Antidotes: Difference between revisions

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{| class="wikitable"
{| {{table}}
|-
|-
|  
| '''TOXIN'''
TOXIN  
| '''ANTIDOTE'''
 
| ANTIDOTE
|-
|-
| [[Acetaminophen (Tylenol)|Acetaminophen]]  
| [[Acetaminophen]]  
|  
|  
[[N-Acetylcysteine]]
[[N-Acetylcysteine]]
 
*150mg/kg IV load over 60min; followed by 50mg/kg IV over 4hr and then 100mg/kg IV over 16hr   
150mg/kg IV load over 60min; followed by 50mg/kg IV over 4hr and then 100mg/kg IV over 16hr   
 
|-
|-
| Anticholinergics  
| [[Anticholinergic toxicity|Anticholinergics]]
|  
| [[Physostigmine]]
Physostigmine
 
|-
|-
| [[Arsenic]]
| [[Arsenic]]
| Dimercaprol (BAL)
| [[Dimercaprol]] (BAL)
|-
|-
| [[Benzodiazepines]]  
| [[Benzodiazepines]]  
|  
|  
Flumazenil  
[[Flumazenil]]
 
*Adult: 0.2mg IV  
Adult: 0.2mg IV  
*Peds: 0.01mg/kg IV  
 
Peds: 0.01mg/kg IV  
 
|-
|-
| [[Beta-Blocker Toxicity|Beta blockers]]
| [[Beta-Blocker Toxicity|Beta blockers]]
|  
|  
[[Glucagon]]
[[Glucagon]]
 
*Adult: 3-10mg IV  
Adult: 3-10mg IV  
*Peds: 50-150mcg/kg IV  
 
Peds: 50-150mcg/kg IV  
 
|-
|-
|  
| [[Calcium Channel Blocker Toxicity|Ca channel blockers]]  
[[Calcium Channel Blocker Toxicity|Ca channel blockers]]  
 
|  
|  
[[Calcium chloride]] 10%  
[[Calcium chloride]] 10%  
 
*Adult: 10 mL IV  
Adult: 10 mL IV  
*Peds: 0.2-0.25 mL/kg IV  
 
Peds: 0.2-0.25 mL/kg IV  
 
High Dose Insulin (1 unit/kg/hr)
High Dose Insulin (1 unit/kg/hr)
|-
|-
|  
| [[Clonidine Toxicity|Clonidine]]
[[Clonidine Toxicity|Clonidine]]
 
|  
|  
[[Naloxone]]
[[Naloxone]]
 
*Adult: 0.4-2mg IV  
Adult: 0.4-2mg IV  
*Peds: 0.1mg/kg IV (max 2mg)
 
Peds: 0.1mg/kg IV (max 2mg)
 
|-
|-
| [[Cyanide]]  
| [[Cyanide]]  
|  
|  
Hydroxycobalamin
[[Hydroxocobalamin]]
OR
'''OR'''
Cyanide Antidote Kit (Amyl Nitrite, Sodium Nitrite, and Sodium Thiosulfate)
[[Cyanokit]] (Amyl Nitrite, Sodium Nitrite, and Sodium Thiosulfate)
 
|-
| [[Dabigatran]]
| [[Idarucizumab]] 5mg IV
|-
|-
| [[Digoxin Toxicity|Digoxin]]
| [[Digoxin Toxicity|Digoxin]]
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| [[Ethylene Glycol Poisoning|Ethylene glycol]]
| [[Ethylene Glycol Poisoning|Ethylene glycol]]
|  
|  
Fomepizole  
[[Fomepizole]]
 
*15mg/kg IV; then 10mg/kg q12h  
15mg/kg IV; then 10mg/kg q12h  
|-
 
| Factor Xa Inhibitor (e.g. [[apixaban]], [[rivaroxaban]]
| [[Andexanet alfa]]
4-factor [[PCC]]
|-
|-
| Fluoride  
| Fluoride  
| Calcium Gluconate
| [[Calcium gluconate]]
|-
|-
| [[Heparin (Unfractionated)|Heparin]]  
| [[Heparin (Unfractionated)|Heparin]]  
|  
|  
Protamine Sulfate
[[Protamine sulfate]]
 
*Adult: 25-50mg IV (empiric dose) over 10 minutes
Adult: 25-50mg IV (empiric dose) over 10 minutes
*Peds: 0.6mg/kg IV (empiric dose)  
 
Peds: 0.6mg/kg IV (empiric dose)  


''Note: Rapid protamine infusion causes hypotension''<ref>Hirsh J. et al. "Parenteral anticoagulants: ACCP Evidence-Based Clinical Practice Guidelines. Chest 2008; 133</ref>
''Note: Rapid protamine infusion causes hypotension''<ref>Hirsh J. et al. "Parenteral anticoagulants: ACCP Evidence-Based Clinical Practice Guidelines. Chest 2008; 133</ref>
|-
|-
| [[Iron (Fe)|Iron]]  
| [[Iron (Fe)|Iron]]  
| Deferoxamine
| [[Deferoxamine]]
|-
|-
| Isoniazid (INH)  
| [[Isoniazid]] (INH)  
|  
|  
Pyridoxine (Vit B6)
[[Pyridoxine]] (Vit B6)
 
*Adult: 5gm IV  
Adult: 5gm IV  
*Peds: 1gm/kg regardless of age <ref>Minns, A. et al.  Isoniazid-Induced Status Epilepticus in a Pediatric Patient After Inadequate Pyridoxine Therapy. Pediatric Emergency Care. 2010:26(5)380-381</ref>
 
Peds: 1gm/kg regardless of age <ref>Minns, A. et al.  Isoniazid-Induced Status Epilepticus in a Pediatric Patient After Inadequate Pyridoxine Therapy. Pediatric Emergency Care. 2010:26(5)380-381</ref>


|-
|-
| [[Lead toxicity|Lead]]
| [[Lead toxicity|Lead]]
| EDTA, succimer
| [[EDTA]], [[succimer]]
|-
|-
| [[Mercury Poisoning|Mercury]]
| [[Mercury Poisoning|Mercury]]
| Dimercaprol (BAL)
| [[Dimercaprol]] (BAL)
|-
|-
| [[Methanol Toxicity|Methanol]]
| [[Methanol Toxicity|Methanol]]
| Fomepizole  
|  
15mi/kg IV; then 10mg/kg q12h<br>
[[Fomepizole]]
*15mi/kg IV; then 10mg/kg q12h<br>
|-
|-
| [[Methemoglobinemia]]  
| [[Methemoglobinemia]]  
| Methylene blue  
| [[Methylene blue]]
|-
|-
| [[Opioid Overdose|Opiods]]   
| [[Methotrexate toxicity]]
| [[Glucarpidase]]
|-
| [[Opioid Overdose|Opioids]]   
| [[Naloxone]]
| [[Naloxone]]
|-
|-
| [[Organophosphates]]  
| [[Organophosphates]]  
| [[Atropine]] + Pralidoxime
| [[Atropine]] + [[Pralidoxime]]
|-
|-
| [[Sulfonylurea Toxicity|Sulfonylurea]]
| [[Sulfonylurea Toxicity|Sulfonylurea]]
|  
|  
Octreotide  
[[Octreotide]]
 
*Adult:&nbsp;50–100mcg SC q6hr  
Adult:&nbsp;50–100mcg SC q6hr  
*Peds: 1mcg/kg SC q6hr  
 
Peds: 1mcg/kg SC q6hr  


|-
|-
| [[Tricyclic (TCA) Toxicity]]
| [[Tricyclic (TCA) Toxicity]]
|  
|  
Bicarbonate  
[[Bicarbonate]]
 
*1-2mEq/kg IV bolus followed by 2mEq/kg/hr IV infusion  
1-2mEq/kg IV bolus followed by 2mEq/kg/hr IV infusion  
 
|-
|-
| [[Valproic acid toxicity|Valproate]]
| [[Valproic acid toxicity|Valproate]]
| L-Carnitine
| [[L-carnitine]]
|-
|-
| [[Warfarin (Coumadin) Reversal|Warfarin]]   
| [[Warfarin (Coumadin) Reversal|Warfarin]]   
| [[Vitamin K]], [[Fresh Frozen Plasma|FFP]], Prothrombin Complex Concentrates
| [[Vitamin K]], [[Fresh Frozen Plasma|FFP]], [[Prothrombin complex concentrate]]
|}
|}


== Source  ==
==References==
<references>
<references>


[[Category:Tox]]
[[Category:Toxicology]]

Latest revision as of 20:45, 22 September 2019

TOXIN ANTIDOTE
Acetaminophen

N-Acetylcysteine

  • 150mg/kg IV load over 60min; followed by 50mg/kg IV over 4hr and then 100mg/kg IV over 16hr 
Anticholinergics Physostigmine
Arsenic Dimercaprol (BAL)
Benzodiazepines

Flumazenil

  • Adult: 0.2mg IV
  • Peds: 0.01mg/kg IV
Beta blockers

Glucagon

  • Adult: 3-10mg IV
  • Peds: 50-150mcg/kg IV
Ca channel blockers

Calcium chloride 10%

  • Adult: 10 mL IV
  • Peds: 0.2-0.25 mL/kg IV

High Dose Insulin (1 unit/kg/hr)

Clonidine

Naloxone

  • Adult: 0.4-2mg IV
  • Peds: 0.1mg/kg IV (max 2mg)
Cyanide

Hydroxocobalamin OR Cyanokit (Amyl Nitrite, Sodium Nitrite, and Sodium Thiosulfate)

Dabigatran Idarucizumab 5mg IV
Digoxin Dig Immune Fab
Ethylene glycol

Fomepizole

  • 15mg/kg IV; then 10mg/kg q12h
Factor Xa Inhibitor (e.g. apixaban, rivaroxaban Andexanet alfa

4-factor PCC

Fluoride Calcium gluconate
Heparin

Protamine sulfate

  • Adult: 25-50mg IV (empiric dose) over 10 minutes
  • Peds: 0.6mg/kg IV (empiric dose)

Note: Rapid protamine infusion causes hypotension[1]

Iron Deferoxamine
Isoniazid (INH)

Pyridoxine (Vit B6)

  • Adult: 5gm IV
  • Peds: 1gm/kg regardless of age [2]
Lead EDTA, succimer
Mercury Dimercaprol (BAL)
Methanol

Fomepizole

  • 15mi/kg IV; then 10mg/kg q12h
Methemoglobinemia Methylene blue
Methotrexate toxicity Glucarpidase
Opioids Naloxone
Organophosphates Atropine + Pralidoxime
Sulfonylurea

Octreotide

  • Adult: 50–100mcg SC q6hr
  • Peds: 1mcg/kg SC q6hr
Tricyclic (TCA) Toxicity

Bicarbonate

  • 1-2mEq/kg IV bolus followed by 2mEq/kg/hr IV infusion
Valproate L-carnitine
Warfarin Vitamin K, FFP, Prothrombin complex concentrate

References

<references>

  1. ↑ Hirsh J. et al. "Parenteral anticoagulants: ACCP Evidence-Based Clinical Practice Guidelines. Chest 2008; 133
  2. ↑ Minns, A. et al. Isoniazid-Induced Status Epilepticus in a Pediatric Patient After Inadequate Pyridoxine Therapy. Pediatric Emergency Care. 2010:26(5)380-381
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