Admission Criteria

All intentional MAOI overdoses and accidental exposures of greater than 1.0 mg/kg require admission to an intensive care unit. Accidental exposures of less than 1.0 mg/kg still require hospital admission but are unlikely to develop life-threatening complications. Therefore, these patients can be admitted to a less acutely monitored bed. It is important to remember that even a single MAOI pill may produce life-threatening drug interactions, such as serotonin syndrome, under the right circumstances. Therefore, emergency physicians should have a very low threshold to admit all MAOI exposures. Asymptomatic patients should be monitored for at least 24 h before medical clearance. Vital sign abnormalities should be recognized early and treated appropriately. Dietary and medication restrictions should be meticulously followed during the hospitalization. All patients should be instructed to avoid contraindicated foods and medications for a minimum of 2 weeks. Consultation with a medical toxicologist through the nearest regional poison control center is strongly recommended. Patients who require transfer to hospitals with intensive care units should be transferred as soon as possible to avoid the problems anticipated with delayed onset of toxicity. All patients being transferred should be accompanied by medical personnel capable of performing advanced cardiac life support and endotracheal intubation.

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