Naloxone
Brand: Narcan 4mg nasal
Indication: Opioid overdose — fentanyl + heroin + prescription opioids
🇺🇸 United States 🇺🇸 United States · Poison Control · AAPCC · ATSDR · OSHA recordkeeping
Acute poisoning pathway
US acute poisoning management built around the canonical resources: Poison Control (AAPCC regional poison center routing), the ATSDR toxic substance program, and emergency department supportive care, with OSHA recordkeeping for work-related cases. This page orientates — it does not replace Poison Control.
US Poison Control — 24/7 · free · confidential
1-800-222-1222Poison Help · public + HCP · AAPCC routing to your regional poison center.
- CHEMTREC (chemical emergency): 1-800-424-9300
- ATSDR (toxic substances): 1-888-422-8737
- Call 911 / ED if symptomatic — time-critical; do not delay for advice when the patient is unstable.
Poisoning classification
Four broad categories steer the Poison Control consult and the antidote/decontamination decision.
Drugs / pharmaceuticals
Intentional or accidental overdose — opioids (fentanyl), acetaminophen, benzodiazepines, antidepressants, cardiac drugs.
Chemicals
Occupational and household — solvents, corrosives, pesticides, cleaning agents, gases.
Plants / fungi
Foraged or ornamental — Amanita species, foxglove, oleander, water hemlock.
Animals
Envenomation — pit vipers (rattlesnake), coral snake, black widow / brown recluse, scorpion, jellyfish (varies by US region).
Occupational toxic exposures
Work-related poisoning often needs biological monitoring against an exposure limit. Cross-reference the OSHA Permissible Exposure Limits (PELs).
Carbon monoxide
→ Blood carboxyhemoglobin (COHb %)
Boilers, vehicle exhaust, furnaces, fires, generators.
Lead
→ Blood lead level (BLL) — 29 CFR 1910.1025; medical removal at 60 µg/dL
Smelting, battery work, demolition, radiator repair.
Hydrofluoric acid
→ Calcium gluconate gel (topical) + IV calcium
Semiconductor, glass etching, refining, pickling.
Organophosphates
→ Pralidoxime + atropine; plasma/RBC cholinesterase
Agricultural pesticide handlers (Category I/II).
Methemoglobinemia
→ Methylene blue 1-2 mg/kg IV
Aniline dyes, nitrites, nitrate processing, meat curing.
Core antidotes
US brands and indications. Dosing always per Poison Control or the agent-specific protocol — see the full antidote set for all 20.
Atropine + pralidoxime (2-PAM)
Brand: DuoDote (atropine + pralidoxime auto-injector)
Indication: Organophosphate + carbamate cholinergic crisis (anti-AChE pesticides)
Hydroxocobalamin
Brand: Cyanokit
Indication: Cyanide poisoning — fire smoke inhalation + chemical exposure
Calcium gluconate + calcium chloride
Indication: Hydrofluoric acid (HF) exposure (skin + systemic) + hyperkalemia
Methylene blue
Indication: Methemoglobinemia (aniline dyes + nitrites + dapsone + benzocaine + chlorate)
Fomepizole (4-methylpyrazole)
Brand: Antizol (FDA 1997)
Indication: Methanol + ethylene glycol poisoning
Acute management essentials
ABCDE first. Specifics below complement, never replace, the Poison Control recommendation for the agent.
Decontamination
- ▸Skin: remove clothing, copious water irrigation; protect staff.
- ▸Eye: immediate prolonged irrigation; check pH for corrosives.
- ▸GI: activated charcoal within 1 h (per Poison Control); whole-bowel irrigation selected cases.
Supportive care
- ▸Airway protection, oxygen, ventilation as needed.
- ▸IV fluids, correct electrolytes and acid–base.
- ▸Seizure control, temperature management, specific antidote.
Monitoring + admission
- ▸ECG, observations, acetaminophen/salicylate levels, blood gas.
- ▸Admit if symptomatic, delayed-toxicity agent, or intentional overdose.
- ▸Observation window per Poison Control for the specific toxin.
OSHA recordkeeping
Work-related acute poisoning may be OSHA recordable under 29 CFR 1904. Severe cases trigger OSHA reporting deadlines: an in-patient hospitalization must be reported within 24 hours (a work-related fatality within 8 hours) to OSHA.
Workers' compensation
Coverage and reporting for occupational poisoning are state-variable. Consult HR and the relevant state workers' compensation board for filing requirements, deadlines, and authorized treating providers in your jurisdiction.
Reference resources
Under the physician's clinical judgement
- Poison Control (1-800-222-1222) is the canonical US resource — this page orientates and cannot replace it; confirm management against the poison center consult.
- Obtain the patient's consent for toxicology testing where the situation is not immediately life-threatening; in an emergency, treat first.
- Maintain confidentiality and safeguarding duties if the overdose is intentional — assess capacity and self-harm risk.
- Keep workers' compensation documentation separate from the clinical record.
- No patient data is stored by this tool.