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Do not treat prophylactically with vitamin K wait for evidence of anticoagulation (elevated prothrombin time) If the INR is elevated, give phytonadione (vitamin K1), 10 25 mg orally, and additional doses as needed to restore the prothrombin time to normal Doses as high as 200 mg/d have been required after ingestion of superwarfarins Give freshfrozen plasma or activated Factor VII as needed to rapidly correct the coagulation factor deficit if there is serious bleeding If the patient is chronically anticoagulated and has strong medical indications for being maintained in that status (eg, prosthetic heart valve), give much smaller doses of vitamin K (1 mg orally) and fresh-frozen plasma (or both) to titrate to the desired prothrombin time If the patient has ingested brodifacoum or a related superwarfarin, prolonged observation (over weeks) and repeated administration of large doses of vitamin K may be required

Dolin EK et al A 44-year-old woman with hematemesis and cutaneous hemorrhages as a result of superwarfarin poisoning J Am Osteopath Assoc 2006 May;106(5):280 4 [PMID: 16717370] Watt BE et al Anticoagulant rodenticides Toxicol Rev 2005;24 (4):259 69 [PMID: 16499407]

Maintain a patent airway and assist ventilation, if necessary Treat coma or seizures as described at the beginning of this chapter Rapidly lower the body temperature (see hyperthermia, p 1361) in patients who are hyperthermic (40 C)

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Treat agitation, psychosis, or seizures with a benzodiazepine such as lorazepam, 2 3 mg intravenously Add phenobarbital 15 mg/kg intravenously for persistent seizures Treat hypertension with a vasodilator drug such as phentolamine (1 5 mg intravenously) or a combined - and -adrenergic blocker such as labetalol (10 20 mg intravenously) Do not administer a pure -blocker such as propranolol alone, as this may result in paradoxic worsening of the hypertension as a result of unopposed -adrenergic effects Treat tachycardia or tachyarrhythmias with a short-acting -blocker such as esmolol (25 100 mcg/kg/min by intravenous infusion) Treat hyperthermia as described above Treat hyponatremia as outlined in 21

Hendrickson RG et al Parachuting meth: a novel delivery method for methamphetamine and delayed-onset toxicity from body stuffing Clin Toxicol (Phila) 2006;44(4):379 82 [PMID: 16809139] Rusyniak DE et al Toxin-induced hyperthermic syndromes Med Clin North Am 2005 Nov;89(6):1277 96 [PMID: 16227063]

It is often necessary to block specific customer master records This may be due to the fact that you have blacklisted a customer, or there may be a trade negotiation in place in which you wish to temporarily restrict sales Whatever the reason, it is possible to block customer master records from creating either sales orders, deliveries, or billing documents in specific sales areas or all sales areas To set the block on a customer master record, as seen in Figure 10-21, use the following menu path

Anticonvulsants (carbamazepine, phenytoin, valproic acid, and many newer agents) are widely used in the management of seizure disorders In addition, carbamazepine and valproic acid are increasingly used for treatment of mood disorders Phenytoin can be given orally or intravenously Rapid intravenous injection of phenytoin can cause acute myocardial depression and cardiac arrest owing to the solvent propylene glycol; a newer form of phenytoin (fosphenytoin) is available that does not contain this diluent Chronic phenytoin intoxication can occur following only slightly increased doses because of zero-order kinetics and a small toxic-therapeutic window Phenytoin intoxication can also occur following acute intentional or accidental overdose The overdose syndrome is usually mild even with high serum levels The most common manifestations are ataxia, nystagmus, and drowsiness Choreoathetoid movements have been described Carbamazepine is used for treatment of trigeminal neuralgia, temporal lobe epilepsy, and other seizure disorders Intoxication causes drowsiness, stupor and, with high levels, coma and seizures Dilated pupils and tachycardia are common Toxicity may be seen with serum levels greater than 20 mg/L, though severe poisoning is usually associated with concentrations greater than 30 40 mg/L Because of erratic and slow absorption, intoxication may progress over several hours to days Valproic acid intoxication produces a unique syndrome consisting of hypernatremia (from the sodium component of the salt), metabolic acidosis, hypocalcemia, elevated serum ammonia, and mild liver aminotransferase elevation Hypoglycemia may occur as a result of hepatic metabolic dysfunction Coma with small pupils may be seen and

Warfarin and related compounds (including ingredients of many commercial rodenticides) inhibit the clotting mechanism by blocking hepatic synthesis of vitamin K dependent clotting factors Anticoagulants may cause hemoptysis, gross hematuria, bloody stools, hemorrhages into organs, widespread bruising, and bleeding into joint spaces The prothrombin time is increased within 12 24 hours (peak 36 48 hours) after a single overdose After ingestion of brodifacoum and indanedione rodenticides (so-called superwarfarins ), inhibition of clotting factor synthesis may persist for several weeks or even months after a single dose

Discontinue the drug at the first sign of gross bleeding, and determine the prothrombin time (international normalized

can mimic opioid poisoning Encephalopathy and cerebral edema can occur The newer anticonvulsants lamotrigine and tiagabine have been reported to cause seizures after overdose Topiramate intoxication has caused acute agitation and confusion

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