Montra Overdosage

Symptoms: The common symptoms of nitrate overdose includes severe hypotension, tachycardia, bradycardia, heart block, palpitation, death secondary to circulatory collapse, vertigo, confusion, fever, syncope (particularly in the upright posture), persistent throbbing headache, visual disturbances, increased intracranial pressure, paralysis and coma followed by seizures, flushing and diaphoresis, cold and clammy skin, nausea and vomiting, colic and bloody diarrhea, dyspnea, and methemoglobinemia.
Treatment: Manage nitrate overdose by inducing emesis, then administer activated charcoal. In the occurrence of marked hypotension, place the patient in supine position with legs elevated. Give further symptomatic treatment, including IV fluids, if necessary. If bradycardia is present, atropine may be useful. When methemoglobinemia is diagnosed, IV administration of methylene blue 1-2 mg/kg may be required. Management of ISMN overdosage in patients with renal disease or congestive heart failure may be difficult and may require invasive monitoring.
Dialysis is ineffective in removing ISMN from the body.