Antidotes: Difference between revisions

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


TOXIN         
==References==
 
<references>
ANTIDOTE
Acetaminophen N-acetylcysteine
Antidepressants Bicarb
 
Arsenic Dimercaprol (BAL)
Benzodiazepines Flumazenil
Beta blockers Glucagon
Ca channel blockers
 
Calcium chloride
Clonidine 
 
Yohimbine
Cyanide Kit- Hydroxycobalamin, Sodium nitrite, Sodium thiosulfate
 
Digoxin Dig immune Fab
Ethylene glycol  Fomepizole
Fluoride Calcium
Heparin Protamine
Iron Deferoxamine
Isoniazid (INH) Pyridoxine
Lead EDTA, succimer
Mercury Dimercaprol (BAL)
Methanol Fomepizole
Methemoglobin Methylene blue
Opiods Nalaxone
Organophosphates Atropine+pralidoxime
Sulfonylurea Octreotide
Valproate Carnitine
Warfarin Vit K, FFP
 
Source
 
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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