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Although the basics of evaluating and treating most unknown ingestants are well known, many overdoses require very specific treatment if the patient is to have any chance of survival. Despite widespread public education, childproof containers, and other safety measures, accidental overdoses continue to occur. In the United States, poison control centers receive over 2.2 million calls each year, 47% of which concern children less than six years of age. Most pediatric accidental ingestions involve cosmetics and personal care products, followed by cleaning products, and then analgesics and prescription medications. Adult overdoses usually are due to the intentional ingestion of analgesics and sedative-hypnotics. This activity reviews the deadly single dose toxic agents and discusses the interprofessional team's role in educating families on protecting children from exposure to these agents. Objectives: Outline the challenges of public education in regard to preventing overdoses. Identify the common causes of pediatric and adult overdoses. Describe the common interventions for single-dose agent overdoses. Review the interprofessional team's role in educating families on protecting children from exposure to these deadly single-dose toxic agents. Access free multiple choice questions on this topic.

Although the basics of evaluating and treating most unknown ingestants are well known, many overdoses require very specific treatment if the patient is to have any chance of survival.[1] Countless studies have been published supporting Dr. Gideon Koren's 1993 landmark article "Medications Which Can Kill a Toddler with One Tablet or Teaspoonful" in the Journal of Toxicology.[2][3][4][5] while each has its own merits, most focus solely on pediatric overdoses, and relatively few of them provide an exhaustive list or act as a "quick-reference" when dealing with real-time ingestions. Despite widespread public education, childproof containers, and other safety measures, accidental overdoses continue to occur.  In the United States, poison control centers receive over 2.2 million calls each year, 47% of which concern children less than six years of age.  Most pediatric accidental ingestions involve cosmetics and personal care products, followed by cleaning products, and then analgesics and prescription medications.  Adult overdoses usually are due to the intentional ingestion of analgesics and sedative-hypnotics. Following are the list of toxic drugs (in decreasing severity/difficulty of treatment) included in this summary: Alpha-2 adrenergic agonists - clonidine, naphazoline, oxymetazoline, tetrahydrozoline Sulfonylureas - chlorpropamide, glyburide, glipizide, glimepiride Calcium channel blockers - nifedipine, verapamil, diltiazem, amlodipine, nicardipine Beta-blockers - metoprolol, labetalol Tricyclic antidepressants - imipramine, desipramine, amitriptyline, nortriptyline Opioids - codeine, hydrocodone, methadone, morphine, heroin Anti-diarrheals - diphenoxylate + atropine, loperamide Salicylates/Methyl salicylates - wintergreen oil, bismuth subsalicylate, mentholated balms Antipsychotics - loxapine, thioridazine, chlorpromazine Antimalarials - chloroquine, hydroxychloroquine, quinine Antiarrhythmics - quinidine, disopyramide, procainamide, flecainide Terpenoid (camphor) - analgesic, anti-itch, and cooling gels, ointments, and balms Non-alkaloid toxic lignan - podophyllin, podofilox Plant toxin/secondary metabolite - colchicine Oral acetylcholinesterase inhibitors - rivastigmine, donepezil, galantamine Methylxanthine - theophylline: 1,3-dimethylxanthine Partial opioid agonist/synthetics - buprenorphine/fentanyl Toxic alcohols - methanol, ethylene glycol

Terpenoid (camphor) - analgesic, anti-itch, and cooling gels, ointments, and balms Non-alkaloid toxic lignan - podophyllin, podofilox Plant toxin/secondary metabolite - colchicine Oral acetylcholinesterase inhibitors - rivastigmine, donepezil, galantamine Methylxanthine - theophylline: 1,3-dimethylxanthine Partial opioid agonist/synthetics - buprenorphine/fentanyl Toxic alcohols - methanol, ethylene glycol Caustics /household products - acidic or alkaline household products, hydrofluoric acid, selenious acid, ammonia fluoride, methacrylic acid (cosmetic glue), naphthalene (mothballs)

Although identification and proper management of toxic ingestions are vital skills for emergency and acute care clinicians, one cannot forget those that support our mission both before arrival and after treatment and discharge.  Caring for these complicated overdoses is a daunting task, especially for the pre-hospital personnel, as well as those providing aftercare. Numerous studies and articles are now focusing on reducing unnecessary ER visits for minor ingestions and patient safety, and proper mental health or substance abuse referrals.[15] More evidence-based research is necessary on preventing recidivism, and more collaborative programs need to be developed to provide clear pathways to recovery for the patients who have intentionally overdosed. As the U.S. opioid crisis has received federal attention (and funding to address it) - now is the time to capitalize on the national momentum to improve our comprehensive care of these patients.  Now is also the time to build our care teams when these patients present to the ER. A collaboration of EMS, ED providers, clinical pharmacologists, poison control, intensivists, mental health providers, and addiction specialists is necessary for this patient's journey to full recovery. Due to the complexity and risk of patients exposed to these agents, an interprofessional team approach will lead to the best outcomes. The nurse should help the clinician obtain an accurate patient and family history, including making calls as necessary to family members and pharmacists. The specialty-trained toxicology pharmacist should evaluate drug-drug interactions, select antidotes, and provide guidance for care to the team. The clinician should consult a clinical toxicologist in most cases to assist in guiding evaluation and therapy. Often a mental health counselor is involved as well. Only by working together as a team will these patients obtain the best care and chance for long-term survival. [Level 5]