![]() Ethanol (less effective than fomepizole).Formation of toxic metabolites in the liver → anion gap metabolic acidosis, seizures, dyspnea (see ethylene glycol poisoning and methanol poisoning).Methemoglobin-forming agents (e.g., amyl nitrite, sodium nitrite, 4-DMAP).Blocks electron transport chain → anion gap metabolic lactic acidosis, bitter almond breath, altered mental status.Formation of carboxyhemoglobin → tissue hypoxia → cherry-red skin tone with bullous skin lesions, somnolence, agitation, headache, vomiting, coma.Normal or high concentration oxygen depending on severity.↑ CO 2 decreases O 2 concentratio n → headaches, cardiac arrhythmias, respiratory depression, coma.Deferoxamine (“De- Fe-roximine”), deferasirox, deferiprone: iron.Dimercaprol, succimer: arsenic, gold, lead, mercury.Chelating agents (bind free metal ions).For toxicity and findings, see the specific metal poisoning.And/or prothrombin complex concentrate (immediate antidote).Vitamin K antagonism ( γ- carboxylation of clotting factors) → excessive bleeding.Benzodiazepines for control of seizures.Sodium bicarbonat e (to stabilize cardiac cell membrane).Muscarinic ACh receptor inhibition → anticholinergic syndrome (see tricyclic antidepressant toxicity).Catalyze conversion of plasminogen to plasmin → excessive bleeding.Thrombolytic agents (e.g., recombinant tPA) Salicylate metabolites accumulate in liver → hepatic failure and metabolic acidosis (see salicylate toxicity).μ-, κ-, and δ- receptor agonism (see opioid intoxication) → miosis, altered mental status, respiratory depression.Increases activity of antithrombin → excessive bleeding.Renal elimination → supratherapeutic levels → excessive bleeding, acute renal failure.Inhibits Na+/K+-ATPase → cardiac arrhythmias, xanthopsia (see cardiac glycoside poisoning).Insulin and glucose to correct hypoglycemia.Glucagon: increases cardiac contractility.Inhibit sympathetic effect → bradycardia, hypotension, hypoglycemia (see beta blocker overdose). ![]()
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