White oval shaped Acetaminophen tablets in a pile sitting on a grey counter.

ARE YOU UP-TO-DATE? TREATMENT CHANGES IN ACETAMINOPHEN OVERDOSE

Julie Weber Poison Alerts

Acetaminophen overdose is very common and if the antidote, n-acetylcysteine, is given within 8 hours it prevents hepatotoxicity in most cases. The revolutionary change in NAC dosing was introduced about 5 years ago, but the complexity of the different concentrations of NAC in each IV bag leads to frequent dosing and administration errors.

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The chemical composition written over Metformin tablets on a blue background.

METFORMIN OVERDOSE: THINK LACTIC ACIDOSIS, NOT HYPOGLYCEMIA

Julie Weber Poison Alerts

It is only natural to assume that an overdose with an agent used to treat diabetes will result in very low blood sugar. This is certainly true with insulin and sulfonylurea agents such as glipizide or glyburide, but it is not the case with metformin overdose. Metformin is one of the most commonly prescribed drugs in the world, used as a first-line treatment for Type 2 diabetes and many off-label indications such as polycystic ovary syndrome, obesity, and antipsychotic-induced weight gain.

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BUPROPION OVERDOSE

Julie Weber Poison Alerts

It should come as no surprise that bupropion (Wellbutrin®, Aplenzin®, formerly Zyban®, others) can cause serious symptoms in overdose. It is used to treat depression and to reduce cravings in smoking cessation, obesity, and other substance use disorders.

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SECOND GENERATION ANTIPSYCHOTIC OVERDOSE

Julie Weber Poison Alerts

Second-generation antipsychotics (SGA) include aripiprazole (Abilify®), quetiapine (Seroquel®), risperidone (Risperdal®), olanzapine (Zyprexa®) and ziprasidone (Geodon®). They were originally called “atypical neuroleptics” when introduced in the 1990s because they had an “atypical” side effect profile compared to the long-used, first-generation antipsychotics (FGA) such as haloperidol and the phenothiazines.

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SPECIAL ALERT: How to Properly Manage Snake Bites

Julie Weber Poison Alerts

How to Properly Manage Snake Bites Snake bite calls have been increasing at the Missouri Poison Center signaling the start of snake season as the warmer weather brings snakes (and people!) out of their nests. Most snakes found in Missouri are harmless and beneficial in the ecosystem, but we have five venomous species. We have already seen unnecessary and potentially harmful interventions used in the management of snake bites in hospitals across Missouri. Before you manage your next snake bite, review our recommendations for optimum treatment of a snake bite.

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SPECIAL ALERT: Chloroquine & Hydroxychloroquine

Julie Weber Poison Alerts

Chloroquine & Hydroxychloroquine Chloroquine (formerly Aralen®) and its close relative Hydroxychloroquine (Plaquenil®) are in the news as potential treatments for COVID-19. Individuals are obtaining supplies of these drugs from both pharmaceutical and non-pharmaceutical sources, intending to use them either as prophylaxis and/or as treatment for COVID-19.

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BETA BLOCKER OVERDOSE

Julie Weber Poison Alerts

Although they end in “lol,” beta blocker overdoses are no laughing matter. They require careful management since they can cause life-threatening effects. Recently, the Missouri Poison Center updated and clarified its guidelines to ensure the best evidence-based treatment of beta blocker overdoses

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Marijuana and CBD: Use, Intoxication, and Treatment

Julie Weber Poison Alerts

The marijuana plant produces numerous related compounds; the two most abundant are ∆9 THC (tetrahydrocannabinol) and CBD (cannabidiol). THC is responsible for the psychoactive effects, while CBD is non-psychoactive but purported to have beneficial health effects.

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What is Kratom? Which of Your Patients Might Be Using It?

Julie Weber Poison Alerts

Two million Americans have Opioid Use Disorder (DSM-V), showing a pattern of opioid use leading to problems or distress. One distinguishing characteristic is experiencing withdrawal and taking opioids (or a closely related substance) to relieve or avoid withdrawal symptoms.  Another is craving – the intense desire for repeated opioid use.  …

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Loperamide – An Unexpected Drug of Abuse

Julie Weber Poison Alerts

Does anything surprise us anymore?– Yes, even the over-the-counter antidiarrheal drug, loperamide (Imodium), can be abused.  It is a legal, inexpensive, and accessible alternative for someone with opioid use disorder, or merely curious about the pleasurable effects of opioids.  It is also used for self-treatment of opioid withdrawal symptoms, giving …

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