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Antidotes for Emergency Treatment of Poisonings
Arizona Regional Poison Centers 1-800-222-1222
Antidotes for Emergency Treatment of Poisonings
These recommendations are guidelines. Definitive
recommendations for specific patients are best discussed
with your regional poison center or a Medical Toxicologist.
All listed ‘antidotes’ are associated with risks and side effects. Consider the risk to benefit ratio before use is all cases.
Call 1-800-222-1222 for immediate assistance or patient transfer.
| Decontamination | Use / Indication | Comment / Dose |
| Activated Charcoal (without sorbitol) |
Consider use within one hour of a life threatening ingestion | 1 g/kg (up to 100g) |
| Other Decontamination Techniques (e.g. multidose charcoal, dialysis etc) |
Discuss specific indications with your regional poison center |
| Antidote | Use / Indication | Comment / Dose |
Recommended Stocking Amount |
| Antivenom- Blackwidow Spider | Latrodectus envenomation | 1 vial | Consider having 1 vial |
| Antivenom – Rattlesnake: (CroFab®) |
Crotalidae envenomation (rattlesnake, copperhead, water moccasin) |
4 to 6 vial LD, then 2 vials every 6 hrs for 18 hrs | 18 vials |
| Atropine | Organophosphates / Carbamates toxicity | Adults 1-5mg (children 0.02 mg/kg). Repeated, escalating doses as needed for airway secretions every 1-3 mins | 150 mg |
| Benzodiazepines | Seizures, Agitation, Sympathomimetic toxicity. Ethanol (GABA-agonist) withdrawal | Dosing varies greatly. Repeated, escalating doses as needed for hyperadrenergic signs every 5-10 mins |
|
| Botulinum antitoxin | Botulism | Discuss with your regional poison center |
Contact local health department or cdc.org |
| Calcium salts (gluconate or chloride |
Hydrofluoric acid exposure; B-blocker, CCB toxicity |
Discuss with your regional poison center |
200 mEq (20 X 10ml 10% aliquots) |
| Cyanide Antidote Kit Or Hydroxocobalamin |
Cyanide toxicity | Follow package insert |
2 kits Or 10 grams |
| Deferoxamine mesylate | Iron toxicity | 15 mg/kg/hr |
8.4 grams |
| Dextrose (in water) |
Hypoglycemia
|
As needed for hypoglycemia, consider a drip | |
| Digoxin Immune Fab | Digoxin / Cardioglycoside toxicity | Discuss with your regional poison center |
15 vials |
| Dimercaprol (BAL) | Heavy metal toxicity (arsenic, copper, gold, lead, mercury) |
Discuss with your regional poison center |
280 mg |
| DMSA (Succimer) | Heavy metal toxicity (arsenic, copper, gold, lead, mercury, zinc) |
Discuss with your regional poison center |
1 gram |
| EDTA (calcium disodium EDTA) |
Heavy metal toxicity | Discuss with your regional poison center |
1 gram |
| Ethanol | Ethylene glycol / Methanol toxicity | Oral or IV; LD, then maintenance dose required |
1 L of 10% ethanol (oral ethanol should also be available) |
| Folinic acid | Methanol, methotrexate toxicity | Dosing varies; 50 mg IV q 4 hrs for methanol |
|
| Fomepizole | Ethylene glycol, Methanol toxicity | LD: 15 mg/kg, then 10mg/kg q 12 hrs x 48 hrs, then 15 mg/kg q 12 hrs until level < 20 mg/dL | 4 X 1.5 mL vials, 1g/mL |
| Glucagon | B-blocker, CCB toxicity | LD: 50-100 mcg/kg IVP, then 1-5 mg/hr drip | 50 mg |
| Methylene blue | Methemoglobinemia | Rule out existing G6PD def. 1-2 mg/kg IV over 5 mins, may repeat in 30mins If needed |
280 mg |
| N-acetylcysteine | Acetaminophen toxicity, Drug-induced hepatic injury |
IV preferred but oral acceptable. Follow package insert or contact poison center | 21 g of IV formulation or 93.1 g for oral use |
| Naloxone | Narcotic toxicity | Dilute 2mg in 10mL NSS and titrate to effect. May lead to withdrawal | 30 mg |
| Octreotide | Sulfonylurea-induced hypoglycemia | 1mcg/kg IV or SQ q 12 hrs. Observe patient > 24 hrs |
1 mg |
| Physostigmine | Anticholinergic toxicity | Consider seizure risk. 1-2 mg (children 0.02 mg/kg up to 0.5mg) IV over 5 mins; may repeat once if needed |
8 mg (4 X 2mL ampules) |
| Phytonadione (vitamin K1) |
Anticoagulant toxicity (e.g. warfarin, anticoagulant pesticides) |
Consider pt’s need for anticoagulation. Doses vary; contact poison center |
|
| Pralidoxime (2-PAM) | Organophosphate toxicity | 1-2 g (children 25-50 mg/kg) IV over 30 minutes. Repeated (or maintenance) doses usually required | 2 gram |
| Protamine | Heparin, Enoxaparin toxicity | Doses vary; 1mg will reverse ~ 100mg of heparin (or 100 antifactor Xa units) |
|
| Pyridoxine (vitamin B-6) |
Ethylene glycol, isoniazid, Gyromitra toxicity | Dosing varies; 1g per g of INH (up to 5g), 50 mg q 6 hrs x 4 for ethylene glycol |
10 gram |
| Sodium bicarbonate | Cyclic antidepressants, salicylate toxicity; serum alkalinization | Varies by indication. 1-2mEq/kg for acidosis or QRS widening | 10 x 150 mEq ampules |
