SalioSAM/toxsample11 huggingface dataset:
Poisoning cause: SEVERE Timolol TOXICITY
Toxic dose : Over 30 mg (adult), Over 0 mg (child)
Management: Perform early orotracheal intubation for airway protection if the patient has altered mental status. Initially manage hypotension with intravenous fluids (500 mL boluses up to 2L) and atropine for symptomatic bradycardia. Glucagon should be considered if patient does not respond appropriately to intravenous fluids. Give catecholamines to those who do not respond to intravenous fluids and glucagon. No one catecholamine has been shown to be consistently effective; dopamine, norepinephrine and epinephrine may be considered. High doses may be required. If catecholamines are required despite glucagon and intravenous fluids, high-dose insulin euglycemia should be considered. Catecholamines should be titrated down when high-dose insulin euglycemia therapy starts to take effect. Intravenous lipid emulsion should be considered in patients with refractory hypotension. Other non-pharmacological therapies include: cardiac pacing, placement of an intraaortic balloon pump, cardiopulmonary bypass, and extracorporeal membrane oxygenation (ECMO). Seizures (rarely progress to status epilepticus) may require aggressive use of benzodiazepines (e.g. 1 to 2 mg lorazepam IV and increase as needed) and/or propofol. Monitor for dysrhythmias and treat accordingly.
Clinical effect 1: Conduction disturbances/AV block
Clinical effect 3: Congestive heart failure
Clinical effect 4: Coma
Clinical effect 5: Cardiac arrest 
Clinical effect 6: Bradycardia
Clinical effect 7: Hypotension
Clinical effect 8: Bronchospasm
Clinical effect 9: Respiratory depression
Clinical effect 10: Seizure
Clinical effect 11: QRS widening
Clinical effect 12: Renal failure
Clinical effect 13: Pulmonary edema
Poisoning cause: MILD TO MODERATE Sotalol TOXICITY
Toxic dose : Over 160 mg (adult), Over 4 mg/kg (child)
Management: Mild to moderate sotalol exposures require only symptomatic and supportive care. Patients can be monitored via a cardiac monitor and fluids can be given for hypotension and atropine for symptomatic bradycardia. 
Clinical effect 1: Bradycardia
Clinical effect 2: Hypotension
Clinical effect 3: Bronchospasm
Clinical effect 4: Hypoglycemia
Clinical effect 5: QTc prolongation
Poisoning cause: SEVERE Sotalol TOXICITY
Toxic dose : Over 160 mg (adult), Over 4 mg/kg (child)
Management: Intubate patients with severe toxicity early. Primary focus is treatment of ventricular dysrhythmias and hypotension. CardiOvert unstable ventricular dysrhythmias. Correct electrolyte abnormalities. Treat torsades de pointes with IV magnesium, Overdrive pacing is second-line therapy. Treat hypotension initially with IV fluids, add vasopressors, if unresponsive. Consider glucagon, calcium and insulin euglycemia if hypotension persists, although experience is limited. 
Clinical effect 1: Syncope
Clinical effect 2: CNS depression
Clinical effect 3: Seizure
Clinical effect 4: Hypotension
Clinical effect 5: Torsades de pointes
Clinical effect 6: Ventricular tachycardia
Clinical effect 7: Premature ventricular complexes
Clinical effect 8: Ventricular fibrillation
Clinical effect 9: Death
Poisoning cause: Pramipexole Toxicity
Management: Supportive care is sufficient in nearly all patients. Antiemetics should be given if nausea and vomiting occurs. Investigation should be undertaken to assess for possibility of co-ingestants that may complicate the clinical course
Clinical effect 1: Tachycardia
Clinical effect 2: Vomiting
Clinical effect 3: Agitation/Irritability/Restlessness
Clinical effect 4: Hallucinations
Clinical effect 5: Drowsiness/lethargy
Poisoning cause: MILD TO MODERATE Cyclobenzaprine TOXICITY
Toxic dose : >100 mg
Management: The vast majority of cyclobenzaprine Overdoses require only supportive care; activated charcoal is indicated if patients present shortly after ingestion. Treat agitation and delirium with benzodiazepines. Hypotension normally responds well to hydration. Hypertension and tachycardia are generally mild and well tolerated, and do not require specific treatment.
Clinical effect 1: Drowsiness/lethargy
Clinical effect 2: Anticholinergic symptoms
Clinical effect 3: Mydriasis
Clinical effect 4: Flushing
Clinical effect 5: Fever/hyperthermia
Clinical effect 6: Dry mouth
Clinical effect 7: Decreased bowel sounds
Clinical effect 8: Hallucinations
Clinical effect 9: Tachycardia
Clinical effect 10: Hypertension
Clinical effect 11: Hypotension
Clinical effect 12: Nausea
Clinical effect 13: Vomiting
Poisoning cause: SEVERE Cyclobenzaprine TOXICITY
Toxic dose : >100 mg
Management: Patients who experience respiratory compromise or significant CNS depression require early endotracheal intubation for airway protection. While activated charcoal is indicated in these cases, it should be performed only in patients who can protect their airway or who are intubated due to the predictable CNS depression and risk of aspiration. Those experiencing severe anticholinergic features, such as delirium and agitation, may require large doses of benzodiazepines for sedation. Physostigmine is an alternative to reverse CNS anticholinergic effects. Seizures are very rare and typically respond to benzodiazepines. Monitor for QRS widening and ventricular dysrhythmias; treat with intravenous sodium bicarbonate (1 to 2 mEq/kg IV bolus starting dose, titrate to blood pH 7.45 to 7.55). Monitor core temperature and treat hyperthermia with aggressive benzodiazepine sedation to control agitation, and external cooling. Clinical manifestations may be prolonged due to prolonged absorption in the setting of anticholinergic ileus.
Clinical effect 1: Significant hypotension
Clinical effect 2: Respiratory depression
Clinical effect 3: Coma
Clinical effect 4: Conduction delays
Clinical effect 5: Ventricular dysrhythmia
Clinical effect 6: Cardiac arrest
Poisoning cause: Severe mirtazapine (Remeron) toxicity
Toxic dose : >300 mg in adults(150–450 mg). In children, doses around 60 mg to 165 mg.  Per Olson Guideline:over 150-450 mg in adults
Management: Symptomatic and supportive treatment. •For severe hypotension: Use IV fluids, dopamine, or norepinephrine. •For severe hyponatremia: Administer 0.9% sodium chloride; in extreme cases, use 3% sodium chloride. •For seizures: Start with IV benzodiazepines; if ineffective, consider barbiturates or propofol. •For rare neuroleptic malignant syndrome: Use oral bromocriptine, IV benzodiazepines, cooling, and other supportive measures. Dantrolene may be needed in extreme cases. •For QT prolongation and related cardiac issues: Address with IV magnesium sulfate, correct electrolyte imbalances, and consider Overdrive pacing for torsades de pointes. Follow ACLS protocols for ventricular dysrhythmias.
Clinical effect 1: Drowsiness/lethargy
Clinical effect 2: Confusion
Clinical effect 3: Tremor
Clinical effect 4: Headache
Clinical effect 5: Impaired memory
Clinical effect 6: Tachycardia
Clinical effect 7: Bradycardia
Clinical effect 8: Hypotension
Clinical effect 9: Hypertension
Clinical effect 10: Nausea
Clinical effect 11: Vomiting
Clinical effect 12: Ataxia
Clinical effect 13: Miosis
Clinical effect 14: Visual impairment
Clinical effect 15: Hepatitis
Clinical effect 16: Rhabdomyolysis
Clinical effect 17: QTc prolongation
Clinical effect 18: Torsades de pointes
Clinical effect 19: Ventricular tachycardia
Clinical effect 20: Sudden death
Poisoning cause: Mild to moderate Mirtazapine (Remeron) toxicity
Toxic dose : >300 mg in adults(150–450 mg). In children, doses around 60 mg to 165 mg.Per Olson Guideline:over 150-450 mg in adults
Management: resuscitate with 0.9% saline; blood products may be necessary. Early airway management in patients with upper airway edema or respiratory distress. Early (within 12 hours) gastrointestinal endoscopy to evaluate for burns. Early bronchoscopy in patients wi
Clinical effect 1: Drowsiness/lethargy
Poisoning cause: Severe Mirtazapine (Remeron)Toxicity
Toxic dose : 300 mg in adults. In children, doses around 60 mg to 165 mg.Per Olson Guideline:over 150-450 mg in adults
Management: Symptomatic and supportive treatment.
•For severe hypotension: Use IV fluids, dopamine, or norepinephrine.
•For severe hyponatremia: Administer 0.9% sodium chloride; in extreme cases, use 3% sodium chloride.
•For seizures: Start with IV benzodiazepines; if ineffective, consider barbiturates or propofol.
•For rare neuroleptic malignant syndrome: Use oral bromocriptine, IV benzodiazepines, cooling, and other supportive measures. Dantrolene may be needed in extreme cases.
•For QT prolongation and related cardiac issues: Address with IV magnesium sulfate, correct electrolyte imbalances, and consider Overdrive pacing for torsades de pointes. Follow ACLS protocols for ventricular dysrhythmias
Clinical effect 1: Drowsiness/lethargy
Clinical effect 2: Confusion
Clinical effect 3: Tremor
Clinical effect 4: Headache
Clinical effect 5: Impaired memory
Clinical effect 6: Tachycardia
Clinical effect 7: Bradycardia
Clinical effect 8: Hypotension
Clinical effect 9: Hypertension
Clinical effect 10: Nausea
Clinical effect 11: Vomiting
Clinical effect 12: Ataxia
Clinical effect 13: Miosis
Clinical effect 14: Visual impairment
Clinical effect 15: Hepatitis
Clinical effect 16: Rhabdomyolysis
Clinical effect 17: QTc prolongation
Clinical effect 18: Torsades de pointes
Clinical effect 19: Ventricular tachycardia
Clinical effect 20: Sudden death
Poisoning cause: MILD TO MODERATE Aricept (Donepezil) TOXICITY
Toxic dose : Acute ingestion of as little as 15–40 mg/kg can produce toxicity.
Management: Treatment is symptomatic and supportive. Monitor vital signs and mental status. Monitor fluid status and electrolyte balance if the patient develops significant fluid loss (ie, vomiting, diarrhea, diaphoresis). Treat nausea and vomiting with antiemetics and fluid replacement. Initially treat hypotension with IV fluids. If hypotension persists, administer dopamine or norepinephrine. Atropine is the drug of choice to treat cholinergic effects (ie, salivation, diarrhea, bradycardia, bronchorrhea).
Clinical effect 1: Nausea
Clinical effect 2: Vomiting
Clinical effect 3: Diaphoresis
Clinical effect 4: Increased salivation
Clinical effect 5: Increased urination
Clinical effect 6: Abdominal pain
Clinical effect 7: Diarrhea
Clinical effect 8: Lacrimation
Poisoning cause: SEVERE Aricept (Donepezil) TOXICITY
Toxic dose : Severe toxicity is common after ingestion of 80–150 mg/kg.With chronic use, 10–20% of patients will develop hepatic toxicity when the dose is 10 mg/kg/day, but less than 2% will develop this toxicity if the dose is 3–5 mg/kg/day. Older persons are more susceptible to chronic toxicity​​.
Management: Treatment is symptomatic and supportive. Treat seizure activity with IV benzodiazepines (diazepam or lorazepam). Consider phenobarbital or propofol if seizures recur. Therapeutic doses of donepezil may cause prolongation of the QT interval and torsades de pointes. Treat torsades de pointes with IV magnesium sulfate, and correct electrolyte abnormalities, Overdrive pacing may be necessary
Clinical effect 1: Bradycardia
Clinical effect 2: Hypotension
Clinical effect 3: Seizure
Clinical effect 4: Bronchospasm
Clinical effect 5: Increasing muscle weakness
Clinical effect 6: Respiratory depression
Clinical effect 7: Respiratory paralysis
Clinical effect 8: Death
Poisoning cause: MILD TO MODERATE Lacosamide (Vimpat) TOXICITY
Toxic dose : <50 kg:	>0.5 mg/kg,
≥50 kg:	>800 mg.
Management: Treatment is symptomatic and supportive
Clinical effect 1: Dizziness
Clinical effect 2: Nausea
Clinical effect 3: Seizure
Clinical effect 4: Status epilepticus
Poisoning cause: SEVERE Lacosamide (Vimpat) TOXICITY
Management: Treatment is symptomatic and supportive. Patients may require airway management; closely monitor neurologic function. Treat QRS prolongation with sodium bicarbonate; an initial dose of 1 to 2 mEq/kg is reasonable. Monitor ECG and arterial blood gases. 
Clinical effect 1: Conduction disturbances/AV block
Clinical effect 2: Confusion
Clinical effect 3: QRS widening
Clinical effect 4: Conduction disturbances/AV block
Clinical effect 5: Cardiogenic shock
Clinical effect 6: Cardiac arrest
Clinical effect 7: Coma
Clinical effect 8: Epileptic waveforms on EEG
Poisoning cause: MILD TO MODERATE Central Acting Skeletal Muscle Relaxants TOXICITY
Management: For mild to moderate exposures, good symptomatic and supportive care is the only necessary treatment. While decontamination may decrease the absorption of these drugs, it may not be necessary as most patients require little more than supportive care.
Clinical effect 1: CNS depression
Clinical effect 2: Nystagmus
Clinical effect 3: Mydriasis
Clinical effect 4: Visual impairment
Clinical effect 5: Tachycardia
Clinical effect 6: Hypotension
Clinical effect 7: Nausea
Clinical effect 8: Vomiting
Clinical effect 9: Dry mouth
Clinical effect 10: Drowsiness/lethargy
Clinical effect 11: Euphoria
Clinical effect 12: Confusion
Clinical effect 13: Incoordination
Clinical effect 14: Hallucinations
Clinical effect 15: Ataxia
Clinical effect 16: Muscle weakness
Clinical effect 17: Anticholinergic symptoms
Clinical effect 18: Serotonin syndrome
Poisoning cause: SEVERE Central Acting Skeletal Muscle Relaxants TOXICITY
Management: For severe toxicity, administer intravenous fluids and vasopressors for hypotension, and endotracheal intubation and mechanical ventilation for severe CNS and respiratory depression
Clinical effect 1: Coma
Clinical effect 2: Shock
Clinical effect 3: Respiratory depression
Clinical effect 4: Seizure
Poisoning cause: MILD TO MODERATE Risperidone TOXICITY
Toxic dose : 1 mg (children <12 years) or 5 mg (children ≥12 years) 
Management: Management will primarily be symptomatic and supportive. Treat seizures with benzodiazepines. Manage mild hypotension with IV fluids.
Clinical effect 1: Tachycardia
Clinical effect 2: Hypotension
Clinical effect 3: CNS depression
Clinical effect 4: Drowsiness/lethargy
Clinical effect 5: Extrapyramidal symptoms
Clinical effect 6: Dizziness/vertigo
Clinical effect 7: Reversible cardiovascular effects
Clinical effect 8: Reversible neuromuscular effects
Poisoning cause: SEVERE Risperidone TOXICITY
Toxic dose : 1 mg (children <12 years) or 5 mg (children ≥12 years) 
Management: Treat seizures with benzodiazepines. Manage hypotension with IV fluids and pressors if needed (norepinephrine is preferred). Treat ventricular dysrhythmias with sodium bicarbonate; add lidocaine or amiodarone if unresponsive to serum alkalinization. Manage severe extrapyramidal symptoms with anticholinergics and/or benzodiazepines. Treat neuroleptic malignant syndrome with benzodiazepines, bromocriptine, consider dantrolene, as well as cooling and supportive measures.
Clinical effect 1: QTc prolongation
Clinical effect 2: Extrapyramidal symptoms
Clinical effect 3: Respiratory depression
Poisoning cause: MILD TO MODERATE Lurasidone TOXICITY
Management: Management will primarily be symptomatic and supportive. Manage mild hypotension with IV fluids. Obtain a baseline ECG and repeat as needed; continuous cardiac monitoring may be necessary in symptomatic patients. If required, administer antiarrhythmic therapy. In patients with an acute lurasidone Overdose, administration of disopyramide, procainamide, and quinidine carry a theoretical hazard of additive QT-prolonging effects
Clinical effect 1: Drowsiness/lethargy
Clinical effect 2: Vomiting
Clinical effect 3: Tachycardia
Clinical effect 4: Hypertension
Clinical effect 5: Hypotension
Clinical effect 6: Conduction disturbance
Clinical effect 7: Dystonia
Clinical effect 8: Ataxia
Clinical effect 9: Elevated tsh
Poisoning cause: SEVERE Lurasidone TOXICITY
Management: Treat hypotension with IV fluids and pressors if needed (norepinephrine is preferred). Manage dystonic reactions with anticholinergic agents. Treat severe neutropenia with colony stimulating factors. Although rare, treat neuroleptic malignant syndrome with benzodiazepines, bromocriptine, consider dantrolene, as well as cooling and supportive measures
Clinical effect 1: Hypotension
Clinical effect 2: CNS depression
Poisoning cause: Xylazine Toxicity
Management: Treatment is symptomatic and supportive. DRUG OF ABUSE: In recent years, xylazine has been used parenterally, primarily with fentanyl, and/or heroin to enhance the effects of these drugs. Deaths have been reported. Treatment is primarily supportive to manage xylazine. See Fentanyl Management for information on naloxone therapy and other treatment recommendations. Although xylazine is primarily an injectable drug, ingestion of an injectable formulations have occurred. Treatment is supportive and directed mainly at managing apnea or the loss of protective airway reflexes, bradycardia, and hypotension. Monitor vital signs including blood pressure. Bradycardia, hypotension and CNS depression often respond to physical stimulation. For mild hypotension begin IV 0.9% NaCl at 10 to 20 mL/kg. Bradycardia is typically mild and usually doesn't require any treatment
Clinical effect 1: Hypotension
Clinical effect 2: Bradycardia
Clinical effect 3: Respiratory depression
Clinical effect 4: Dysrhythmia
Clinical effect 5: Hyperglycemia
Clinical effect 9: Hypothermia
Poisoning cause: MILD TO MODERATE Hydrocodone TOXICITY
Management: Patients may only need observation. 
Clinical effect 1: Euphoria
Clinical effect 2: Drowsiness/lethargy
Clinical effect 3: Constipation
Clinical effect 4: Nausea
Clinical effect 5: Vomiting
Clinical effect 6: Miosis
Clinical effect 7: Bradycardia
Clinical effect 8: Hypotension
Poisoning cause: SEVERE Hydrocodone TOXICITY
Management: Administer oxygen and assist ventilation for respiratory depression. Naloxone is the antidote indicated for severe toxicity (respiratory or CNS depression). Orotracheal intubation for airway protection should be performed early in cases of obtundation and/or respiratory depression that do not respond to naloxone.
Clinical effect 1: Respiratory depression
Clinical effect 2: Respiratory arrest
Clinical effect 3: Hypoxia
Clinical effect 4: Coma
Clinical effect 5: Bradycardia
Clinical effect 6: Acute lung injury
Clinical effect 7: Seizure
Clinical effect 8: Death
Poisoning cause: MILD TO MODERATE Olanzapine TOXICITY
Toxic dose : A dose of more than 10 mg is potentially toxic in a drug naive child less than 12 years old. A dose of more than 25 mg is potentially toxic in a drug naive child aged 12 years or greater. In children on chronic olanzapine therapy, an acute ingestion of more than 5 times their current single dose (not daily dose) is potentially toxic
Management: Hypotension usually responds to IV fluids. Sedated patients should be monitored to assure that their airway remains patent
Clinical effect 1: Drowsiness/lethargy
Clinical effect 2: Ataxia
Clinical effect 3: Extrapyramidal effects
Clinical effect 4: Tachycardia
Clinical effect 5: Miosis
Clinical effect 6: Nystagmus
Poisoning cause: SEVERE Olanzapine TOXICITY
Toxic dose : A dose of more than 10 mg is potentially toxic in a drug naive child less than 12 years old. A dose of more than 25 mg is potentially toxic in a drug naive child aged 12 years or greater. In children on chronic olanzapine therapy, an acute ingestion of more than 5 times their current single dose (not daily dose) is potentially toxic
Management: Intubate patients with significant CNS depression. Hypotension that does not respond to IV fluids should be treated with sympathomimetic agents. Agents with beta adrenergic activity such as epinephrine or dopamine may worsen hypotension in the setting of olanzapine-induced alpha blockade. Agents with alpha adrenergic effects such as norepinephrine or phenylephrine may be preferred. Treat seizures with IV benzodiazepines; barbiturates or propofol may be needed if seizures persist or recur. Consider intravenous lipid therapy early for patients with ventricular dysrhythmias or hypotension. 
Clinical effect 1: Seizure
Clinical effect 2: Delirium
Clinical effect 3: Coma
Clinical effect 4: Respiratory depression
Clinical effect 5: Hypotension
Clinical effect 6: Oculogyric crisis
Clinical effect 7: Central diabetes insipidus
Poisoning cause: MILD TO MODERATE Guanfacine TOXICITY
Toxic dose : The triage criteria for Guanfacine ingestion are as follows:
6 months - 5 years: Triage to ER if ingested amount is greater than 0 mg.
6 years - 17 years: Triage to ER if ingested amount is greater than 1 mg.
18 years - 64 years: Triage to ER if ingested amount is greater than 3 mg.
65 years - 79 years: Triage to ER if ingested amount is greater than 1 mg.
Management: Treatment is symptomatic and supportive; bradycardia and hypotension can develop. Monitor vital signs and neurologic function frequently (ie somnolence, lethargy are common (especially in children)). Atropine is first-line therapy for symptomatic bradycardia. Patients may initially present with transient hypertension which generally does not require treatment. For hypotension, administer IV fluids, dopamine, norepinephrine as needed. NALOXONE: May be useful in treating hypotension, CNS depression, and apnea. DOSE: Adult or Pediatric: Initial: 0.4 to 2 mg IV; repeat as needed. 
Clinical effect 1: Drowsiness/lethargy
Clinical effect 3: Bradycardia
Clinical effect 4: QTc prolongation
Clinical effect 5: Hypotension
Clinical effect 6: Hypertension
Poisoning cause: SEVERE Guanfacine TOXICITY
Management: CNS depression and cardiac events should be anticipated. Hypotension may be delayed and prolonged. Frequently monitor vital signs and cardiac monitoring. Assess airway and respiratory function; airway support may be necessary. Pulmonary edema developed in one teenager following an inadvertent significant exposure to extended-release guanfacine; mechanical ventilation was needed for several days
Clinical effect 1: CNS depression
Clinical effect 3: Hypotension
Poisoning cause: MILD TO MODERATE Seroquel (Quetiapine)  TOXICITY
Toxic dose : Based on triage guidelines for quetiapine ingestion: 6 months - 5 years (>5 mg/kg), 6 years - 11 years (>100 mg), 12 years - 79 years (>125 mg)c.
Management: Primarily supportive care; activated charcoal may prevent or shorten the duration of symptoms in patients presenting shortly after ingestion of a significant amount of the drug.
Clinical effect 1: Dry mouth
Clinical effect 2: Constipation
Clinical effect 3: Drowsiness/lethargy
Clinical effect 4: Dizziness
Clinical effect 5: Tachycardia
Poisoning cause: SEVERE Seroquel (Quetiapine)  TOXICITY
Toxic dose : Based on triage guidelines for quetiapine ingestion: 6 months - 5 years (>5 mg/kg), 6 years - 11 years (>100 mg), 12 years - 79 years (>125 mg)
Management: Consider activated charcoal if a patient presents early after ingestion. If significant CNS depression occurs, perform orotracheal intubation for airway protection before giving charcoal. Administer benzodiazepines to treat seizures. Mild hypotension can be treated with normal saline. A Foley catheter may be necessary in case of urinary retention. 
Clinical effect 1: Coma
Clinical effect 2: Anticholinergic symptoms
Clinical effect 3: Pronounced tachycardia
Clinical effect 4: Urinary retention
Clinical effect 5: Seizure
Clinical effect 6: Myoclonic jerks
Clinical effect 7: Hypotension
Clinical effect 8: Increased serum liver enzymes
Clinical effect 9: QTc prolongation
Clinical effect 10: Respiratory depression
Poisoning cause: VILOXAZIN toxicity
Toxic dose : 6 months - 5 years	>14.3 mg/kg OR >400 mg
6 years - 17 years	>14.3 mg/kg OR >800 mg
18 years - 79 years	>14.3 mg/kg OR >1000 mg
Management: Treatment is symptomatic and supportive. Monitor vital signs regularly. Manage mild hypotension with IV fluids
Clinical effect 1: Drowsiness/lethargy
Clinical effect 2: Impaired consciousness
Clinical effect 3: Diminished reflexes
Clinical effect 4: Tachycardia
Clinical effect 5: Transient loss of consciousness
Clinical effect 6: Seizure
Clinical effect 7: Extrapyramidal syndrome