antidote.docx
Short Description
for various drugs, doses of antidote and comments....
Description
Substance
Antidote
Acetaminophen
N-acetylcysteine
Anticholinergic agents (eg, atropine)
Physostigmine
Benzodiazepines
Flumazenil
β-Adrenergic antagonists
Glucagon
Insulin and dextrose
Amrinone
Carbon monoxide
Calcium-channel blockers
Dose
IV: 150 mg/kg over 15 min, then 50 mg/kg over 4 hr, then 100 mg/kg over 16 hr
Comments
AE: vomiting (PO); anaphylactoid reaction (IV).
IV protocol requires large volumes of free water, which may cause hyponatremia and seizures in children.
PO: 140 mg/kg load, then 70 mg/kg/dose every 4 hr for 17 doses
P: 0.5 mg IV slowly
May repeat dose after 15 min.
A: 2 mg IV slowly
AE: cholinergic symptoms occur with excessive dosing.
P: 0.01 mg/kg IV slowly every min (max 1 mg)
A: 0.1–0.2 mg IV slowly every min (max 1 mg)
Titrate to effect or maximal dose. May not reverse respiratory depression. If positive response is of short duration, may be administered as a continuous infusion.
AE: withdrawal symptoms in dependent or chronic use; seizures or dysrhythmias in cyclic antidepressant overdose.
If positive response is of short duration, may be administered as a continuous infusion.
AE: vomiting, hyperglycemia, hypocalcemia.
P: 0.1 mg/kg IV slowly
A: 3–5 mg IV slowly
Insulin 0.5 U/kg/hr IV, with
Dextrose 1 g/kg/hr
750 mcg/kg over 3–5 min slowly (max 3 mg/kg)
AE: hypo- or hyperglycemia, hypokalemia.
May use other phosphodiesterase inhibitors with equal efficacy (eg, milrinone).
AE: hypotension.
Oxygen (100%)
100% oxygen by nonrebreather
Treat until normal CO level or until hyperbaric oxygen initiated.
Oxygen (hyperbaric)
100% oxygen at 23 atmosphere for 20 min
AE: pneumothorax, perforated tympanic membrane.
Calcium chloride (10%)
P: 20 mg/kg (0.2 mL/kg)
May use glucagon, insulin, and dextrose as adjunctive
IV slowly, via central line
Calcium gluconate (10%)
Cyanide
Amyl nitrate
Sodium nitrite (3%)
Sodium thiosulfate (25%)
Digoxin
Ethylene glycol and methanol
Digoxin-specific antibody fragments (Digibind)
Ethanol (10%)
A: 1–2 g (10–20 mL) IV slowly
P: 60 mg/kg (0.6 mL/kg)
A: 3–6 g (30–60 mL) IV
One ampule by inhalation for 30 seconds every 3 min until IV access
P: 0.33 mL (10 mg) IV (for Hb at 12)
A: 10 mL IV over 10 min
P: 1.6 mL/kg IV (for Hb at 12)
A: 50 mL IV over 3 min
For known ingested dose: number of vials = mg ingested × 1.5
For known serum digoxin concentration (SDC, ng/mL): number of vials = SDC × weight (kg)/100
For unknown SDC or dose acute overdose: 10–20 vials
For chronic overdose: P: 2 vials; A: 5 vials
800 mg/kg (8 mL/kg) IV over 20-60 min, then 80-130 mg/kg/hr (0.8-1.3 mL/kg/hr) IV
treatment in CCB as in BB toxicity.
AE: hypercalcemia, phlebitis, nausea, vomiting, flushing, confusion, angina.
AE: methemoglobinemia (see caution for sodium nitrite below).
Dose varies according to weight and Hb level. See package insert.
AE: methemoglobinemia.
Use with caution in unconfirmed or unlikely cyanide poisoning (eg, in the setting of smoke inhalation), because induced methemoglobinemia may exacerbate hypoxemia from other causes.
Dose varies according to weight and Hb count. See package insert.
AE: hypotension, CNS toxicity.
Each 40-mg vial binds 0.6 mg digoxin.
AE: hypokalemia, worsening CHF.
Titrate to serum ethanol 100 mg/dL. Increase dose during dialysis and in chronic alcoholics. Oral dosing may be used in select cases.
Fomepizole (4methylpyrazole)
15 mg/kg over 30 min IV, then 10 mg/kg/dose every 12 hr × 4 doses, then 15 mg/kg/dose every 12 hr
Heparin
Protamine sulfate
Use 1 mg protamine for every 100 units of heparin to be neutralized.
Iron
Deferoxamine
5–15 mg/kg/hr IV (max 6 g/24 hr)
Continue therapy until serum methanol or ethylene glycol level < 20 mg/dL. Increase dose during dialysis.
AE: headache, nausea, dizziness bradycardia, eosinophilia, transient increase of liver enzyme levels
AE: hypotension, bradycardia, hemorrhage. Use with caution with known fish allergy.
Isoniazid
Lead
Pyridoxine (vitamin B6)
Succimer (DMSA)
Dimercaprol (BAL)
Known INH dose: 1g per g of INH ingested IV slowly
Unknown INH dose: 5 g IV over 10 min
10 mg/kg/dose PO every 8 hr × 5 days, then 10 mg/kg/dose twice daily × 14 days
CaNa2 EDTA
Methanol
See Ethylene glycol
75 mg/m2/dose IM every 4 hr Max: 450 mg/m2/dose/24 hr
1–1.5 g/m2/day continuous IV infusion × 5 days
Titrate dose slowly to avoid hypotension. Continue therapy until vin rose urine color clears, symptoms clinically resolve, or maximal dose attained. Deferoxamine challenge no longer suggested.
AE: flushing, hypotension, acute respiratory distress syndrome.
Administer 1 g every 23 min.
AE: CNS toxicity—headache, seizure, peripheral neurotoxicity.
AE: rash, neutropenia, increased LFTs, GI upset.
Pretreatment with diphenhydramine suggested. Contraindicated with peanut allergy, hepatic insufficiency.
AE: G6PD hemolytic crisis, nausea, vomiting, histamine release.
In cases of encephalopathy, administer after dimercaprol to prevent increased CNS lead levels.
AE: phlebitis.
Methemoglobinemia Methylene blue (1%)
Opioids
Cholinergic agents (eg, malathion)
Naloxone
Atropine
Pralidoxime
Oral antidiabetic agents
Octreotide
Dextrose
1–2 mg/kg IV over 5 min
0.5–2 mg IV/IM/SC/ET (max 10 mg)
P: 0.02 mg/kg IV initial dose (minimum 0.1 mg)
A: 0.5–1 mg IV initial dose
P: 25–50 mg/kg over 30– 60 min, then 20 mg/kg/hr
A: 1–2 g IV over 15–30 min, then 0.5 g/hr
P: 1–2 mcg/kg SC/IV every 6–12 hr
A: 50–100 mcg SC/IV, then 50 mcg every 12 hr
Neonate: 0.2 g/kg IV (use D10W, 2 mL/kg)
P: 0.5–1 g/kg IV (use D25W, 2–4 mL/kg)
A: 25–50 g IV (use D50W)
Repeat doses as needed.
AE: dyspnea, chest pain, and hemolysis.
Higher dose may be required for certain agents. Can repeat dose every 2–3 min until response or max dose. If no response to total 10-mg dose, unlikely opioid intoxication. If positive response is of short duration, may be administered as a continuous infusion. In setting of possible opioid dependence, consider initial dose of 0.05 mg to avoid withdrawal.
AE: opioid withdrawal (piloerection, agitation, vomiting).
Double dose every 3–5 min. Titrate to reduced bronchorrhea or improved oxygen saturation. May require total doses 5 or 10 times the initial dose or higher.
AE: anticholinergic toxicity.
Pralidoxime should be administered in addition to atropine. Continue therapy for 24–72 hr.
Continue therapy until euglycemic. May require several days of therapy.
AE: bradycardia, dysrhythmias, GI upset, hyperglycemia.
AE: hyperglycemia, extravasation may cause local tissue reaction.
Tricyclic antidepressants
Sodium bicarbonate
Warfarin
Vitamin K
1–2 mEq/kg IV bolus, then titrate to pH ~7.5 with additional doses or with continuous infusion
P: 1–5 mg SC/IM/IV/PO, every 6–8 hr PRN
A: 10 mg SC/IM/IV/PO, every 6–8 hr PRN
AE: volume overload, hypernatremia, metabolic alkalosis.
Much larger doses may be required. Continue therapy until INR within normal limits.
Abbreviations: AE, adverse effects; BB, β-adrenergic blocker; CCB, calcium-channel blocker; CHF, congestive heart failure; CNS, central nervous system; CO, carbon monoxide; D10W, 10% dextrose and water; ET, endotracheally; G6PD, glucose-6-phosphate dehydrogenase; GI, gastrointestinal; Hb, hemoglobin; INH, isoniaizid; IM, intramuscular; INR, international normalized ratio of prothrombin time; IV, intravenous; LFT, liver function tests; max, maximum; PO, oral; PRN, as needed; SC, subcutaneous; SDC, serum digoxin concentration. *Pediatric (P) and adult (A) doses are the same unless specifically noted.
View more...
Comments