Antidotes

Question 1

Atropine

Answer 1

1. OP and Carbamate
   
   • 1.2mg and double every 2-3 mins
   • END - dry secretions
2. AVB - glycosides, BB, CCB
   * 0.6mg rpt uptp 1.8 mg

Question 2

Calcium

• Calcium Cl₂
• Calcium gluconate

Answer 2

1. Hypo Ca, Hyper K, Mg
   * 10% CaCl₂ - 1g OR Ca gluconate 2g over 10mins till normal Ca++ level

2. CCB

• CaCl2 2g OR Ca gluconate 6g ( 1ml/kg) over 10 min till HD (Rpt max x 3 every 20 mins)
  3. HF acid ( DO NOT USE Ca Chloride )
• 2.5% Gel
• Ca gluconate SC inj
• Ca gluconate 1g in 40 ml N/S - Biers block / intra arterial (4h)
• Ca gluconate Nebs 2.5%
• END - Pain resolution

Question 3

Cyproheptadine

Answer 3

• Serotonin syndrome -Mild to Mod
  
  • PO 8mg and then 8mg q8h for 24 h

Question 4

Desferrioxamine

Answer 4

• Acute Iron overdose
  
  • Clinical fx of toxicity
  • Levels >90 µmol/L @ 4-6 h END <60 µmol/L
• Chronic

Adverse effects ;

• Hypotension
• Hypersensitivity
• ARDS (> 24h)
• Toxic retinopathy
• Secondary infections -Yersinia

Question 5

HIET

High dose Insulin Euglyceamic therapy

Answer 5

• I - CCB , Beta blockers
• As Inotrophic support and not for vasoconstriction
• Bolus ;
  
  • IV 50% dextrose 50 ml (25g)
  • IV short acting insulin 1U /kg
• Maintainance ;
  
  • IV 50% dextrose 50ml/hour (via central line)
  • IV insulin 0.5U /kg /hour
• Aim for normal HD (SBP> 90, HR >60 ) , Euglyceamia
• monitor for BSL, K (3-3.5) , Mg, PO4