Critical Care Toxicology

Jeffrey BrentSenior Editor

Keith Burkhart • Paul DarganBenjamin Hatten • Bruno MegarbaneRobert Palmer • Julian WhiteEditors

Critical Care Toxicology

Diagnosis and Management ofthe Critically Poisoned Patient

Second Edition

With 675 Figures and 487 Tables

Senior EditorJeffrey BrentDepartment of MedicineDivision of Clinical Pharmacologyand ToxicologyUniversity of ColoradoSchool of MedicineAurora, CO, USA

EditorsKeith BurkhartFDA, Office of NewDrugs/Immediate OfficeCenter for Drug Evaluationand ResearchSilver Spring, MD, USA

Paul DarganClinical ToxicologySt Thomas’ HospitalSilver Spring, MD, USA

Benjamin HattenToxicology AssociatesUniversity of ColoradoSchool of MedicineDenver, CO, USA

Bruno MegarbaneMedical Toxicological IntensiveCare UnitLariboisiere HospitalParis-Diderot UniversityParis, France

Robert PalmerToxicology AssociatesUniversity of ColoradoSchool of MedicineDenver, CO, USA

Julian WhiteToxinology DepartmentWomen’s and Children’s HospitalNorth Adelaide, SA, Australia

ISBN 978-3-319-17899-8 ISBN 978-3-319-17900-1 (eBook)ISBN 978-3-319-17901-8 (print and electronic bundle)DOI 10.1007/978-3-319-17900-1

Library of Congress Control Number: 2017930938

1st edition: # Mosby 2005# Springer International Publishing AG 2017, corrected publication 2017This work is subject to copyright. All rights are reserved by the Publisher, whether the whole orpart of the material is concerned, specifically the rights of translation, reprinting, reuse ofillustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way,and transmission or information storage and retrieval, electronic adaptation, computer software, orby similar or dissimilar methodology now known or hereafter developed.The use of general descriptive names, registered names, trademarks, service marks, etc. in thispublication does not imply, even in the absence of a specific statement, that such names are exemptfrom the relevant protective laws and regulations and therefore free for general use.The publisher, the authors and the editors are safe to assume that the advice and information in thisbook are believed to be true and accurate at the date of publication. Neither the publisher nor theauthors or the editors give a warranty, express or implied, with respect to the material containedherein or for any errors or omissions that may have been made. The publisher remains neutral withregard to jurisdictional claims in published maps and institutional affiliations.

Printed on acid-free paper

This Springer imprint is published by Springer NatureThe registered company is Springer International Publishing AGThe registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

Foreword

Critical Care Toxicology belongs in every critical care unit, emergency depart-ment, poison center, library, emergency response center, and on the most easilyreached shelf for anyone interested in or who comes in contact with medicaltoxicology. This masterful compilation of information has many attributes,among which are:

• Evidence based well-referenced information• Editors and authors who are experts in their fields• Concise and clear presentation• Tables that convey critical data• Figures and diagrams that are clinically relevant• Paragraph headers that allow focused access to information• Calculations and formulas that are fully explained• Lists of treatment materials to obtain in advance with contact information of

unusual items• Therapeutic dosages that are detailed enough to be utilized without addi-

tional references

In most cases, diagnostic and therapeutic information can be obtained in afew minutes given the book’s careful organization. For those patients pre-senting with complicated or multiple exposures, the structure provides astraightforward method of rapidly developing and working through a differ-ential diagnosis.

The quality of this book should come as no surprise after looking at theimpressive listing of authors. The editors, each of whom I have known, workedwith, and respected for many years, have selected an international group ofexperts whose credibility is unmatched. They represent the best of our profes-sion of medical toxicology and have written a large percentage of the mostimportant and groundbreaking publications in our field. The editors andauthors are the most sought-after educators in our annual toxicology meetingsaround the world and provide clinical expertise as well as leadership andtraining for all of us who work in this wide and varied area.

In the preface to the first edition of Critical Care Toxicology, the word“passion” occurs in the very first sentence. For all of us who have ever written ascientific monograph, paper, chapter, book, or prepared a teaching session, theword passion certainly defines a major requirement for preparation of materials

v

that will communicate the knowledge that is intended. It takes time and effortto write something that will stand the test of time, and when written withpassion it means that the author has not skipped over anything and left nothingof importance unaddressed. It requires thorough knowledge of the subject, realworld experience, fully researched literature, and draft after draft until com-munication is assured. When reading this book, it is apparent that the editorsand authors have achieved their goal.

Before writing this foreword, the editors provided me with some chaptersfrom the second edition. In reviewing four of them – “Acid-base,” “Hypoten-sion and Shock,” “Seizures,” and “Acute Respiratory Distress Syndrome” – itwas readily apparent that this second edition is an improvement on an alreadyexcellent book. More current materials are included as expected, but usingthese chapters as examples the authors have dramatically improved this book.Acid-base in the critical care setting is a complicated and often difficult issue.To address that the authors have doubled the length of this chapter andsubstantially added information which will be valuable to all who utilize it.The chapters on hypotension and shock and acute respiratory distress syn-drome have been broken out of their previous locations and addressed com-prehensively to reflect their importance. The chapter on seizures has also beendoubled in length and contains a considerable amount of new information thatis clearly presented.

The authors have also added speed of access to this book through the use ofa table of contents at the beginning of each chapter. This further enhances theability of the reader to get to an answer under emergent circumstances.

The book also has another purpose than just providing critical informationin a clinical setting. It provides a very readable and understandable educationalexperience for all those who are studying this area. This must includeaddressing controversial areas with which the reader may be familiar and ifnot familiar ought to be familiar, and this book engages all of this.

Even those of us who have been in this field for a long time stand to learnsomething from this book. The discussion of the strong anion gap in the acid-base chapter coupled with the very practical explanations of the other factors inthis important area is the clearest I have ever read. An area in which I have littleknowledge is malignant hyperthermia, and this chapter provides a clear expla-nation along with even a phone number and website to get additional updatedinformation in what is apparently a rapidly evolving issue. The editors clearlywant readers to get the right answers to their questions.

Critical Care Toxicology covers all of the areas in medical toxicology in aseries of well-written chapters following the excellent chapters that provide anapproach to the critically poisoned patient and an understanding of toxicsyndromes. Images of various aspects of toxicological encounters providevisual reinforcement of the written materials.

The index is very well done and comprehensive. Unlike the 7th edition in1959 of Nelson’s pediatric text where the editor’s daughter, who hated havingto produce the index, entered under B “Birds, for the” and listed the entirebook, the index of Critical Care Toxicology was obviously prepared bysomeone who had a passion for helping readers get to answers.

vi Foreword

Critical Care Toxicology provides a very valuable contribution to allaspects of medical toxicology from education to, as the title states, criticalcare. It should be readily accessible to everyone who may face this issue fromforming a differential diagnosis to rendering care.

Rocky Mountain Poison and Drug Center Barry H. RumackDenver, Colorado Director EmeritusUSA

Foreword vii

Preface to the Second Edition

Those readers who are familiar with the first edition of Critical Care Toxicol-ogy (CCT) know that it was about passion – our collective passion for caringfor patients with the group of fascinating physiological derangements causedby exogenous chemical exposures. While our passion for the field of clinicaltoxicology remains unabated, an additional theme that characterizes the sec-ond edition of Critical Care Toxicology is scientific evidence.

In the 10 years since the publication of the first edition, a considerable bodyof new scientific evidence has emerged, new antidotes have become available,and systematic reviews andmeta-analyses have becomemore commonplace inthe field of clinical toxicology. Seizing upon the opportunity to provide acompendium of this accumulated evidence-based knowledge, we have workedwith our chapter authors to assure that they have stayed true to the existingbody of empirical data and, in the many places, where data gaps exist identifythem so that the user of this book will understand the basis for the treatmentrecommendations we provide. In order for the user of CCT to quickly discernthe veracity of the evidence supporting the treatment recommendations pro-vided, we have adopted the US Public Health Service’s rating of scientificevidence. These gradings allow the reader to instantly know the level ofscientific support for various treatment recommendations and thus to be ableto rely most heavily on well-supported therapeutic modalities.

We are highly cognizant of the reality that there are many areas where theevidence base relating to treatment decisions is insufficient. Nevertheless, theclinician treating the critically poisoned patient still requires guidance. Giventhat so many of our chapter authors represent the world’s authority on theirtopic, we have also strongly encouraged them to give their highly informedopinions on how to proceed in the many areas where there are clear knowledgegaps. Where they have supplied these opinions they have been identified assuch, and we have worked with them to also explain their thought processesunderlying these opinions.

We are very proud of the group of chapter authors that have been broughttogether in CCT. Where possible we have endeavored to recruit a group ofinternational experts in their respective subject matter who are also experi-enced clinicians, proficient in the intensive care of patients poisoned by thetoxins and toxicants they have addressed. This quest for such a uniquelyqualified group of chapter authors has required us to seek out scholars frommany areas of the world. Being such highly respected individuals, our chapter

ix

authors are for the most part very busy with their various academic and clinicalpursuits. We are greatly indebted to them for the generous donation of the timethey gave us to not only produce their excellent chapters but also to put up withour compulsively detailed editing and challenges to them for justification ofthe information contained in their chapters. In most instances, they have doneso because they were dedicated to the idea of working with us to achieve thegoals enumerated above.

Critical Care Toxicology is not a static textbook in the traditional sense. Theonline version is a living dynamic document that can, and will, be updated asneeded and new chapters will be provided beyond the date of the originalpublication of the current edition. In this way, we will feel confident that you,the reader of CCT, will have the most up-to-date information available to youin your care of your critically poisoned patients.

Jeffrey BrentKeith Burkhart

Paul DarganBenjamin HattenBruno Megarbane

Robert PalmerJulian White

x Preface to the Second Edition

Preface to the First Edition

To us, this book is about passion. It is the result of the passion we share for theclinical challenges we face every day in caring for critically poisoned patientsand in understanding their unique and enchanting pathophysiology and itstherapeutic implications. This is a passion we hope to elicit in all who ventureinto the world of clinical toxicology as they read this book. To the medicaltoxicologist, the care of the seriously poisoned patients merges the diverseworlds of critical care, emergency medicine, pharmacology, altered drugpharmacokinetics (hence the term “toxicokinetics”), diagnostic challenges,multisystem involvement in often otherwise healthy patients, and the use ofspecific and often esoteric treatment strategies and antidotes.

Before embarking on the extraordinarily labor-intensive activity of gener-ating a book of this depth and complexity, we queried the importance ofproducing another clinical toxicology textbook. We are aware of severalexcellent general clinical toxicology textbooks on the market and appreciatetheir attempts to achieve a far greater breadth than the present work. However,toxicology is such a broad field that general textbooks encompassing all ofclinical toxicology necessarily must limit the extent of their coverage of theintensive care unit management of major poisonings. Thus, the intensivist, andcritically poisoned patients, deserve a reference that specifically addressestheir needs. This need is made all the more important by the life-threateningnature of many of these poisonings. Stark evidence of the complexity of justthese issues is that to cover them adequately required 160 chapters and 1633pages.

Our goal was to have the most knowledgeable and experienced medicaltoxicologists author relevant chapters. In order to achieve this goal we draftedour colleagues with unique experience and expertise worldwide. As witnessedby our contributor list, all continents, except Antarctica, are represented. Weproudly boast that our collective chapter authors represent a significant pro-portion of the most experienced critical care toxicologists in the world. Med-ical toxicologists interested in acute care tend to be domiciled at the bedside, inpoison centers, or both. Because of the highly clinical nature of this book, weselected authors with a predominantly bedside care orientation.

With the ready access to facts and data via the Internet, the very nature ofhard copy books has changed dramatically. No longer is it necessary for booksto be compendia of facts. However, electronic databases cannot convey thereasoned clinical approaches and the synthesis of pathophysiology with

xi

clinical effects and treatment that characterizes the pages that follow. Certainly,important physiologic and monitoring parameters as well as drug dosages areamply provided. The degree to which they are included represents our view ofthe best balance between those that are important to know and the desire todedicate as much space as necessary to an elucidation of relevant concepts anda critical discussion of therapeutic controversies. We have embraced ratherthan glossed over controversies. The reader will find that this is not simply a“how to” handbook. Our aim is to provide the practitioner with the data neededto care for his or her individual patients. As an aid to those who choose to delvemore deeply into the concepts, approaches, and controversies in this book,chapters are well referenced with primary source citations.

It is our hope and expectation that this book will evoke the same passion inthe reader that the subject does for us.

Jeffrey Brent, M.D., Ph.D.Kevin L. Wallace, M.D.Keith K. Burkhart, M.D.Scott D. Phillips, M.D.J. Ward Donovan, M.D.Robert B. Palmer, Ph.D.

xii Preface to the First Edition

Contents

Volume 1

Part I General Management of the Critically PoisonedPatient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

1 The Critically Poisoned Patient . . . . . . . . . . . . . . . . . . . . . . . 3J. Ward Donovan, Keith Burkhart, and Jeffrey Brent

2 The Diagnostic Process in Medical Toxicology . . . . . . . . . . . 29Anthony F. Pizon, Joseph H. Yanta, andGreg S. Swartzentruber

3 Therapeutic Approach to the Critically Poisoned Patient . . . 43Evan S. Schwarz

4 Extracorporeal Membrane Oxygenation andCardiopulmonary Bypass in the Poisoned Patient . . . . . . . . 79William P. Kerns II and Alan C. Heffner

5 Post-Resuscitation Management of the Poisoned Patient . . . 101Michael Lynch and Jon C. Rittenberger

6 Psychiatric Issues in the Critically Poisoned Patient . . . . . . . 117J. J. Rasimas and Gregory L. Carter

7 Poisoning in Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159Kevin F. Maskell Jr., Kirk L. Cumpston,Timothy B. Erickson, and Jerrold B. Leikin

8 Geriatric Poisoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193Janetta L. Iwanicki

9 Intensive Care of Pediatric Poisoning Cases . . . . . . . . . . . . . 205Prashant Joshi and Mitchell P. Ross

10 The Critically Poisoned Worker . . . . . . . . . . . . . . . . . . . . . . . 223Michael G. Holland

11 Complications of Chronic Alcoholism That AffectCritical Illness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249Alison L. Jones

xiii

12 Extracorporeal Substance Removal . . . . . . . . . . . . . . . . . . . . 267Monique J. Cormier and Marc Ghannoum

13 Poisoning Fatalities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279Philippe E. Hantson

Part II Toxic Syndromes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293

14 The Assessment and Management of Hypotensionand Shock in the Poisoned Patient . . . . . . . . . . . . . . . . . . . . . 295Florian Eyer

15 Acid–Base Balance in the Poisoned Patient . . . . . . . . . . . . . . 325Stephen W. Borron

16 Treatment of Acute Respiratory Distress Syndromein the Poisoned Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 359Dylan W. de Lange

17 Toxicant-Induced Hepatic Injury . . . . . . . . . . . . . . . . . . . . . . 385Kim Dalhoff

18 Toxicant-Induced Renal Injury . . . . . . . . . . . . . . . . . . . . . . . 409Joshua D. King

19 Toxicant-Induced Alterations in Consciousness . . . . . . . . . . 425Jerrold B. Leikin and Andrea Carlson

20 Toxicant-Induced Seizures . . . . . . . . . . . . . . . . . . . . . . . . . . . 447Philippe E. Hantson

21 Cardiac Conduction and Rate Disturbances . . . . . . . . . . . . . 475Hallam Gugelmann and Neal Benowitz

22 Toxicant-Induced Torsade de Pointes . . . . . . . . . . . . . . . . . . . 509Jonas Höjer and Donna Seger

23 Anticholinergic Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . 519William J. Boroughf

24 Serotonin Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 539Peter R. Chai and Edward W. Boyer

25 Sympathomimetic Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . 549Andrew M. King, Eric R. Malone, and Cynthia K. Aaron

26 Toxicant-Induced Immunological Reactions . . . . . . . . . . . . . 569Jenny M. Stitt and Stephen C. Dreskin

27 Withdrawal Syndromes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 591Adhi N. Sharma and Robert S. Hoffman

28 Acute Radiation Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 605Ziad N. Kazzi

xiv Contents

29 Malignant Hyperthermia . . . . . . . . . . . . . . . . . . . . . . . . . . . . 619Henry Rosenberg, Dorothea Hall, and Harvey Rosenbaum

30 Toxicant-Induced Hematologic Syndromes . . . . . . . . . . . . . . 643Steven C. Curry and A. Min Kang

31 Neuroleptic Malignant Syndrome . . . . . . . . . . . . . . . . . . . . . . 661Rebecca E. Bruccoleri and Michael J. Burns

32 Toxicant-Induced Rhabdomyolysis . . . . . . . . . . . . . . . . . . . . . 679G. Patrick Daubert

Part III Medication Safety in the Intensive Care Unit . . . . . . . . . 691

33 Adverse Drug Reactions in the Intensive Care Unit . . . . . . . 693Philip Moore and Keith Burkhart

34 Medication Errors and Drug–Drug Interactions in theIntensive Care Unit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 741Brenna Farmer and Luke Yip

Part IV Medications: Cardiovascular . . . . . . . . . . . . . . . . . . . . . . . . 749

35 Alpha-2 Adrenergic and Imidazoline ReceptorAgonists: Clonidine, Dexmedetomidine, and RelatedAntihypertensives, Decongestants, and Sedatives . . . . . . . . . 751Anthony J. Tomassoni

36 Beta-Receptor Antagonists . . . . . . . . . . . . . . . . . . . . . . . . . . . 771Michael Levine and Jeffrey Brent

37 Calcium Channel-Blocking Agents . . . . . . . . . . . . . . . . . . . . . 787Maude St-Onge and Jeffrey Brent

38 Digitalis Glycosides . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 807Bruno Mégarbane

39 Sodium Channel-Blocking Antidysrhythmics . . . . . . . . . . . . 821Silas W. Smith

40 Sodium Nitroprusside . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 843Steven C. Curry and Meghan B. Spyres

41 Sympathomimetic Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . 851Robert J. Hoffman and Lewis S. Nelson

Part V Medications: Decongestant/Antihistaminergic/Bronchodilatory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 867

42 Antihistamines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 869Jerry W. Snow and R. Brent Furbee

Contents xv

43 Theophylline and Other Methylxanthines . . . . . . . . . . . . . . . 883Ann-Jeannette Geib

Part VI Medications: Psychotropic . . . . . . . . . . . . . . . . . . . . . . . . . . 905

44 Antipsychotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 907Bradley L. Demeter and Michael J. Burns

45 Anxiolytics, Sedatives, and Hypnotics . . . . . . . . . . . . . . . . . . 935C. William Heise and Daniel E. Brooks

46 Barbiturates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 955Steven J. Walsh and Kenneth D. Katz

47 Bupropion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 965Peter Wu and David Juurlink

48 Cyclic Antidepressants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 975Mark K. Su

49 Lithium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 991Eric J. Lavonas and Jeffrey Brent

50 Monoamine Oxidase Inhibitors . . . . . . . . . . . . . . . . . . . . . . . 1009Ayrn D. O’Connor and Kirk C. Mills

51 Serotonergic Antidepressants . . . . . . . . . . . . . . . . . . . . . . . . . 1027Andrew H. Dawson

Volume 2

Part VII Medications: Anticonvulsant . . . . . . . . . . . . . . . . . . . . . . . 1041

52 Hydantoin Anticonvulsants: Phenytoin andFosphenytoin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1043Frank LoVecchio

53 Iminostilbene Anticonvulsants: Carbamazepine andOxcarbazine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1053Hwee Min Lee and Andis Graudins

54 Second Generation Anticonvulsants: Gabapentin,Lamotrigine, Levetiracetam, and Topiramate . . . . . . . . . . . . 1065M. P. Emswiler and Kirk L. Cumpston

55 Valproic Acid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1083Wayne R. Snodgrass and Chia Wei Hsu

xvi Contents

Part VIII Medications: Neuromuscular . . . . . . . . . . . . . . . . . . . . . . 1095

56 Antiparkinsonian Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1097Steven J. Walsh and Kenneth D. Katz

57 Baclofen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1119Erin Stewart and Laura M. Tormoehlen

58 Centrally Acting Muscle Relaxants . . . . . . . . . . . . . . . . . . . . 1133Madeline L. McCarthy and Carl R. Baum

Part IX Medications: Analgesic/Anti-Inflammatory . . . . . . . . . . 1143

59 Acetaminophen/Paracetamol . . . . . . . . . . . . . . . . . . . . . . . . . 1145D. Nicholas Bateman

60 Methotrexate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1171Yedidia Bentur and Yael Lurie

61 Nonsteroidal Anti-Inflammatory Drugs . . . . . . . . . . . . . . . . . 1219Kimberlie A. Graeme

62 Opioids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1237Scott Lucyk and Lewis S. Nelson

63 Salicylates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1251Steven C. Curry and Meghan B. Spyres

Part X Medications: Antimicrobial . . . . . . . . . . . . . . . . . . . . . . . . . . 1269

64 Chloroquine and Quinine . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1271Alison L. Jones

65 Isoniazid and Related Hydrazines . . . . . . . . . . . . . . . . . . . . . 1287Cynthia Koh, Alicia B. Minns, and Richard F. Clark

66 Rifampin, Dapsone, and Vancomycin . . . . . . . . . . . . . . . . . . . 1299Cyrus Rangan and Richard F. Clark

Part XI Medications: Hematologic . . . . . . . . . . . . . . . . . . . . . . . . . . 1311

67 Iron . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1313Sean M. Bryant and Jerrold B. Leikin

68 Oral Anticoagulants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1325George Sam Wang

69 Thrombolytics, Heparin and Derivatives,and Antiplatelet Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1341Robert A. Raschke and Steven C. Curry

Contents xvii

Part XII Medications: Miscellaneous . . . . . . . . . . . . . . . . . . . . . . . . 1361

70 Antidiabetic Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1363Jenna M. LeRoy and Samuel J. Stellpflug

71 Antitubulin Agents: Colchicine, Vinca Alkaloids, andPodophyllin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1387Jerry W. Snow, Louise W. Kao, and R. Brent Furbee

Part XIII Drugs of Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1411

72 Amphetamines and Their Derivatives . . . . . . . . . . . . . . . . . . 1413Nicholas J. Connors and Robert S. Hoffman

73 Arylcyclohexamines: Ketamine, Phencyclidine, andAnalogues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1439James H. Ho and Paul I. Dargan

74 Cathinones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1485Rachelle Abouchedid and David M. Wood

75 Cocaine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1525Ruben Olmedo, Christopher Yates, and Robert S. Hoffman

76 Gamma-Hydroxybutyrate and Its Related AnaloguesGamma-Butyrolactone and 1,4-Butanediol . . . . . . . . . . . . . . 1555David M. Wood

77 Hallucinogens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1587Curtis P. Snook

78 Synthetic Cannabinoid Receptor Agonists . . . . . . . . . . . . . . . 1609Andrew A. Monte

Part XIV Chemical Agents: Metals and Related Substances . . . 1617

79 Antimony and Nickel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1619Matthew D. Sztajnkrycer

80 Arsenic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1639Michael J. Kosnett

81 Cadmium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1669Jan Meulenbelt

82 Lead . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1675Michael J. Kosnett

83 Mercury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1705Irma de Vries

xviii Contents

84 Phosphorus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1719Emily B. Austin and Marco L. A. Sivilotti

85 Thallium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1733Sean H. Rhyee

Part XV Chemical Agents: Solvents, Glycols, and Alcohols . . . 1741

86 Ethylene Glycol and Other Glycols . . . . . . . . . . . . . . . . . . . . 1743Knut Erik Hovda, Kenneth McMartin, and Dag Jacobsen

87 Isopropyl Alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1761Heath A. Jolliff

88 Methanol and Formaldehyde . . . . . . . . . . . . . . . . . . . . . . . . . 1769Knut Erik Hovda, Kenneth McMartin, and Dag Jacobsen

Part XVI Chemical Agents: Pesticides . . . . . . . . . . . . . . . . . . . . . . . 1787

89 Chlorophenoxy Herbicides . . . . . . . . . . . . . . . . . . . . . . . . . . . 1789Sally M. Bradberry and J. Allister Vale

90 Fumigants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1797Matthew Zuckerman

91 Fungicides . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1811Annette M. Lopez and Daniel Sudakin

92 Organophosphate and Carbamate Insecticide . . . . . . . . . . . . 1829J. Allister Vale and Sally M. Bradberry

93 Paraquat and Diquat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1855Michael Eddleston

94 Phosphate and Phosphine . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1875Ashish Bhalla

95 Rodenticides . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1887Ryan Chuang and Jennie A. Buchanan

Part XVII Chemical Agents: Gases and Vapors . . . . . . . . . . . . . . . 1909

96 Carbon Monoxide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1911Christopher Hoyte

97 Cyanide: Hydrogen Cyanide, Inorganic Cyanide Salts, andNitriles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1929Steven C. Curry and Meghan B. Spyres

98 Hydrocarbons and Halogenated Hydrocarbons . . . . . . . . . . 1951Jakub Furmaga, Kurt Kleinschmidt, and Kapil Sharma

Contents xix

99 Hydrogen Sulfide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1963Aaron Skolnik and C. William Heise

100 Irritant and Toxic Pulmonary Injuries . . . . . . . . . . . . . . . . . . 1973Joseph K. Maddry

Part XVIII Chemical Agents: Caustics and Corrosives . . . . . . . . . 2003

101 Caustics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2005Diane P. Calello

102 Hydrofluoric Acid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2021Kennon Heard

Volume 3

Part XIX Natural Toxins: Marine . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2031

103 Ciguatera . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2033Shaun Greene

104 Marine Vertebrates, Cnidarians, and Mollusks . . . . . . . . . . . 2045L. Keith French and B. Zane Horowitz

105 Scombroid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2075Mark A. Suguitan and Rama B. Rao

106 Tetrodotoxin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2085Chen-Chang Yang

Part XX Natural Toxins: Mushrooms . . . . . . . . . . . . . . . . . . . . . . . . 2101

107 Overview of Mushroom Poisoning . . . . . . . . . . . . . . . . . . . . . 2103Michael C. Beuhler

108 Cyclopeptide-Containing Mushrooms: The DeadlyAmanitas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2129Thomas Zilker and Heinz Faulstich

109 Gyromitra Mushrooms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2149Daniel E. Brooks and Kimberlie A. Graeme

Part XXI Natural Toxins: Plants and Herbals . . . . . . . . . . . . . . . . . 2161

110 Overview of Plant and Herbal Toxicity . . . . . . . . . . . . . . . . . 2163Philip Aplin

111 Anticholinergic Plants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2175Robert N. E. French and Frank G. Walter

xx Contents

112 Cardiotoxic Plants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2187Barbarajean Magnani and Alan D. Woolf

113 Poison Hemlock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2205Frederick W. Fiesseler and Richard D. Shih

114 Toxalbumins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2213Jennifer A. Oakes and Richard Y. Wang

115 Water Hemlock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2225Edward W. Cetaruk

Part XXII Natural Toxins: Scorpions . . . . . . . . . . . . . . . . . . . . . . . . . 2237

116 Overview of Scorpion Envenoming . . . . . . . . . . . . . . . . . . . . 2239Julian White

117 Middle East and North African Scorpions . . . . . . . . . . . . . . . 2255Yona Amitai

118 North American Scorpions . . . . . . . . . . . . . . . . . . . . . . . . . . . 2269Michael Levine and Anne-Michelle Ruha

Part XXIII Natural Toxins: Snakes . . . . . . . . . . . . . . . . . . . . . . . . . . . 2277

119 Overview of Snake Envenoming . . . . . . . . . . . . . . . . . . . . . . . 2279Julian White

120 African Snakes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2319Jean-Philippe Chippaux, Julian White, andAbdulrazaq G. Habib

121 Asian Snakes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2343Aniruddha Ghose and Julian White

122 Australian and Pacific Snakes . . . . . . . . . . . . . . . . . . . . . . . . . 2405Julian White

123 European Snakes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2441Luc de Haro and David Boels

124 Non-Front-Fanged Colubroid Snakes . . . . . . . . . . . . . . . . . . 2453Scott A. Weinstein

125 North American Coral Snakes and Related Elapids . . . . . . . 2493Jeffrey N. Bernstein

126 Rattlesnakes and Other North American Crotalids . . . . . . . 2503Anne-Michelle Ruha

127 South and Central American Snakes . . . . . . . . . . . . . . . . . . . 2527Ceila Maria Sant’Ana Malaque and José María Gutiérrez

Contents xxi

Part XXIV Natural Toxins: Spiders . . . . . . . . . . . . . . . . . . . . . . . . . . 2549

128 Overview of Spider Envenoming . . . . . . . . . . . . . . . . . . . . . . 2551Julian White

129 Australian Funnel Web Spiders . . . . . . . . . . . . . . . . . . . . . . . 2565Julian White

130 Loxosceles Spiders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2577Ceila Maria Sant’Ana Malaque, Richard S. Vetter, andMarlene Entres

131 Widow and Related Lactrodectus Spiders . . . . . . . . . . . . . . . 2595Jeena Jacob and Julian White

Part XXV Natural Toxins: Miscellaneous . . . . . . . . . . . . . . . . . . . . 2607

132 Botulism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2609B. Zane Horowitz

133 Massive Bee Envenomation . . . . . . . . . . . . . . . . . . . . . . . . . . . 2627Hui Wen Fan and Jorge Kalil

Part XXVI Threat Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2637

134 Chemical Terrorism Incidents and Intensive Care . . . . . . . . 2639R. Steven Tharratt and Timothy E. Albertson

135 Nerve Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2655Mahdi Balali-Mood, Beeta Balali-Mood, andKia Balali-Mood

136 Sulfur Mustard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2683Dirk Steinritz and Horst Thiermann

Part XXVII Antidotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2713

137 Antidigitalis Fab Fragments . . . . . . . . . . . . . . . . . . . . . . . . . . 2715Bruno Mégarbane

138 Atropine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2725Robert N. E. French and Frank G. Walter

139 Calcium Edetate (Calcium Disodium EDTA) . . . . . . . . . . . . 2733Michael J. Kosnett

140 Cyanide-Binding Antidotes: Dicobalt Edetate andHydroxocobalamin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2737Vikhyat S. Bebarta

141 Cyproheptadine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2747Karen E. Simone

xxii Contents

142 Dantrolene . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2757Blaine E. Benson

143 Deferoxamine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2771F. Lee Cantrell

144 4-Dimethylamino Phenol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2779Thomas Zilker and Peter Eyer

145 Dimercaprol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2791Michael J. Kosnett

146 Ethanol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2795Tammi H. Schaeffer

147 Euglycemic Insulin Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . 2801Kristin Engebretsen

148 Flumazenil . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2811Allyson Kreshak and Stephen Munday

149 Folic and Folinic Acids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2819Michelle A. Hieger and S. Rutherfoord Rose

150 Fomepizole . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2829Kenneth McMartin, Knut Erik Hovda, and Dag Jacobsen

151 Immunotherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2843Steven A. Seifert and Brandon J. Warrick

152 Lipid Resuscitation Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . 2859Jeffrey Brent and Michael Levine

153 Methylene Blue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2867Jack Clifton II and Jerrold B. Leikin

154 N-Acetylcysteine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2879Eric Villeneuve and Sophie Gosselin

155 Nitrites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2889Bruce D. Anderson

156 Octreotide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2897Bryan D. Hayes

157 Opioid Receptor Antagonists . . . . . . . . . . . . . . . . . . . . . . . . . 2907Scott Lucyk and Lewis S. Nelson

158 Oximes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2913J. Allister Vale

159 D-Penicillamine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2929Cristy Eidelman and Jennifer A. Lowry

160 Pentetic Acid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2937Shikha Kapil and Ziad N. Kazzi

Contents xxiii

161 Physostigmine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2943William J. Boroughf

162 Prussian Blue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2957Pierre-André Dubé and Sophie Gosselin

163 Pyridoxine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2963Ashleigh Kennedy and Tammi H. Schaeffer

164 Sodium Bicarbonate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2967Sara K. Lookabill, Anna Rouse Dulaney,Greene Shepherd, and William P. Kerns II

165 Succimer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2987Michael J. Kosnett

166 Thiamine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2993Alfred Aleguas Jr.

167 Thiosulfate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3001F. Lee Cantrell

168 Unithiol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3005Michael J. Kosnett

Erratum to: Critical Care Toxicology – Diagnosis andManagement of the Critically Poisoned Patient . . . . . . . . . . . . . . . E1

Jeffrey Brent, Keith Burkhart, Paul Dargan, Benjamin Hatten,Bruno Megarbane, Robert Palmer, and Julian White

Appendix: Sympathomimetic Pressors . . . . . . . . . . . . . . . . . . . . . . 3009Jeffrey Brent

Grading System for Levels of Evidence SupportingRecommendations in Critical Care Toxicology, 2nd Edition . . . . . . 3017

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3019

xxiv Contents

About the Editors

Jeffrey Brent holds the rank of Distinguished Clinical Professor of Medicine,in the Division of Clinical Pharmacology and Toxicology, at the University ofColorado, School of Medicine. He holds secondary appointments in theDepartments of Emergency Medicine and Pediatrics and in the ColoradoSchool of Public Health.

Dr. Brent has received numerous awards and honors during his professionalcareer. Among these are multiple career achievement awards, including theLouis Roche Award by the European Association of Poisons Centres andClinical Toxicologists, the Career Achievement Award by the AmericanAcademy of Clinical Toxicology, the Ellenhorn Award by the AmericanCollege of Medical Toxicology, and the Clinical Translational ToxicologyCareer Achievement Award by the Society of Toxicology.

A former President of the American Academy of Clinical Toxicology,Dr. Brent has also served on the board of directors of the American Collegeof Medical Toxicology.

Dr. Brent has served as a consultant to the World Health Organization andto several US government agencies, including the Department of Health andHuman Services, and the National Vaccine Program. Currently, he is an activeconsultant with the US Food and Drug Administration.

Dr. Brent is Director of a large National Institutes of Health and Food andDrug Administration supported multicenter research group in clinical toxicol-ogy known as the Toxicology Investigators Consortium.

xxv

Keith K. Burkhart Dr. Burkhart is the Senior Advisor for Medical Toxicol-ogy and Lead Medical Officer for the Biomedical Informatics Team in theDivision of Applied Regulatory Science in the Office of Clinical Pharmacol-ogy within the Office of Translational Science in the Center for Drug Evalu-ation and Research at the FDA. He is board certified in Emergency Medicineand Medical Toxicology. He is a Clinical Professor of Emergency Medicine atthe Penn State University. He practices critical care toxicology at thePinnacleHealth Hospital System. He is the former Medical Director of thePenn State Poison Center. Dr. Burkhart received his medical toxicologytraining at the Rocky Mountain Poison Center in Denver. He received hisemergency medicine training at the University of Cincinnati. He is a graduateof the former Medical College of Pennsylvania, nowDrexel University. He is apast President of the American College of Medical Toxicology. His FDAworkfocuses upon using bioinformatics and cheminformatics tools to data mine theFDA Adverse Event Reporting System to learn mechanistic insights into drugsafety issues.

Paul Dargan Professor Paul I Dargan is a Consultant Physician and ClinicalToxicologist and Clinical Director at Guy’s and St Thomas’ NHS FoundationTrust, London, UK. He is also a Professor of Clinical Toxicology at King’sCollege London. He has an active research program with a focus on recrea-tional drug toxicity, new psychoactive substances, prescription medicine mis-use, self-poisoning (in particular, paracetamol/acetaminophen), and heavy

xxvi About the Editors

metal toxicity (in particular, lead). He has published over 250 peer-reviewedpapers and numerous book chapters. He is active in postgraduate training inclinical toxicology and in undergraduate education of medical students atKing’s College London Medical School. He is a board member of theEuropean Association of Poisons Control Centres and Clinical Toxicologists,and the Asia Pacific Association of Clinical Toxicology. He sits on the UKAdvisory Council on the Misuse of Drugs (ACMD) and the Scientific Com-mittee of the European Monitoring Centre for Drugs and Drugs Addiction(EMCDDA). He is an expert adviser to a number of other bodies, including theUS Food and Drug Administration (FDA) and the World Health Organization(WHO).

Benjamin Hatten Dr. Hatten received his M.D. in 2006 at the University ofTexas – Southwestern Medical Center in Dallas, TX. After completion of thisdegree, he entered residency in emergency medicine at Denver Health MedicalCenter in Denver, CO. Subsequently, he entered the medical toxicologyfellowship training at Oregon Health and Science University in Portland,OR. During his fellowship, he simultaneously obtained a Masters in PublicHealth in epidemiology and biostatistics. Upon completion of his fellowshipand M.P.H. degree, he returned to Denver in 2013 and joined the faculty at theUniversity of Colorado School of Medicine, the Rocky Mountain Poison andDrug Center, and Toxicology Associates. He is currently an Assistant Profes-sor at the University of Colorado School of Medicine with a primary appoint-ment in the Section of Medical Toxicology, Department of EmergencyMedicine. In addition, he is an attending physician at the Rocky MountainPoison and Drug Center as well as a member of Toxicology Associates, Prof.LLC – a hospital based, single specialty medical group dedicated solely tomedical toxicology. Dr. Hatten is board certified in both emergency medicineand medical toxicology.

About the Editors xxvii

Bruno Mégarbane is Professor of Critical Care Medicine at Paris DiderotUniversity and directs a research team at INSERM UMRS-1144. He is theHead of the Department of Medical and Toxicological Critical Care atLariboisière Hospital, Assistance Publique – Hôpitaux de Paris, in Paris,France. He is the current President of the European Association of PoisonsCentres and Clinical Toxicologists (EAPCCT). He conducted several clinicaland experimental studies in clinical toxicology, mainly regarding mechanismsof opioid-related respiratory toxicity, prognostic factors of life-threateningpoisonings, and management of refractory cardiotoxicant poisonings usingECMO. He is a member of the EXTRIP group and an Associate Editor forClinical Toxicology.

Robert Palmer Clinical Assistant Professor, Medical Toxicology, EmergencyMedicine, School of Medicine, University of Colorado, Aurora, CO, USA.Attending Toxicologist and Faculty, Medical Toxicology Fellowship Program,Rocky Mountain Poison and Drug Center, Denver Health and HospitalsAuthority, Denver, CO, USA.

Dr. Robert Palmer received his undergraduate degree in chemistry from theUniversity of Idaho. His M.S. and Ph.D. degrees were obtained in organic-medicinal chemistry from the University of Washington in Seattle. He com-pleted a postdoctoral appointment at the University of Washington HealthSciences Center, followed by joining the faculty at the University of NewMexico in Albuquerque. Dr. Palmer then relocated to Colorado and completeda fellowship in clinical toxicology at the Rocky Mountain Poison and DrugCenter (RMPDC) in Denver, CO. He is board certified in clinical toxicology

xxviii About the Editors

and an elected Fellow of the American Academy of Clinical Toxicology.Dr. Palmer maintains a faculty position at RMPDC teaching in the medicaltoxicology fellowship program, as well as serving as an attending toxicologiston the medical toxicology clinical service. He is a member of multiple medicaland scientific associations and lectures locally, nationally, and internationally.He has authored over 50 scientific papers and more than 30 book chapters.Among his clinical and research interests are postmortem toxicology andopioid abuse.

Julian White is Professor and Head of Toxinology at the Women’s andChildren’s Hospital, Adelaide, Australia. He has been treating cases ofenvenoming since he graduated from the University of Adelaide MedicalSchool over 40 years ago and in 1990 was invited to found the ToxinologyDept., WCH. Author of hundreds of papers, monographs, book chapters, andbooks, mostly on aspects of toxinology, he is internationally known for hiswork as a clinical toxinologist and has presented at many international meet-ings, mostly by invitation. In 1997, he co-founded the Clinical ToxinologyShort Course, through the University of Adelaide, and this internationallyrecognized course, the only one of its type, is run every 2 years, plus mini-versions at selected medical meetings, and attracts both an international expertfaculty and doctors attending from many nations. Julian has been involved inaspects of venom research and clinical research throughout most of his career.Since 1994, he has been the national consultant on envenoming for the soleAustralian antivenom producer, CSL Ltd (now Seqirus), via his hospital(WCH; he is not paid by CSL/Seqirus). He has been an occasional consultanton clinical toxinology to WHO since about 1988 and to Australian PoisonsInformation Centres since the 1990s. A current focus of his activity is theMyanmar Snakebite Project, a large foreign aid project, funded by theAustralian Government, aiming to improve outcomes for snakebite patientsin that country. He is also developing a higher-level training program forclinical toxinology at the international level, through his role as Chair of theBoard of Clinical Toxinology of the International Society on Toxinology

About the Editors xxix

(IST); he is also Secretary of IST and is on the editorial board of Toxicon.He founded the Clinical Toxinology Resources Website (www.toxinology.com) in 2002. In 2015, he was presented with an award for “OutstandingContribution to Medicine” by the Australian Medical Association and in 2016was made a Member of the Order of Australia (AM) for his work in clinicaltoxinology. Julian is married, has two adult children, and lives with his wife inthe Adelaide Hills, when not traveling overseas to meetings.

xxx About the Editors

Contributors

Cynthia K. Aaron Michigan Regional Poison Control Center, Children’sHospital Michigan, Detroit, MI, USA

Rachelle Abouchedid Clinical Toxicology and Emergency Medicine, Guy’sand St Thomas’ NHS Foundation Trust and King’s Health Partners, London,UK

Timothy E. Albertson Internal Medicine, UC Davis School of Medicine,Davis, CA, USA

Alfred Aleguas Jr. Florida Poison Information Center – Tampa, Tampa, FL,USA

Yona Amitai Department of Management, Bar Ilan University, Jerusalem,Israel

Bruce D. Anderson School of Pharmacy, University of Maryland-Baltimore,Baltimore, MD, USA

Philip Aplin Emergency Medicine, Flinders Medical Centre, Adelaide,South Australia, Australia

Emily B. Austin Division of Emergency Medicine, University of Toronto,Toronto, ON, Canada

Beeta Balali-Mood MoodBioPharm, London, UK

Kia Balali-Mood Workstream Lead, Medical Business Intelligence atBoehringer Ingelheim Pharma, London, UK

Mahdi Balali-Mood Medical Toxicology Research Centre, Faculty of Med-icine, Mashhad University of Medical Sciences, Mashhad, Iran

D. Nicholas Bateman Pharmacology, Toxicology and Therapeutics, TheUniversity of Edinburgh-College of Medicine and Veterinary Science, Edin-burgh, UK

Carl R. Baum Pediatrics and Department to Pediatric Emergency Medicineand Medical Toxicology, Yale University, New Haven, CT, USA

Vikhyat S. Bebarta Department of Emergency Medicine, University ofColorado Denver – Anschutz Medical Campus, Aurora, CO, USA

xxxi

Neal Benowitz Department of Medicine, University of California SanFrancisco School of Pharmacy, San Francisco, CA, USA

Blaine E. Benson National Capital Poison Center, Washington, DC, USA

Yedidia Bentur Israel Poison Information Center, Clinical Pharmacologyand Toxicology Section, Rambam Health Care Campus, The RappaportFaculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel

Jeffrey N. Bernstein Miller School of Medicine, University of Miami,Miami, FL, USA

Michael C. Beuhler Carolinas Poison Center, Department of EmergencyMedicine, Carolinas Medical Center, Charlotte, NC, USA

Ashish Bhalla Department of Internal Medicine, Post Graduate Institute ofMedical Education and Research, Chandigarh, India

David Boels Toxicovigilance Unit, Poison Centre of Angers, Angers, France

William J. Boroughf Emergency Medicine, University of Colorado Schoolof Medicine, Denver, CO, USA

Stephen W. Borron Medical Toxicology, Texas Tech University, El Paso,TX, USA

Edward W. Boyer Department of Emergency Medicine, University of Mas-sachusetts Medical School, Worcester, MA, USA

Sally M. Bradberry National Poisons Information Service (BirminghamUnit), City Hospital, Birmingham, UK

School of Biosciences, University of Birmingham, Birmingham, UK

Jeffrey Brent Department of Medicine, Division of Clinical Pharmacologyand Toxicology, University of Colorado, School of Medicine, Aurora, CO,USA

Daniel E. Brooks Department of Medical Toxicology, Banner - UniversityMedical Center, Phoenix, AZ, USA

Rebecca E. Bruccoleri Program in Medical Toxicology, Division of Emer-gency Medicine, Children’s Hospital Boston, Boston, MA, USA

Sean M. Bryant Cook County Hospital (Stroger), Chicago, IL, USA

Jennie A. Buchanan Staff Physician Denver Health and Hospital AuthorityDepartment of Emergency Medicine, Rocky Mountain Poison and DrugCenter, Denver, CO, USA

Division of Medical Toxicology/Department of Emergency Medicine, Uni-versity of Colorado, Boulder, CO, USA

Keith Burkhart FDA, Office of New Drugs/Immediate Office, Center forDrug Evaluation and Research, Silver Spring, MD, USA

Michael J. Burns Division of Toxicology, Department of Emergency Med-icine, Beth Israel Deaconess Medical Center, Boston, MA, USA

xxxii Contributors

Diane P. Calello New Jersey Poison Information and Education System,Department of Emergency Medicine, New Jersey Medical School, RutgersBiomedical and Health Sciences, Newark, NJ, USA

F. Lee Cantrell School of Pharmacy, University of California, San Francisco,San Francisco, CA, USA

Andrea Carlson Advocate Christ Medical Center, Oak Lawn, IL, USA

Gregory L. Carter School of Medicine and Public Health, The University ofNewcastle Australia, Callaghan, Newcastle, Australia

Edward W. Cetaruk School of Medicine, Division of Clinical Pharmacol-ogy and Toxicology, University of Colorado - Denver, Aurora, CO, USA

Peter R. Chai Department of Emergency Medicine, University of Massa-chusetts Medical School, Worcester, MA, USA

Jean-Philippe Chippaux UMR MERIT, Institut de Recherche pour leDéveloppement, Cotonou, Benin

Sorbonne Paris Cité, Faculté de Pharmacie, Université Paris Descartes, Paris,France

Ryan Chuang Poison and Drug Information Service (PADIS), AlbertaHealth Services, Calgary, Alberta, USA

Department of Emergency Medicine, University of Calgary, Calgary, Alberta,USA

Richard F. Clark University of California San Diego, School of Medicine,San Diego, CA, USA

Jack Clifton II ACPRU and Clinical Pharmacology Medical Department,AbbVie Clinical Pharmacology Research Unit, Grayslake, IL, USA

Nicholas J. Connors Division of Emergency Medicine, Medical Universityof South Carolina, Charleston, SC, USA

Monique J. Cormier Department of Nephrology, University of Montreal,Verdun Hospital, Verdun, QC, Canada

Kirk L. Cumpston Division of Clinical Toxicology, Department of Emer-gency Medicine, Virginia Commonwealth University Health System, Rich-mond, VA, USA

Steven C. Curry Department of Medical Toxicology, Banner – UniversityMedical Center Phoenix, Phoenix, AZ, USA

Kim Dalhoff Department of Clinical Pharmacology, Bispebjerg and Freder-iksberg University Hospital, Copenhagen, Denmark

Paul I. Dargan Clinical Toxicology, Guy’s and St Thomas’NHS FoundationTrust, London, UK

G. Patrick Daubert Department of Emergency Medicine for the KaiserPermanente South Sacramento Medical Center, Kaiser Permanente Northern

Contributors xxxiii

California Regional Toxicology Service, Sacramento, CA, USA

Andrew H. Dawson Sydney Medical School, The University of Sydney,Sydney, NSW, Australia

Luc de Haro Toxicovigilance Unit, Poison Centre of Marseille, Marseille,France

Dylan W. de Lange Department of Intensive Care Medicine and the DutchNational Poison Information Center, (NPIC) of the University Medical Center,University Utrecht, Utrecht, The Netherlands

Irma de Vries National Poisons Information Center, University MedicalCenter Utrecht, Utrecht, The Netherlands

Bradley L. Demeter Harvard Medical Toxicology Fellow, Children’s Hos-pital, Boston, MA, USA

J. Ward Donovan Emergency Medicine, Penn State University, Hershey,PA, USA

Stephen C. Dreskin Division of Allergy and Clinical Immunology, Depart-ment of Medicine, University of Colorado Denver – Anschutz Medical Cam-pus, Aurora, CO, USA

Pierre-André Dubé Department of Environmental Health and Toxicology,Institut national de santé publique du Québec, QC, Canada

Faculty of Pharmacy, Université Laval, QC, Canada

Anna Rouse Dulaney Clinical Toxicology, Carolinas Poison Center andCarolinas Medical Center, Charlotte, NC, USA

Michael Eddleston Pharmacology, Toxicology and Therapeutics, The Uni-versity of Edinburgh, Edinburgh, UK

Cristy Eidelman Pharmacology and Toxicology, Children’s Mercy HospitalKansas City, Kansas City, MO, USA

M. P. Emswiler Department of Emergency Medicine, Toxicology, VirginiaCommonwealth University, Richmond, VA, USA

Kristin Engebretsen Department of Emergency Medicine, Regions Hospi-tal, Minneapolis, MN, USA

Marlene Entres Center for Poisoning Control, Federal University of Paraná,Curitiba, Brazil

Timothy B. Erickson Division of Medical Toxicology, Department of Emer-gency Medicine, Brigham and Women’s Hospital Faculty, Harvard MedicalSchool and Harvard Humanitarian Initiative, Boston, MA, USA

Florian Eyer Department of Clinical Toxicology, Klinikum rechts der Isar –Technical University of Munich, Munich, Germany

xxxiv Contributors

Peter Eyer Walther-Straub-Institute of Pharmacology and Toxicology,Ludwig-Maximilians-University, Munich, Germany

Hui Wen Fan Instituto Butantan, São Paulo, Brazil

Brenna Farmer Weil Cornell Medical College, New York, NY, USA

Heinz Faulstich Max-Planck-Institut für medizinische Forschung, Heidel-berg, Germany

Frederick W. Fiesseler Department of Emergency Medicine, MorristownMedical Center, Morristown, NJ, USA

Robert N. E. French Department of EmergencyMedicine, The University ofArizona, Tucson, AZ, USA

L. Keith French Department of Emergency Medicine, Oregon Health Sci-ences University, Portland, Oregon, USA

R. Brent Furbee Department of Emergency Medicine / Division of MedicalToxicology, Indiana University School of Medicine, Indianapolis, IN, USA

Jakub Furmaga Emergency Medicine, The University of Texas Southwest-ern Medical Center, Dallas, TX, USA

Ann-Jeannette Geib Rutgers Robert Wood Johnson Medical School,Rutgers University, New Brunswick, NJ, USA

Marc Ghannoum Department of Nephrology, University of Montreal, Ver-dun Hospital, Verdun, QC, Canada

Aniruddha Ghose Department of Medicine, Chittagong Medical College,Chittagong, Bangladesh

Sophie Gosselin Department of Medicine and Emergency Medicine, McGillUniversity Health Centre, Montreal, QC, Canada

Kimberlie A. Graeme Medical Toxicology, Banner — University MedicalCenter, Phoenix, AZ, USA

Andis Graudins Clinical Toxicology and Emergency Medicine, School ofClinical Sciences at Monash Health, Monash University and Monash Health,Dandenong, VIC, Australia

Shaun Greene Victorian Poisons Information Centre, Heidelberg, VIC,Australia

Hallam Gugelmann Clinical Pharmacy, University of California SanFrancisco School of Pharmacy, San Francisco, CA, USA

José María Gutiérrez Instituto Clodomiro Picado, Facultad de Micro-biología, Universidad de Costa Rica, San José, Costa Rica

Peter Eyer and Heinz Faulstich are retired.

Contributors xxxv

Jonas Höjer Karolinska Institute, Swedish Poisons Information Centre,Stockholm, Sweden

Abdulrazaq G. Habib Infectious and Tropical Diseases Unit, College ofHealth Sciences, Bayero University, Kano, Nigeria

Dorothea Hall Department of Anesthesiology and Perioperative Medicine,UCLA, David Geffen School of Medicine, Los Angeles, CA, USA

Philippe E. Hantson Louvain Centre for Toxicology and Applied Pharma-cology, Catholic University of Louvain, Louvain, Belgium

Bryan D. Hayes Department of Pharmacy, Department of Emergency Med-icine Massachusetts General Hospital, Harvard Medical School, Boston, MA,USA

Kennon Heard School of Medicine, Emergency Medicine and MedicalToxicology and Pharmacology, University of Colorado-Denver, Aurora, CO,USA

Alan C. Heffner Department of Internal Medicine, Department of Emer-gency Medicine, Carolinas Medical Center, Charlotte, NC, USA

C. William Heise Center for Toxicology and Pharmacology Education andResearch, University of Arizona College of Medicine Phoenix, Phoenix, AZ,USA

Department of Medical Toxicology, Banner – UMCP, Phoenix, AZ, USA

Michelle A. Hieger VCU Health System, Richmond, VA, USA

James H. Ho Clinical Toxicology, Guy’s and St. Thomas’ NHS FoundationTrust, London, UK

Robert J. Hoffman Emergency Medicine, Sidra Medical and ResearchCenter, Doha, Qatar

Robert S. Hoffman Ronald O. Perelman Department of EmergencyMedicine, NYU Langone Medical Center, New York, NY, USA

Michael G. Holland Emergency Medicine, State University of New York,Upstate Medical University, Syracuse, NY, USA

B. Zane Horowitz Department of Emergency Medicine, Oregon Health andScience University, Portland, OR, USA

Knut Erik Hovda The Norwegian CBRNE Centre of Medicine, Departmentof Acute Medicine, Medical Division, Oslo University Hospital, Oslo,Norway

Christopher Hoyte UC Denver, Aurora, CO, USA

Chia Wei Hsu University of Texas Medical Branch, School of Medicine,Galveston, TX, USA

Janetta L. Iwanicki Medical Toxicology, Rocky Mountain Poison and DrugCenter, Denver, CO, USA

xxxvi Contributors

Jeena Jacob Medical Toxicology/Emergency Medicine, North Shore Uni-versity Hospital, Manhasset, NY, USA

Dag Jacobsen Department of Acute Medicine, Division of Medicine, OsloUniversity Hospital, Oslo, Norway

Heath A. Jolliff Wexner Medical Center, Ohio State University, Columbus,OH, USA

Alison L. Jones Faculty of Science, Medicine and Health, University ofWollongong, Wollongong, NSW, Australia

Prashant Joshi Paul L. Foster School of Medicine, Texas Tech UniversityHealth Sciences Center El Paso, El Paso, TX, USA

David Juurlink Departments of Medicine and Pediatrics, University ofToronto, Toronto, ON, Canada

Jorge Kalil Instituto Butantan, São Paulo, Brazil

Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil

A. Min Kang Department of Medical Toxicology, Banner – UniversityMedical Center Phoenix, Phoenix, AZ, USA

Louise W. Kao Department of Emergency Medicine, Indiana UniversitySchool of Medicine, Indianapolis, IN, USA

Shikha Kapil Department of Emergency Medicine, Emory UniversitySchool of Medicine, Atlanta, GA, USA

Kenneth D. Katz University of South Florida Morsani School of Medicine,Tampa, FL, USA

Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA

Medical Toxicology and Emergency Medicine Core Faculty, Lehigh ValleyHealth Network, Allentown, PA, USA

Ziad N. Kazzi Department of Emergency Medicine, Emory UniversitySchool of Medicine, Atlanta, GA, USA

Ashleigh Kennedy Department of Emergency Medicine, Maine MedicalCenter, Portland, ME, USA

William P. Kerns II Division of Medical Toxicology, Department of Emer-gency Medicine Carolinas Medical Center, Charlotte, NC, USA

Andrew M. King Emergency Medicine, Wayne State University School ofMedicine, Detroit, MI, USA

Joshua D. King Department of Medicine, Division of Nephrology; Depart-ment of Emergency Medicine, Division of Medical Toxicology, University ofVirginia, Charlottesville, VA, USA

Kurt Kleinschmidt Emergency Medicine, The University of Texas South-western Medical Center, Dallas, TX, USA

Cynthia Koh University of California, San Diego, San Diego, CA, USA

Contributors xxxvii

Michael J. Kosnett Division of Clinical Pharmacology and Toxicology,Department of Medicine, University of Colorado School of Medicine, Aurora,CO, USA

Department of Environmental and Occupational Health, Colorado School ofPublic Health, Aurora, CO, USA

Allyson Kreshak Department of Emergency Medicine, University of Cali-fornia, San Diego Health Sciences, La Jolla, CA, USA

Eric J. Lavonas Department of Emergency Medicine and Rocky MountainPoison and Drug Center, Denver Health and Hospital Authority, Denver, CO,USA

Department of Emergency Medicine, University of Colorado School of Med-icine, Aurora, CO, USA

Hwee Min Lee Monash Emergency Medicine, Monash Health Clinical Tox-icology and Addiction Medicine Service, Melbourne, VIC, Australia

Jerrold B. Leikin University of Chicago Pritzker School of Medicine, Glen-view, IL, USA

Jenna M. LeRoy Emergency Medicine, Regions Hospital, Minneapolis,MN, USA

Michael Levine Medical Toxicology, Banner Good Samaritan Medical Cen-ter, Phoenix, AZ, USA

Department of Emergency Medicine, Division of Medical Toxicology, Uni-versity of Southern California, Los Angeles, CA, USA

Sara K. Lookabill Clinical Toxicology, Carolinas Poison Center and Caro-linas Medical Center, University of North Carolina Eshelman School ofPharmacy, Charlotte, North Carolina, USA

Annette M. Lopez Department of Emergency Medicine, Oregon HealthSciences University, Portland, OR, USA

Frank LoVecchio Medical Toxicology, Banner Poison and Drug InformationCenter, Phoenix, AZ, USA

Jennifer A. Lowry Section of Toxicology Pediatrician, Department of Pedi-atrics, Children’s Mercy Hospital, Kansas City, MO, USA

Scott Lucyk Department of Emergency Medicine, New York University,New York, NY, USA

Yael Lurie Israel Poison Information Center, Clinical Pharmacology andToxicology Section, Rambam Health Care Campus, The Rappaport Facultyof Medicine, Technion-Israel Institute of Technology, Haifa, Israel

Michael Lynch University of Pittsburgh, Pittsburgh, PA, USA

Bruno Mégarbane Department of Medical and Toxicological Critical Care,Lariboisière Hospital, Paris-Diderot University, Paris, France

xxxviii Contributors

Joseph K. Maddry Medical Toxicology, San Antonio Military MedicalCenter, San Antonio, TX, USA

Barbarajean Magnani Department of Pathology and Laboratory Medicine,Tufts Medical Center, Boston, MA, USA

Eric R. Malone Detroit Medical Center, Detroit, MI, USA

Kevin F. Maskell Jr. Division of Clinical Toxicology, Department of Emer-gency Medicine, Virginia Commonwealth University Health System, Rich-mond, VA, USA

Madeline L. McCarthy Pediatrics and Department to Pediatric EmergencyMedicine, Yale University, New Haven, CT, USA

Kenneth McMartin Department of Pharmacology, Toxicology and Neuro-science, Louisiana State University Health Sciences Center - Shreveport,Shreveport, LA, USA

Jan Meulenbelt National Institute for Public Health and the Environment,Utrecht, The Netherlands

Kirk C. Mills Emergency Medicine, Wayne State University, Detroit, MI,USA

Alicia B. Minns University of California, San Diego, San Diego, CA, USA

Andrew A. Monte University of Colorado School of Medicine, Aurora, CO,USA

Philip Moore Associates in Medical Toxicology, Harrisburg, PA, USA

Stephen Munday Sharp-Rees-Stealy Medical Group, San Diego, CA, USA

Lewis S. Nelson Rutgers New Jersey Medical School, New York, NewJersey, USA

Department of Emergency Medicine, New York University, New York, NY,USA

Ayrn D. O’Connor Department of Medical Toxicology, Banner –UniversityMedical Center Phoenix, Phoenix, AZ, USA

Department of Emergency Medicine, University of Arizona College of Med-icine Phoenix, Phoenix, AZ, USA

Jennifer A. Oakes Emergency Medicine and Medical Toxicology, KaweahDelta Medical Center, University of California, Irvine, Visalia, CA, USA

Ruben Olmedo Medical Toxicology – Emergency Medicine, The MountSinai Hospital, New York, NY, USA

Anthony F. Pizon University of Pittsburgh Medical Center, Division ofMedical Toxicology, Department of Emergency Medicine, Pittsburgh, PA,USA

Cyrus Rangan Bureau of Toxicology and Environment, Los AngelesCounty of Public Health, Los Angeles, CA, USA

Contributors xxxix

Rama B. Rao Weill Cornell Medical College, Cornell University, New York,NY, USA

Robert A. Raschke Critical Care Services, Banner Good Samaritan MedicalCenter, Phoenix, AZ, USA

J. J. Rasimas Hennepin County Medical Center, Minneapolis, MN, USA

Sean H. Rhyee Department of Emergency Medicine, University of Massa-chusetts Medical School, Worchester, MA, USA

Jon C. Rittenberger University of Pittsburgh, Pittsburgh, PA, USA

S. Rutherfoord Rose Division of Clinical Toxicology, Department of Emer-gency Medicine, Virginia Commonwealth University Health, Richmond, VA,USA

Harvey Rosenbaum Department of Anesthesiology and Perioperative Med-icine, UCLA, David Geffen School of Medicine, Los Angeles, CA, USA

Henry Rosenberg Department of Medical Education and Clinical Research,Saint Barnabas Medical Center, Livingston, NJ, USA

Mitchell P. Ross Critical Care Medicine, Providence Pediatric Intensive CareUnit St Vincent, Portland, OR, USA

Anne-Michelle Ruha Medical Toxicology, Banner – University MedicalCenter Phoenix, Phoenix, AZ, USA

Ceila Maria Sant’Ana Malaque Vital Brazil Hospital, Instituto Butantan,São Paulo, Brazil

Intensive Care Unit, Instituto de Infectologia Emilio Ribas, São Paulo, Brazil

Tammi H. Schaeffer Department of Emergency Medicine, Division ofMedical Toxicology, Maine Medical Center, Portland, ME, USA

Tufts University School of Medicine, Boston, MA, USA

Evan S. Schwarz Emergency Medicine, Washington University, St Louis,MO, USA

Donna Seger School of Medicine, Vanderbilt University, Nashville, TN,USA

Steven A. Seifert Department of Emergency Medicine, and New MexicoPoison and Drug Information Center, University of New Mexico HealthSciences Center, Albuquerque, NM, USA

Kapil Sharma Emergency Medicine, The University of Texas SouthwesternMedical Center, Dallas, TX, USA

Adhi N. Sharma Medical Affairs, South Nassau Communities Hospital,Healthy Way, Oceanside, NY, USA

Emergency Medicine, Hofstra Northwell School of Medicine, Hempstead,NY, USA

xl Contributors

Greene Shepherd Eshelman School of Pharmacy, University of North Car-olina, Chapel Hill, NC, USA

Richard D. Shih Division of Emergency Medicine, Florida Atlantic Univer-sity – Charles E. Schmidt College of Medicine, Boynton Beach, FL, USA

Karen E. Simone Northern New England Poison Center, MaineHealth/Maine Medical Center, Portland, ME, USA

Marco L. A. Sivilotti Departments of Emergency Medicine, and of Biomed-ical and Molecular Sciences, Queen’s University, Kingston, ON, Canada

Aaron Skolnik Department of Critical Care Medicine, University of Pitts-burgh, Pittsburgh, PA, USA

SilasW. Smith Division ofMedical Toxicology, Ronald O. Perelman Depart-ment of EmergencyMedicine, NYU School ofMedicine, NewYork, NY, USA

Wayne R. Snodgrass Department of Pediatrics, The University of TexasMedical Branch at Galveston, Galveston, TX, USA

Curtis P. Snook Medicine, Geisel School ofMedicine,White River Junction,VT, USA

Jerry W. Snow Department of Emergency Medicine / Division of MedicalToxicology, Indiana University School of Medicine, Indianapolis, IN, USA

Meghan B. Spyres Department of Medical Toxicology, Banner – UniversityMedical Center Phoenix, Phoenix, AZ, USA

Dirk Steinritz Bundeswehr Institute of Pharmacology and Toxicology,Munich, Germany

Samuel J. Stellpflug Medical School, University ofMinnesota, Minneapolis,MN, USA

Erin Stewart Kerlan-Jobe Orthopaedic Clinic, Los Angeles, CA, USA

Jenny M. Stitt Division of Allergy and Clinical Immunology, Department ofMedicine, University of Colorado Denver – Anschutz Medical Campus,Aurora, CO, USA

Maude St-Onge Department of Family Medicine and Emergency Medicine,Université Laval / Quebec Poison Centre, Quebec city, QC, Canada

Mark K. Su New York City Poison Control Center, NY, USA

New York University School of Medicine, NY, USA

Daniel Sudakin Environmental and Molecular Toxicology, Oregon StateUniversity, Corvallis, OR, USA

Mark A. Suguitan Emergency Medicine, New York-Presbyterian Hospital,New York, NY, USA

Greg S. Swartzentruber University of Pittsburgh Medical Center, Divisionof Medical Toxicology, Department of Emergency Medicine, Pittsburgh, PA,USA

Contributors xli

Matthew D. Sztajnkrycer Mayo Clinic, Rochester, MN, USA

Minnesota Poison Control System, Minneapolis, MN, USA

R. Steven Tharratt Pulmonary, Critical Care, and SleepMedicine, UCDavisMedical Center, Sacramento, CA, USA

Horst Thiermann Bundeswehr Institute of Pharmacology and Toxicology,Munich, Germany

Anthony J. Tomassoni EmergencyMedicine, Yale School of Medicine, YaleNew Haven Center for Emergency Preparedness and Disaster Response, NewHaven, CT, USA

Laura M. Tormoehlen Clinical Emergency Medicine and Neurology, Indi-ana University School of Medicine, Indianapolis, IN, USA

J. Allister Vale National Poisons Information Service (Birmingham Unit),City Hospital, Birmingham, UK

School of Biosciences, University of Birmingham, Birmingham, UK

Richard S. Vetter Department of Entomology, University of California,Riverside, CA, USA

Eric Villeneuve Department of Pharmacy, McGill University Health Centre,Montreal, QC, Canada

Steven J. Walsh Division of Medical Toxicology, Einstein Medical Center,Philadelphia, PA, USA

Frank G. Walter Department of Emergency Medicine, The University ofArizona, Tucson, AZ, USA

George Sam Wang Department of Pediatrics, University of ColoradoAnschutz Medical Campus, Children’s Hospital Colorado, Aurora, CO, USA

Richard Y. Wang National Center for Environmental Health, Centers forDisease Control and Prevention, Atlanta, Georgia, USA

Brandon J.Warrick Department of Emergency Medicine, and NewMexicoPoison and Drug Information Center, University of New Mexico HealthSciences Center, Albuquerque, NM, USA

Scott A. Weinstein Clinical and Research Toxinologist/Family Physician,Women’s and Children’s Hospital, Adelaide, SA, Australia

Julian White Toxinology Department, Women’s and Children’s Hospital,North Adelaide, Australia

David M. Wood Clinical Toxicology, Guy’s and St. Thomas’ NHS Founda-tion Trust and King’s Health Partners, London, UK

Clinical Toxicology, Faculty of Life Sciences and Medicine, King’s CollegeLondon, London, UK

Alan D. Woolf Pediatric Environmental Health Center, Division of GeneralPediatrics, Boston Children’s Hospital, Boston, MA, USA

xlii Contributors

Peter Wu Department of Medicine, University Health Network, Universityof Toronto, Toronto, ON, Canada

Chen-Chang Yang Clinical Toxicology and Occupational Medicine, Depart-ment of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

Joseph H. Yanta University of Pittsburgh Medical Center, Division of Med-ical Toxicology, Department of Emergency Medicine, Pittsburgh, PA, USA

Christopher Yates Emergency Medicine Department, Clinical ToxicologyUnit, Hospital Universitari Son Espases, Palma de Mallorca, Spain

Luke Yip Denver Health, Rocky Mountain Poison and Drug Center Depart-ment of Medicine, Section of Medical Toxicology Denver, Colorado, USA

Thomas Zilker Clinical Toxicology, Technical University of Munich,Munich, Germany

Matthew Zuckerman Department of Emergency Medicine, University ofColorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA

Thomas Zilker is retired.

The original version of this book was revised. An erratum to this book can be found at https://doi.org/10.1007/978-3-319-17900-1_186

Contributors xliii