Antidotes: Difference between revisions

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{| width="374" border="1"
{| {{table}}
|-
|-
| '''TOXIN'''
| '''ANTIDOTE'''
|-
| [[Acetaminophen]]
|  
|  
TOXIN
[[N-Acetylcysteine]]
 
*150mg/kg IV load over 60min; followed by 50mg/kg IV over 4hr and then 100mg/kg IV over 16hr 
| ANTIDOTE<br/>
|-
| [[Anticholinergic toxicity|Anticholinergics]]
| [[Physostigmine]]
|-
|-
| [[Acetaminophen (Tylenol)|Acetaminophen]]<br/>
| [[Arsenic]]
| N-acetylcysteine<br/>
| [[Dimercaprol]] (BAL)
|-
|-
| Antidepressants<br/>
| [[Benzodiazepines]]
|  
|  
Bicarb
[[Flumazenil]]
 
*Adult: 0.2mg IV
*Peds: 0.01mg/kg IV
|-
|-
| Arsenic<br/>
| [[Beta-Blocker Toxicity|Beta blockers]]
| Dimercaprol (BAL)<br/>
|  
[[Glucagon]]
*Adult: 3-10mg IV
*Peds: 50-150mcg/kg IV
|-
|-
| Benzodiazepines
| [[Calcium Channel Blocker Toxicity|Ca channel blockers]]
| Flumazenil
|  
[[Calcium chloride]] 10%
*Adult: 10 mL IV
*Peds: 0.2-0.25 mL/kg IV
High Dose Insulin (1 unit/kg/hr)
|-
|-
| [[Beta-Blocker Toxicity |Beta blockers]]<br/>
| [[Clonidine Toxicity|Clonidine]]
| Glucagon<br/>
|  
[[Naloxone]]
*Adult: 0.4-2mg IV
*Peds: 0.1mg/kg IV (max 2mg)
|-
|-
| [[Cyanide]]
|  
|  
[[Calcium Channel Blocker Toxicity|Ca channel blockers]]
[[Hydroxocobalamin]]
 
'''OR'''
| Calcium chloride<br/>
[[Cyanokit]] (Amyl Nitrite, Sodium Nitrite, and Sodium Thiosulfate)
|-
| [[Dabigatran]]
| [[Idarucizumab]] 5mg IV
|-
| [[Digoxin Toxicity|Digoxin]]
| [[Dig Immune Fab]]
|-
|-
| [[Ethylene Glycol Poisoning|Ethylene glycol]]
|  
|  
Clonidine
[[Fomepizole]]
 
*15mg/kg IV; then 10mg/kg q12h
| Yohimbine<br/>
|-
| Factor Xa Inhibitor (e.g. [[apixaban]], [[rivaroxaban]]
| [[Andexanet alfa]]
4-factor [[PCC]]
|-
| Fluoride
| [[Calcium gluconate]]
|-
|-
| [[Cyanide]]<br/>
| [[Heparin (Unfractionated)|Heparin]]  
|  
|  
Kit- Hydroxycobalamin, Sodium nitrite, Sodium thiosulfate
[[Protamine sulfate]]
*Adult: 25-50mg IV (empiric dose) over 10 minutes
*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>
|-
|-
| [[Digoxin Toxicity|Digoxin]]<br/>
| [[Iron (Fe)|Iron]]  
| [[Dig Immune Fab]]<br/>
| [[Deferoxamine]]
|-
|-
| [[Ethylene Glycol Poisoning|Ethylene glycol]]<br/>
| [[Isoniazid]] (INH)
| Fomepizole<br/>
|  
[[Pyridoxine]] (Vit B6)
*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>
 
|-
|-
| Fluoride
| [[Lead toxicity|Lead]]
| Calcium
| [[EDTA]], [[succimer]]
|-
|-
| Heparin<br/>
| [[Mercury Poisoning|Mercury]]
| Protamine<br/>
| [[Dimercaprol]] (BAL)
|-
|-
| [[Iron (Fe)|Iron]]<br/>
| [[Methanol Toxicity|Methanol]]
| Deferoxamine<br/>
|  
[[Fomepizole]]
*15mi/kg IV; then 10mg/kg q12h<br>
|-
|-
| Isoniazid (INH)<br/>
| [[Methemoglobinemia]]
| Pyridoxine<br/>
| [[Methylene blue]]
|-
|-
| Lead<br/>
| [[Methotrexate toxicity]]
| EDTA, succimer<br/>
| [[Glucarpidase]]
|-
|-
| Mercury<br/>
| [[Opioid Overdose|Opioids]] 
| Dimercaprol (BAL)<br/>
| [[Naloxone]]
|-
|-
| Methanol<br/>
| [[Organophosphates]]
| Fomepizole<br/>
| [[Atropine]] + [[Pralidoxime]]
|-
|-
| Methemoglobin<br/>
| [[Sulfonylurea Toxicity|Sulfonylurea]]
| Methylene blue<br/>
|  
[[Octreotide]]
*Adult:&nbsp;50–100mcg SC q6hr
*Peds: 1mcg/kg SC q6hr
 
|-
|-
| [[Opiod Overdose|Opiods]]<br/>
| [[Tricyclic (TCA) Toxicity]]
| Nalaxone<br/>
|  
[[Bicarbonate]]  
*1-2mEq/kg IV bolus followed by 2mEq/kg/hr IV infusion
|-
|-
| [[Organophosphates]]<br/>
| [[Valproic acid toxicity|Valproate]]
| Atropine+pralidoxime<br/>
| [[L-carnitine]]
|-
|-
| Sulfonylurea
| [[Warfarin (Coumadin) Reversal|Warfarin]]
| Octreotide
| [[Vitamin K]], [[Fresh Frozen Plasma|FFP]], [[Prothrombin complex concentrate]]
|-
| Valproate<br/>
| Carnitine<br/>
|-
| [[Warfarin (Coumadin) Reversal|Warfarin]]<br/>
| Vit K, FFP<br/>
|}
|}


==Source==
==References==
 
<references>
9/09 PANI (Adapted from Donaldson, Mistry, Pharmacopia)


[[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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