Disulfiramlike Toxin Toxicity Treatment & Management

  • Author: C Crawford Mechem, MD, MS, FACEP; Chief Editor: Asim Tarabar, MD   more...
 
Updated: Mar 9, 2011
 

Prehospital Care

Supportive care and parenteral rehydration are essential.

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Emergency Department Care

Symptomatic treatment (eg, antiemetics) and supportive maneuvers are mainstays of medical management.

  • Provide intravenous fluids if GI effects have not abated.
  • Hypotension generally responds to volume expansion with normal saline.
  • Patients with severe hypotension may require vasopressor agents once volume restoration is ensured. Direct-acting vasopressors (eg, norepinephrine) are preferred over indirect-acting agents (eg, dopamine). Recommendation is an extension of known pharmacology of disulfiram, which inhibits dopamine beta-hydroxylase, thereby depleting presynaptic catecholamines.
  • Activated charcoal may be beneficial if mushrooms were ingested recently.
  • Fomepizole (4-methylpyrazole) could theoretically be of benefit by blocking alcohol dehydrogenase and formation of acetaldehyde. Its use in the treatment of methanol and ethylene glycol poisoning is well established. Fomepizole is currently very expensive, and its use is not established in this clinical setting.
  • Histamine-2 blockers (cimetidine is best studied) reduce the severity of flush and hypotension in Asian patients who experience these effects following ethanol ingestion. The Asian flush is due in part to a relative deficiency of aldehyde dehydrogenase.
  • Antiemetics with alpha-adrenergic blocking properties (eg, aliphatic and piperidine phenothiazines) should be avoided.
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Consultations

Consultation with a regional Poison Control Center, toxicologist, or mycologist may be helpful.

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Contributor Information and Disclosures
Author

C Crawford Mechem, MD, MS, FACEP  Associate Professor, Department of Emergency Medicine, University of Pennsylvania School of Medicine; Emergency Medical Services Medical Director, Philadelphia Fire Department

C Crawford Mechem, MD, MS, FACEP is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

B Zane Horowitz, MD, FACMT  Professor, Department of Emergency Medicine, Oregon Health and Sciences University; Medical Director, Oregon Poison Center; Medical Director, Alaska Poison Control System

B Zane Horowitz, MD, FACMT is a member of the following medical societies: American Academy of Clinical Toxicology and American College of Medical Toxicology

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD  Regional Director of Pharmacy, Sacred Heart & St. Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Michael Hodgman, MD  Assistant Clinical Professor of Medicine, Department of Emergency Medicine, Bassett Healthcare

Michael Hodgman, MD is a member of the following medical societies: American College of Medical Toxicology, American College of Physicians, Medical Society of the State of New York, and Wilderness Medical Society

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD  Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

References

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