Toxin Antidote

Aka: Toxin Antidote, Drug Antidote, Overdose Reversal Agent

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II. Management: Specific Antidotes for AnalgesicOverdoses

  1. Salicylate Overdose (Salicylism)
    1. Alkalinize Urine with Sodium Bicarbonate
    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

III. 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)

IV. Management: Specific Antidotes for psychiatric agents

  1. Benzodiazepine Overdose
    1. Flumazenil (risk of Seizure if chronic daily Benzodiazepine use)
  2. Serotonin Syndrome
    1. Cyproheptadine
  3. Tricyclic Antidepressants Overdose
    1. Sodium Bicarbonate to alkalinize the urine
    2. Benzodiazepines for Seizure (avoid other anticonvulsants)

V. Management: Specific Antidotes for Heavy Metal and metal Overdoses

  1. Arsenic
    1. British Anti-Lewisite (BAL) Chelation or Dimercaprol
  2. Iron
    1. Deferoxamine (Desferal)
  3. Lead
    1. Dimercaptosuccinic acid (DMSA, Succimer or Chemet)
    2. Ethylenediaminetetraacetic acid (EDTA)
  4. Mercury
    1. Dimercaptosuccinic acid (DMSA, Succimer or Chemet)

VI. Management: Specific Antidotes for agents interfering with oxygenation

  1. Carbon Monoxide
    1. Oxygen
    2. Hyperbaric chamber
  2. Cyanide
    1. Nitrites (Cyanokit, Sodium nitrite, Sodium thiosulfate)
    2. Hydroxycobalamin (B12 analog)
    3. Oxygen
  3. Methemoglobinemia
    1. Methylene blue

VII. Management: Specific Antidotes for parasympathetic effects

  1. Anticholinergics
    1. Physostigmine
  2. Organophosphates or CholinergicPoisoning
    1. Atropine
    2. Pralidoxime (2-PAMCl)

VIII. Management: Specific Antidotes for miscellaneous Overdoses

  1. Fluoride
    1. Calcium
  2. Hydrazines
    1. Pyridoxine
  3. Isoniazid (INH)
    1. Pyridoxine
  4. Methanol or Ethylene Glycol
    1. Fomepizole (Antizol)
    2. Ethanol 10%
  5. Oxalates
    1. Calcium
  6. Hydrofluoric Acid
    1. Risk of severe Hypocalcemia and Hypomagnesemia in even minimal exposures
    2. Calcium Gluconate 2.5% gel applied to area
    3. Calcium Gluconate 5% solution may also be injected into the region of contact
  7. Sulfonylurea
    1. See Sulfonylurea Overdose
    2. Octreotide (Sandostatin)
    3. Dextrose
    4. Glucagon (temporizing measure only)
  8. Valproic Acid
    1. Carnitine
  9. Warfarin
    1. Vitamin K
    2. Fresh Frozen Plasma
    3. Prothrombin Complex Concentrate 4 (PCC 4)

IX. References

  1. Ries (2005) Med Clin North Am 89(6):1379-97 [PubMed]
  2. White (2006) Pediatr Emerg Care 22(11):740-6 [PubMed]
  3. Lawrence (2007) Emerg Med Clin North Am 25(2):567-95 [PubMed]

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