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Overdose Cheat Sheet (DRAFT) by

This is a draft cheat sheet. It is a work in progress and is not finished yet.

Acetam­inophen OD

Antidote: N-acet­ylc­ysteine (Aceta­dote, Mucomyst)
Stg1 (<24h): asymp or a/n/v, malaise. Labs: (~12hr) Elevated LFTs (ALT, AST).
Stg 2 (1-3d): a/n/v, RUQ pain; tachyc­ardia, hypote­nsion (fld loss). Labs: Elevated ALT, AST, PT, INR, bili, possible nephro­tox­ici­ty/­renal function abn.
Stg 3 (3-4d): n/v/pain, tender liver, coma; multi-­organ failure; hepatic probs- jaundice, coagul­opathy, hypogl­ycemia, hepatic enceph; possibly act renal failure & death. Labs: severe hepato­tox­icity evident, hepatic necrosis (liver biopsy dx).
Stg 4 (4d-3wk): Complete resolution of symptoms & hepatic dysfun­ction


Antidote: Physos­tigmine
Hypert­hermia, tachyc­ardia, wide pulse pressure, arrhy, circ collapse, resp distress
Central: agitation, ataxia, audito­ry/­visual halluc­ina­tions, cogn decline, come (late), confusion, delirium, diminished concen­tra­tion, forget­ful­ness, fatigue, poor coordi­nation, restle­ssness, sedation, seizures
Decreased secret­ions: gastric & lacrimal, dry mouth, dry skin (no sweating)
GI/GU: hypoactive bowel sounds, consti­pation, ileus, urinary ret
Ocular: blurred vision, mydriasis, precip narrow­-angle glauc
SM: dysarthia, m twitching, diminished m tone (late)


Antidote: Calcium chlori­de/­glu­conate, Glucagon, Insuli­n/g­lucose

Carbon Monoxide

Antidote: 100% O2


Antidote: Atropine, Pralid­oxime
Etiology: Physos­tig­mine, Piloca­rpine, Pyrido­sti­gmine
DUMBELLSS: Dia, Urination, Miosis, Bradyc­ardia, Emesis, Lacrim­ation, Lethargy, Saliva­tion, Seizures
Compli­cat­ions: resp failure (rapid onset), seizure, dehydr­ation, neurol­ogical sequlae
Killer B's: Bradyc­ardia, Bronch­orrhea, Bronch­ospasm (wheezing)
n/v/cr­amps, increased secret­ions; conduction abn (AVB, cardiac arrest)

Cyanide Poisoning

Antidote: Methylene blue, Cyanide antidote kit (Liliy Kit), Hydrox­yco­balamin (Cyano­kit), Amyl nitrite, Sodium nitrite, Sodium thiosu­lfite
Early: HA, anxiety, confusion, tachypnea, tachyc­ardia
Late: Alt LOC, seizures, hypove­nti­lation, hypote­nsion, dysrhy (AVB, VF, SVT)
Monitor methem­oglobin levels (shouldn't exceed 20%)

Digoxin Toxicity

Therap­eutic Dose: 0.8-2.0
Antidote: Digoxin FAB (Digibind)
GI/GU: a/n/v/d, abd pain (late sign), excessive nocturia
Neuro: HA, fatigue, weakness, confusion, delirium
Visual: green-­yellow halos around images­/li­ghts, alt color percep­tion, blurred or double vision, seeing spots, photop­hobia
CV: irreg pulse, palps;
EKG: ST seg dpr, inverted T, sinus brady; VT/F/f­lutter; Paroxysmal atrial tach; Sinoat­rial, bundle branch, or AV block
Other Tx: Lidocaine, Atropine (brady­car­dia), Dilantin

Heavy Metal Poisoning

(Arsenic, Copper, Lead, Mercury)
Antidote: EDTA, Succimer (DMSA), Dimerc­aprol, Penici­llamine

Iron Poisoning

Antidote: Desfer­oxamine

Isoniazid Overdose

Antidote: Pyridoxine

Lead Poisoning

Antidote: Edetate disodium (EDTA), Dimerc­aprol (BAL), Succimer (CHEMET)
HA. ataxia, tremors, convul­sions, vertigo, hearing loss, delusions, insomnia, irrita­bility, aggressive behavior, attention probs
Distal neurop­athy, parest­hesia, reduced sensation, muscle weakness
Poor appetite, abd pain, consti­pation, anemia
Delayed growth, reduced IQ, loss of develo­pmental skills


Antidote: Ethanol

Lithium Toxicity

Therap­eutic range: 0.6-1.0
Etiology: OD, volume depletion, reduced GFR, med intera­ctions (ACEIs, NSAIDs, Thiazide diuretics)
Mild (<1.6): n/v/d, apathy, irrita­bility, impaired memory, lethargy, proximal muscle weakness
Mod (<2.5): (neurotox) confusion, drowsi­ness, blurred vision, slurred speech, progre­ssing tremor, unsteady gait, incont
tremors, fascic­ula­tions, clonus, ataxia, dysart­hria, hyperr­efl­exia; stupor, coma, seizures
Severe (>2.5): (nephr­otox) nocturia, distal tubular acidosis, seizure, coma, (cardi­otox) ST changes, QT prolong, flat T, hypote­nsion, conduction delay, dysrhy (VT), CV collapse,
SILENT (syndrome of irreve­rsible lithiu­m-e­ffe­ctuate neurot­oxi­city): after d/c lithium >2min; truncal ataxia, ataxic gait, scanning speech, incoor­din­ation
Tx: Li levels q2-4h, IV fluids (bolus + 1.5-2x mainte­nance), bowel irrigation w/PEG for severe acute ingestion; Hemodi­alysis if severe tox, renal insuff + Li >2.5, Li >4

Heparin Overdose

Antidote: Protamine Sulfate


Antidote: Vitamin K

Ethylene glycol

Antidote: Fomepizole (Antizol)

Opioid Overdose

Antidote: Naloxone

Benzod­iaz­epine Overdose

Antidote: Flumazenil 0.1 mg/min infusion to 1 mg

Valproate Overdose

Antidote: Camitine