General measures:
(1) gut decontamination if seen soon after the ingestion
(2) pyridoxine antidote administration (see previous section)
(3) protection of the airway
(4) intravenous fluid administration
Gut decontamination if within 1 hour of ingestion:
(1) gastric lavage with airway protection
(2) charcoal slurry (1-2 g per kg body weight) with sorbitol (1-2 g per kg; maximum dose in adults 150 grams; maximum dose in pediatric patient 50 g)
(3) a second dose of charcoal slurry can be given but without the sorbitol
(4) administration of charcoal should be avoided if pyridoxine is administered as an oral slurry prepared from crushed tablets
Metabolic acidosis:
(1) intravenous administration of sodium bicarbonate 1-3 mEq/kg if arterial pH <= 7.1
Seizures:
(1) diazepam initially (5-10 mg in adults; 0.25-0.40 mg per kg in pediatric patients up to 10 mg; repeat if necessary). Diazepam is poorly soluble and it should be injected slowly directly into a large vein.
(2) careful administration of thiopental by an anesthesiologist
In severe intoxication hemodialysis or peritioneal dialysis can be performed.
Monitor the patient for evidence of liver damage with the INR and serum transaminase levels.
