General Management

Ipecac is contraindicated due to excessive vomiting-induced risk of preterm labor. Coma cocktails should contain dextrose and naloxone.

Activated charcoal (AC) is very useful because of gastric axis shift with gastric content stasis. Whole-bowel irrigation (WBI) with polyethylene glycol-electrolyte solution (PEG-ELS) is indicated for iron (Fe) overdose to flush out slow-release tablets; Fe is not AC-adsorbed. Most antidotes are FDA category C or better; only ethanol is category D. Never withhold specific antidotes in pregnancy, especially NAC for acetaminophen (APAP) overdose, a commonly ingested suicidal agent.

Increased dermal absorption: Hexachloro-phene-vacuolar encephalopathy, aniline dyes may cause methemoglobenemia (MetHb), iodine-containing antiseptics may cause hypothyroidism.

Increased protein binding: Sulfonamides and ceftriaxone displace bilirubin from albumin and cause kernicterus in neonates. Reduced hepatic P-450 metabolism: High concentrations of phenytoin, phenobarbital, theophylline cause reduced glucuronidation of chloramphenicol with resulting gray baby syndrome; benzyl alcohol = gasping baby syndrome.

General management: No ipecac or lavage due to existing electrolyte and temperature losses; consider exchange transfusion > hemodialysis > hemoperfusion for drug overdoses.

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