Poisoning cause: SEVERE Loperamide (Imodium) TOXICITY
Toxic dose : Over 0.4 mg/kg (Infant and child Over 6 months old)
Management: Supportive care is the mainstay of treatment. Administer oxygen and monitor for respiratory and CNS depression. The AACT and AAPCC loperamide position statement endorsed by the ACMT, recommends: Consider a starting dose of 0.4 mg naloxone in patients with respiratory depression after acute Overdose, with dose titration to achieve stable respiratory status. Because of the prolonged duration of loperamide Overdose, a continuous naloxone infusion may be necessary, with titration to maintain adequate respirations. Treat cardiac dysrhythmias using ACLS protocols. Use synchronized cardiOversion in patients with ventricular tachycardia and hemodynamic instability and use asynchronous cardiOversion (defibrillation) in patients with ventricular fibrillation or ventricular tachycardia without pulses. Use asynchronous cardiOversion in patients with torsades de pointes or polymorphic ventricular tachycardia, who do not have spontaneous resolution of their dysrhythmia. Treat torsades de pointes with IV magnesium sulfate (2 grams Over 5 to 20 minutes) once there is a perfusing rhythm. Consider amiodarone or transvenous pacing in patients with recurrent dysrhythmias. In several loperamide Overdose cases, treatment with standard anti-arrhythmic agents (eg, magnesium sulfate) were ineffective; however, electrical Overdrive pacing or isoproterenol continuous infusion were effective in treating dysrhythmias and preventing further episodes of torsades de pointes. Correct electrolyte abnormalities, including potassium, calcium, and magnesium, to prevent further QT prolongation. In patients with QRS widening and stable ventilatory status, an empiric bolus of IV sodium bicarbonate 1 to 2 mEq/Kg may be administered. However, it is unknown if this will be effective. Monitor serum potassium, sodium, and pH levels of patients treated with sodium bicarbonate. In order to prevent further prolonged QT, correct sodium bicarbonate induced hypokalemia. In patients with cardiovascular collapse not responding to standard treatment measures, extracorporeal membrane oxygenation (ECMO) or IV fat emulsion may be considered. Because cardiac toxicity may be prolonged, several days of observation and treatment may be required. Treat dystonic reactions with benztropine (1 to 4 mg IV or orally, maximum 6 mg/day) or diphenhydramine. Cardiac dysrhythmias (eg, prolonged QRS and QT intervals, monomorphic and polymorphic (torsades de pointes [TdP]) ventricular dysrhythmias) developed in 5 patients with a history of loperamide abuse (doses: 70 mg to 792 mg daily). Treatment with standard anti-arrhythmic agents were ineffective; however, electrical Overdrive pacing or isoproterenol continuous infusion were effective in treating dysrhythmias and preventing further episodes of TdP. 
Clinical effect 1: Coma
Clinical effect 2: Respiratory depression
Clinical effect 3: Respiratory arrest
Clinical effect 4: Respiratory acidosis
Clinical effect 5: Dysrhytmia
Clinical effect 6: QTc prolongation
Clinical effect 7: Torsades de pointes
Clinical effect 8: Ventricular dysrhythmia
Clinical effect 9: Rhabdomyolysis
Clinical effect 10: Renal failure
Clinical effect 11: Aspiration pneumonitis
Clinical effect 12: Hypotension
Clinical effect 13:  QRS widening