. 300 c.c.-500 cc. N/S
c. 1:1000 0.51.0ml

3.
1)
2)
3) ()
4)

(
)
DIC profile
5) 24 24

24

1) Epinephrine 1:1000 0.51.0ml

2)
3) ()

1.
18 21

Epinephrine 1:1000 0.51.0c.c.

2.
3.
4.

1.
2.

1. atropine

2. physostigmine
(
)
1.
1)
2)
ST T

3)
4)
5)

6)
2.

1)
2)
3)
4) Fab fragment

3.

1)
2) ACLS atropine
pacemaker dilantin lidocaine
3) sodium bicarbonate glucose
calcium gluconate sodium potassium ATPase
sodium and calcium exchanger
19 21

calcium gluconate
4) (Fab fragment):
digibind (0.5 mg digoxin/38 mg digoxin specific Fab/vial)
digitalis antidote BM (1 mg digoxin/80 mg digoxin specific Fab/vial)

1.
2.
3.

4. 120240C.Cxylocaine

5.
6. BUNCrCa2+

1. :
Amanita pantherina
amatoxin penicillin G silibinin
muscarine atropine

1)
(1)
(2)
(3)
(4)
(5)
2)
(1)
(2)
(3)
3)
4) 24

(1) 45-508
(2) 460 W8
5)

20 21

2.

1) ()
2)
(1) muscarine (cholinergic)
(2) isoxazole (block glutamic acid & GABA)
(3) tryptophana. silocybin (like LSD) b. bufotenine c. serotonin
3) amatoxin (block RNA polymerase II) &
phallotoxin (destroy endoplasmic reticulum and mitochondrium)
4) gyromitrin (MFH
P450 & MMHCNS & renal)
5) coprine(disulfiram like), orelline, orellane (renal

failure), porphyrins (photosensitivity)

3.

1.
caffeine,
methyltestosterone
2.

Heroin
1.
2. naxolone 1 amp IV st heroin
5 amp 25amp
3. infective endocarditis

Amphetamine
1.
2. phenobarbital basal
metabolic rate 39

1. Micromedex Inc. Poisindex

2.
3. :
4. (I)1997
5. Lin TM, Tsai CC, Lin SD, Lai CS. Continuous intra-arterial infusion therapy in hydrofluoric
acid burns. JOEM 2000; 42: 892-897.
21 21