Antidotes 12:

Question 1

Acetaminophen

Answer 1

N-acetylcysteine

Question 2

Benzodiazepines

Answer 2

Flumazenil

Question 3

Beta Blockers

Answer 3

Glucagon

Question 4

Cardiac Glycosides

Answer 4

Digoxin immune Fab

Question 5

Crotalid envenomation

Answer 5

Crotalidae polyvalent immune Fab

Question 6

Cyanide

Answer 6

Hydroxocobalamin

Question 7

Ethylene glycol

Answer 7

Fomepizole

Question 8

Iron

Answer 8

Deferoxamine

Question 9

Isoniazid

Answer 9

Pyridoxine

Question 10

Methanol

Answer 10

Fomepizole

Question 11

Methemoglobinemia

Answer 11

Mthylene blue

Question 12

Opioids

Answer 12

Naloxone

Question 13

Organophosphates

Answer 13

Atropine and Pralidoxime

Question 14

Sulfonylureas

Answer 14

Octreotide

Question 15

N-acetylcysteine

Answer 15

Acetaminophen:

IV: 150 mg/kg infused IV over 60 minutes, followed by50 mg/kg over 4 hours, then 100 mg/kg over 16 hours. Must dilute in D5W

Oral: 140 mg/kg, followed by 70 mg/kg every 4 hours for 17 doses.

Note: Special IV dilution required for children

Question 16

Atropine

Answer 16

Cholinesterase inhibitors:

Adults: 1-5 mg IV, double every 3-5 min until bronchorrhea resolves.

Children: 50 mcg/kg (min 0.1 mg; max 0.5 mg) IV, double as for adults.

Note: use 3-5 mg starting dose for adults with severe poisoning

Question 17

L-Carnitine

Answer 17

Valproic acid-induced hyperammonemia or VPA induced elevated AST/ALT:

Clinically ill: 100 mg/kg (up to 6 g) infused IV over 30 min, followed by 15 mg/kg infused over 30 min every 4 hours.

Clinically well: 100 mg/kg/day oral divided every 6 hours up to 3 grams/day.

Question 18

Cyanide antidotes (nitrites and sodium thiosulfate

Answer 18

Cyanide:

Adults:

1. Sodium nitrite: 300 mg (10 mL of a 3% conc) infused IV over 2-5 min.
2. Sodium thiosulfate: d12.5 g (50 mL of a 25% conc) infused IV over 10-30 min or as a bolus.

Children:

1. Sodium nitrite: 6-8 mL/m2 (0.2 mL/kg of a 3% conc) (max 300 mg) infused IV over 2-5 min.
2. Sodium thiosulfate: 7 g/m2 (0.5 g/kg) (max 12.5 g) infused over 10-30 min or as a bolus.

Note: In both adults and children, avoid sodium nitrite when carboxyhemoglobin is expected to be elevated.

Question 19

Deferoxamine

Answer 19

Iron:

Begin continuous IV infusion at 5 mg/kg/hr, titrate to 15 mg/kg/hr as tolerated with a total dose of 6-8 g/day.

Question 20

Dimercaprol (BAL)

Answer 20

Lead encephalopathy:

75 mg/m2 deep IM every 4 hours. First dose to precede edetate calcium disodium (CaNa2 EDTA) by 4 hours.

*Contraindicated if peanut allergy.

Question 21

Digoxin-specific antibody fragments (Fab)

Answer 21

Cardioactive Steroids:

Known Level: # of vials = [wt(kg) x level (ng/mL)/100] rounded up to nearest vial.

Emphiric dosing:
Acute: 10-20 vials.
Chronic: Adults: 3-6 vials; children: 1-2 vials.

Usually given as IV infusion over 30 min. **An IV bolus is acceptable for asystole.

Note: Non-digoxin cardioactive steroids, use empheric dose.

Question 22

Edetate calcium disodium (CaNa2EDTA)

Answer 22

Lead encephalopathy:

1500 mg/m2 (squared)/day as a continuous IV infusion.

Note: Dimercaprol (BAL) should be administered 4 hours prior to starting this dose

Question 23

Folinic acid (leucovorin)

Answer 23

Methotrexate:

100 mg/m2 (squared) infused IV over 15-30 minutes every 3-6 hours for several days or until thotrexated serum conc <1x10 (to the negative 8th power) in the absence of bone marrow toxicity).

Question 24

Fomepizole

Answer 24

Methanol or ethylene glycol:

15 mg/kg infused IV over 30 minutes;
next 4 doses at 10 mg/kg every 12 hours; additional doses at 15 mg/kg every 12 hours if needed

Question 25

Glucagon

Answer 25

Beta-Adrenergic antagonists:

IV infusion over 1-2 minutes.

Adults: 50 mcg/kg
Children: 50 mcg/kg (dose may be increased up to 10 mg in an adult as needed)

Question 26

Methylene blue

Answer 26

Methemoglobinemia:

1-2 mg/kg IV over 5 minutes followed by a 30 mL fluid flush.

Question 27

Naloxone

Answer 27

Opioid-induced respiratory depression:

50 mcg IV titrated upward to reversal, while avoiding opioid withdrawal.

Question 28

Octreotide

Answer 28

Sulfonylurea-induced respiratory depression:

50 mcg IV titrated upward to reversal, while avoiding opioid withdrawal.

Question 29

Physostigmine

Answer 29

Anticholinergic syndrome:

IV infusion over 5 min.

Adults: 1-2 mg.
Children: 20 mcg/kg (max 0.5 mg)

Question 30

Pralidoxime (2-PAM)

Answer 30

Cholinesterase inhibitors:

Adults: 1-2 g infused IV over 30 min and then up to 500 mg/h by infusion for sickest patients.

Children: 20-50 mg/kg (max 1-2 g) infused IV over 30-60 min and then 10-20 mg/kg/hr (max 500 mg/hr)

Question 31

Pyridoxine (Vit. B6)

Answer 31

Isoniazid:

1 g for each gram of isoniazid up to 70 mg/kg (max 5 g) infused IV at 0.5 g/min until seizures stop, with the remainder infused IV over 4-6 hours.

Question 32

Succimer [Dimercaptosuccinic acid (DMSA)]

Answer 32

Lead Poisoning:

Adults: 10 mg/kg orally every 8 hours for five days followed by every 12 hours for 14 days.

Children: 350 mg/m2 (squared) orally as for adults.