Emergency Medicine Book

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Toxin Antidotes

Aka: Toxin Antidotes
  1. See Also
    1. Toxin Ingestion Management
    2. Beta Blocker Overdose
    3. Calcium Channel Blocker Overdose
    4. Clonidine Overdose
    5. Acetaminophen Overdose
    6. Salicylate Overdose
    7. Opioid Overdose
    8. Sulfonylurea Overdose
    9. Tricyclic Antidepressant Overdose
  2. Management: Specific Antidotes for Analgesic overdoses
    1. Salicylate Overdose (Salicylism)
      1. Alkalinize Urine
      2. Consider Dialysis
    2. Acetaminophen Overdose
      1. N-Acetylcysteine (NAC, Mucomyst, PO or Neb, Acetadote IV) based on nomogram
    3. Opioid Overdose (Narcotic Overdose)
      1. Naloxone
  3. Management: Specific Antidotes for cardiovascular agent overdoses
    1. See Beta Blocker Overdose
    2. See Calcium Channel Blocker Overdose
    3. See Clonidine Overdose
    4. Digoxin
      1. Digoxin Immune Fab fragments (Digibind)
  4. Management: Specific Antidotes for miscellaneous overdoses
    1. Anticholinergics
      1. Physostigmine
    2. Arsenic
      1. BAL chelation
      2. DMSA
    3. Carbon Monoxide
      1. Oxygen
    4. Cyanide
      1. Nitrites (Cyanokit, Sodium nitrite, Sodium thiosulfate)
      2. Hydroxycobalamin
      3. Oxygen
    5. Fluoride
      1. Calcium
    6. Hydrazines
      1. Pyridoxine
    7. Iron
      1. Deferoxamine (Desferal)
    8. Isoniazid (INH)
      1. Pyridoxine
    9. Lead
      1. BAL chelation
      2. DMSA
      3. Succimer
    10. Mercury
      1. Succimer
      2. DMSA
    11. Methanol or Ethylene Glycol
      1. Ethanol 10%
      2. Fomepizole (Antizol)
    12. Methemoglobinemia
      1. Methylene blue
    13. Organophosphates or Cholinergics
      1. Atropine
      2. 2-PAMCl
    14. Oxalates
      1. Calcium
    15. Sulfonylurea
      1. See Sulfonylurea Overdose
      2. Octreotide (Sandostatin)
      3. Dextrose
      4. Glucagon (temporizing measure only)
    16. Tricyclic Antidepressants overdose
      1. Sodium Bicarbonate to alkalinize the urine
      2. Benzodiazepines for Seizure (avoid other anticonvulsants)
    17. Warfarin
      1. Vitamin K
      2. Fresh Frozen Plasma
  5. References
    1. Ries (2005) Med Clin North Am 89(6):1379-97
    2. White (2006) Pediatr Emerg Care 22(11):740-6
    3. Lawrence (2007) Emerg Med Clin North Am 25(2):567-95

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