Referral Guidelines for Single Acute Ingestions

Question 1

Acetaminophen (pediatric)

Answer 1

200 mg/kg

Question 2

Acetaminophen (adult)

Answer 2

140 mg/kg

Question 3

Acetaminophen (extended release)

Answer 3

Check 4 and 6 hour levels

Question 4

ACE inhibitors

- Capoten (captopril) Vasotec (enalapril) Prinivil, Zestril (lisinopril) Lotensin (benazepril)

Answer 4

Refer only if symptomatic

Question 5

Acebutolol (beta blocker)

Answer 5

Child > 12 mg/kg

Question 6

Atenolol (beta blocker)

Answer 6

Child > 2 mg/kg

Question 7

Carvedilol (beta blocker)

Answer 7

Child > 0.5 mg/kg

Question 8

Labetalol (beta blocker)

Answer 8

Child > 20 mg/kg

Question 9

Metoprolol (beta blocker)

Answer 9

Child
> 2.5 mg/kg (immediate release)
> 5 mg/kg (sustained release)

Question 10

Nadolol (beta blocker)

Answer 10

Child >2.5 mg/kg

Question 11

Propranolol (beta blocker)

Answer 11

Child
>4 mg/kg (immediate release)
>5 mg/kg (sustained release)

Question 12

Sotalol (beta blocker)

Answer 12

No safe dose - all referred in

Question 13

Timolol (beta blocker)

Answer 13

No safe dose - all referred in

Question 14

Brodificoum

Answer 14

INR at 48 hours if adult suicidal or large pediatric ingestion

Question 15

Bupropion (Wellbutrin)

- antidepressant

Answer 15

Child: >10 mg/kg

Question 16

Button Battery

Answer 16

Immediate referral (if x-ray confirms in stomach or intestines should pass uneventfully)

Question 17

Caffeine

Answer 17

> 40 mg/kg

Question 18

Camphor

Answer 18

> 15 mg/kg

Question 19

Cigarettes

Answer 19

> 1 cigarette or 3 butts

Question 20

Citalopram (Celexa)

- SSRI - antidepressant

Answer 20

> 5.5 mg/kg

Question 21

Clonidine (Catapres)

- hypertension and ADHD

Answer 21

> 0.01 mg/kg

Question 22

Clonidine (transdermal patch)

Answer 22

> 1 lick or ingestion

Question 23

Dextromethorphan

Answer 23

> 10 mg/kg

Question 24

Digoxin (pediatric < 13 y/o not taking dig regularly)

- Digox, Digitek, Lanoxin

Answer 24

> 40 mcg/kg

Question 25

Digoxin (adult not taking dig regularly) | - Digox, Digitek, Lanoxin

Answer 25

> 15 mcg/kg

Question 26

Diltiazem (Cartia XT, Tiazac, DILT-XR, Matzim LA, Cardizem, Taztia XT) - Calcium Channel Blocker

Answer 26

Child: > 1 mg/kg

Question 27

Diphenhydramine (Benadryl, Nytol, Banophen)

Answer 27

> 7 mg/kg

Question 28

Ethanol (100%)

Answer 28

> 1 mL/kg

Question 29

Ethylene Glycol (100%)

Answer 29

> 0.05 mL/kg

Question 30

Fluoride (NaF = 45.2%; SnF = 24.3%)

Answer 30

> 10 mg/kg

Question 31

Guanfacine (Tenex; Intuniv) - Tenex for hypertension - Intuniv for ADHD

Answer 31

No safe dose for under age 6 - all referred in

Question 32

Ibuprofen (Advil, NeoProfen, Caldolor)

Answer 32

> 200 mg/kg

Question 33

Isoniazid | antibiotic for tuberculosis

Answer 33

> 10 mg/kg

Question 34

Iron

Answer 34

Only if develops nausea/vomiting (observe at home 6 hours)

Question 35

Isopropanol 100% (isopropyl alcohol)

Answer 35

> 0.5 mL/kg

Question 36

Lithium (Eskalith, Lithobid)

Answer 36

> 37 mg/kg

Question 37

Methanol (100%)

Answer 37

> 0.07 mL/kg

Question 38

Mothballs (camphor or unknown)

Answer 38

> 1 mothball

Question 39

Mothballs (naphthalene; para-dichlorobenzene)

Answer 39

> 5 mothballs

Question 40

Mushrooms

Answer 40

Refer only if symptomatic | more serious if symptoms occur > 6 hours post-ingestion

Question 41

Phenylephrine

Answer 41

Refer only if symptomatic (e.g. tachycardia, hypertension, n/v, HA)

Question 42

Phenol

Answer 42

>5% or >5 mg/kg

Question 43

Pseudoephedrine (Sudafed)

Answer 43

11 mg/kg

Question 44

Salicylates

Answer 44

>300 mg/kg

Question 45

Salt (NaCl)

Answer 45

>300 mg/kg | 1 teaspoon of salt = about 2,300 mg of NaCl

Question 46

Levothyroxine (Synthroid)

Answer 46

Refer only if symptomatic

Question 47

Venlafaxine (Effexor) - antidepressant - serotonin-norepinephrine reuptake inhibitor (SNRI)

Answer 47

>5.5 mg/kg