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Poison and Antidote Chart

There are few specific indications for antidotal therapy. However, when indicated, they are essential to therapy Caution:Dosages listed may require modification according to specific clinical conditions. CONSULTATION WITH CLINICAL PHARMACY AND/OR THE NATIONAL POISON TREATMENT AND PREVENTION HOTLINE (800 222-1222) IS STRONGLY RECOMMENDED BEFORE ADMINISTRATION OF ANY OF THESE ANTIDOTES.
POISON Acetaminophen SYMPTOMS Hypoglycemic Coma, Hepatic Necrosis ANTIDOTE N-Acetylcysteine (Mucomyst) ADULT DOSAGE 140mg/kg loading dose; then 17 maintenance doses of 70mg/kg po q4h COMMENTS Most effective within 10 hours of ingestion. A serum level must be obtained between 4-24 hours after ingestion for valid interpretation of nomogram, if patient vomits N-acetylcysteine within 60 minutes of receiving dose- repeat dose May cause convulsions, bradycardia. Dilute in 10ml of normal saline and administer no faster than 1mg/min Consider hyperbaric oxygen if available Monitor carboxyhemoglobin levels, ABGs,patients mental status. Consider the risk of toxicity of 100% oxygen for greater than 2 hours Large doses may be required. Signs of atropinization including drying of oraltracheal secretions, tachycardia, mydriasis Digibind is indicated for the treatment of LIFE-THREATENING overdoses not responding to other therapies

Anticholinergics: ie. Atropine, Scopalamine, Belladonna Carbon Monoxide

Tachycardia, hypotension, skin flushed, dry, hot, ataxia Severe headache, Weakness, Cyanosis. Increased pulse and respirations, Coma, Intermittent Seizures Hypotension, Rhinorrhea, Wheezing, Nausea, Fasiculations, Bradycardia Elevation of serum potassium. Progressive bradyarrythmia Severe ventricular arrythmias

Physostygmine

1-2 mg IV slowly, then titrate 100%

Oxygen

Carbamates (Cholinesterase inhibiting agents) Digoxin

Atropine

2-5 mg IV repeat every 1030 min. until signs of atropinization are seen Contact Clinical Pharmacy and/or Poison Control Cernter for correct dosage

Digoxin Immune FAB (Digibind)

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POISON Lead

SYMPTOMS Nausea, Shock Syndrome, Acute Hemolytic crisis,Paresthesias,Vomiting

ANTIDOTE Penicillamine (or) Calcium Disodium Edetate or Vernate (EDTA)

ADULT DOSAGE 250mg po q6h x 5 days 50-75mg/kg/24hr IM or IV (maximum = 1 gram/24hr)

Merury, Arsenic, Copper, Gold, Zinc, Nickel Methyl Alcohol, Ethylene Glycol

Dimercaprol (BAL-British Antilewisite) Ethyl Alcohol

3-5 mg/kg deep IM q4-12h 1mg/kg of 95-100% (absolute) ethyl alcohol in D5W over 20 minutes. Maintain a blood level of 100%mg with approx. 0.15ml/kg/hr 1-2mg/kg (0.1-0.2 ml/kg) of a 1% solution IV over 5 minutes Initial dose of 50-100 grams. Repeat at 1/2 initial dose(0.5-1 gram/kg) q 2-4 hrs until charcoal appears in stool

COMMENTS Cross sensitivity to Penicillamine may appear in patientes allergeic to penicillin Food, Iron,Antacidsdecrease absorptionShort term therapy is unlikely to produce hematologic side effects. May also consider BAL. For EDTA monitor urinary output as the chelated complex is nephrotoxic. Also monitor serum lead and erythrocyte protoporphyrin levels. Rapid IV infusion increases the intracranial pressure in patient with encephalopathy Dose recommendations vary by metal. Use caution with larger doses May use with dialysis if indicated. If dialysis is use the infusion must be adjusted upwards to maintain serum level. Monitor glucose, anion gap, osmolar gap, ABG. Dose may be given IV or PO Additional doses may be needed. Monitor ABG and Methemaglobinemia. DO NOT administer in Cyanide poisoning or in patients with G-6-PD deficiency DO NOT give if an ileus is present or occurs. Monitor the patient for possibility of aspiration. DO NOT use with ingestions of mineral acids and alkalies, electrolytes, cyanide,fluoride, iron, lithiu, or alcohols as these are poorly absorbed.

Methemaglobin Producing Agents ie. Aniline Dyes, Nitrites, Local anesthetics MiscellaneousSalicylates Dilantin Theophylline Carbamazepine

Convulsions, CNS stimulation

Methylene Blue

Vary according to drugie. seizures, nausea, vomiting

Activated Charcoal

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POISON Narcotics ie. Morphine, Pentazocine(Talwin Lomotil, Methadone, Meperidine, Codeine, Propoxyphene (Darvon) Organophosphates

SYMPTOMS CNS and respiratory depression, Miosis, Seizures(Demerol)

ANTIDOTE Naloxone (Narcan)

ADULT DOSAGE 0.4-0.8 mg IV-repeat as needed. Give a minimun of 5 mg before assuming no response

COMMENTS Continuous infusions of 0.4mg/hr may be needed in Codeine, Pentazocine, Propoxyphen, dextramethorphan or methadone overdoses

-See Carbamate-

Atropine Pralidoxime (Protopam, 2PAM-Chloride)

See Carbamates 1-2 grams IV in 250ml Normal Saline over 30 min May repeat q6h if needed Inhale for 30 seconds out of every min. until sodium nitrite given 10ml IV over 5 minutes. 50ml IV over 10 minutes

Cyanide ie.Nitroprusside

Hypoxia, Increased respirations, smell or taste of bitter almonds

Amyl Nitrite Pearls (then) Sodium Nitrite 3% (then) Sodium Thiosulfate 25% Defuroxamine

Iron

Shock, CNS Depression, Abdominal pain, Pallor or Cyanosis

IV-10-15mg/kg/hr q8h (max. 90mg/kg) IM-Initial dose of 4090mg/kg (not more than 1 gram) q8h

Most effective if use within 24 hours of exposure, less effective after 36 hours. Atropinization may occur sooner than expected, especially if high doses of atropine used. May need to repeat dose over several days. If symptoms persist then repeat Sodium Nitrite 3% at 1/2 of initial dose in 30 minutes. Also give 100% oxygen-the Amyl Nitrite should be coordinated with continuous oxygenation. May cause hypotension. Monitor ABGs and methemaglobin levels. Dose assumes normal hemoglobin Infuse IV at a rate less than 15mg/kg/hr to avoid hypotension. Monitor urinary output, urine color as ferrioxamine complex yields a vin-rose color. Do not exceed 6 grams/24 hours. Indications include-shock, CNS depression, serum Fe levels >350mg/100ml or serum Fe >TIBC during the first 6 hours post ingestion, abdominal symptoms, or x-ray reveals iron tablets in the intestine. COMMENTS

POISON Isoniazid

SYMPTOMS Peripheral neuritis, toxic encephalopathy, Paresthesias

ANTIDOTE Pyridoxine (Vitamin B-6)

ADULT DOSAGE 1 gram/1 gram of INH ingested IV. If amount of

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Tricyclic Antidepressants, ie Doxepin, Trazadone, Amitriptyline, Protryptyline, Nortriptyline, Imipramine, Desipramine Warfarin

Seizures, Coma, Tachycardia, Dysrrythmias, Midriasis, Salivation

Sodium Bicarbonate

INH unknown give 2-5 grams IV until seizures stop 1-2 mEq/kg IV -repeat as needed to keep serum pH 7.5-7.55

Obtain serial ABG, electrolytes, and maintain cardiac monitoring. Other indications for therapy include-druginduced acidosis or over doses with disopyramide, quinidine, or ethylene glycol Rapid IV administration may produce an anaphylatic reaction. The maximum IV rate is 1mg/min with may also produce hypotension. Monitor the prothrombin time. Use ONLY if situation is lifethreatening or patient is symptomatic. Rapid IV push may produce hypotension, bradycardia, or flushing. Initial dose should not exceed 100mg secondary to the anticoagulant effect of Protamine. Monitor Partial thromboplastin time. Use only when rapid reversal of anticoagulation is needed. Can also use dialysis, gastric lavage(if within 24 hours of ingestion). Alkalinization of urine and forced diuresis will remove long-acting agents such as phenobarbital and barbital but does not increase excretion of agents such as pentobarbital

Moderate bleeding

Phytonadione (Vitamin K) Fresh Frozen Plasma (FFP) Protamine

5-10mg IV-may repeat q 4-8 hrs depending on prothrombin time 10ml/kg IV (2-3 units) Up to 50mg slow IV push

Severe bleeding Heparin Bleeding

Barbiturates ie. Phenobarbital, Pentobarbital, Secobarbital

Coma, shock, Renal failure, Hypothermia and/or Hyperthermia

Activated Charcoal

-See above-

POISON Benzodiazepines ie. Diazepam, Chlordiazepoxide, Alprazolam, Triazolam,

SYMPTOMS Ataxia, coma, Hallucinations

ANTIDOTE Activated Charcoal Flumazenil

ADULT DOSAGE -See aboveInitial dose 0.2mg IV over 30 seconds, then 0.3-0.5mg IV q 30-60 seconds as

COMMENTS Can also use gastric lavage or saline cathartic for removal of agent ingested. Overdoses are rarely fatal and also rarely result in hospitalization
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Lorazepam

needed up to 3mg

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