Antidotes & Toxidromes

Question 1

Tylenol OD

Answer 1

Acetylcysteine 140mg/kg then 70mg/kg q4 x 17

Question 2

Activated Charcoal (time, dose)

Answer 2

Best if w/i 1h, 1g/kg

Question 3

Crotalidae Invenomation

Answer 3

Antivenom Fab 4-6 vials over 1h then repeat based on sx

Question 4

Ca++ Blocker OD

Answer 4

CaCl 10mL IV (0.25mL/kg IV Peds); CaGluconate 30mL IV (0.8mL/kg IV Peds)
Glucagon 3-10mg IV (50-150ug/kg IV)
IV Lipids 1.5ml/kg IVx2 q5 then 0.25mg/kg/min IV

Question 5

Cyanide Poisoning / Nitroprusside

Answer 5

Amyl Nitrite (1amp in Oxygen Chamber of Vent Bag
Sodium nitrite 10mL IV (0.33mL/kg IV peds)
Sodium thiosulfate 50mL IV (1.65mL/kg IV Peds)
Hydroxocobalamin 70mg/kg IV (do not exceed 5g)

Question 6

Iron Poisoning

Answer 6

Deferoxamine 2g IM or 15mg/kg IV

Question 7

Insulin OD

Answer 7

Glucose 1g/kg IV (0.5g/kg IV Peds)

Question 8

Digoxin Toxicity

Answer 8

Digibind 5-10 vials IV (1-2 Vials IV PEDS)

Question 9

Ethylene glycol/Methanol Poisoning

Answer 9

Ethanol 10mL/kg then 1.2mL/kg/hr

Fomepizole 15mg/kg then 10mg/kg q12h

Question 10

Methotrexate Poisoning

Answer 10

Folic Acid/leucovorin 1-2mg/kg IV q4h

Question 11

Benzo OD (acute)

Answer 11

Flumazenil 0.2mg IV (0.01mg/kg IV PEDS)

Question 12

Oxidizer OD (Nitrite, benzocaine sulfonamide)

Answer 12

Methylene blue (1-2mg/kg IV)

Question 13

Refractory Hypoglycemia

Answer 13

Octreotide 100ug sc q6 (1ug/kg PEDS)

Question 14

Opoid / Clonidine OD

Answer 14

Naloxone 2mg IV; titrate to respirations

Question 15

Anticholinergic OD

Answer 15

Physostigmine (2mg IVx5min), (0.02mg/kg IV PEDS)

Question 16

Cholinergic OD

Answer 16

Pralidoxime (2-PAM) 1-2g IVx5min then 500mg/h infusion (40mg/kg iv PEDS)

Question 17

Heparin Reversal

Answer 17

Protamine 50mg IV (0.6mg/kg IV PEDS)

Question 18

INH, Hydralazine Poisoning

Answer 18

Pyridoxine 5g IV (70mg/kg IV PEDS)

Question 19

Na Channel Blockers

Answer 19

Sodium Bicarb 1-2mEq/kg IV then 2mEq/kg/h IV infusion

Question 20

Wernicke / Wet Beri Beri

Answer 20

Thiamine 100mg IV (5-10mg IV Peds)

Question 21

Warfarin

Answer 21

Vitamin K 20mg/d PO (5mg/d PO Peds)

Question 22

Opoid Toxidrome

Answer 22

CNS depression, Resp Depression, Miosis

Question 23

Sympathomimetic Toxidrome

Answer 23

Agitation, Mydriasis, diaphoresis, tachycardia, HTN, Hypertherm Tx Cooling, Benzo, Hydration

Question 24

Cholinergic Toxidrome

Answer 24

SLUDGE (Salivation, Lacrimation, Urination, Diarrhea, GI Upset, Emesis) Tx Atropine, Pralidoxime

Question 25

Anticholinergic Toxidrome

Answer 25

Mad as a hatter, hot as a hare, blind as a bat, full as a flask (AMS, Hyperthem, Mydriasis, Urinary retention)
Tx Physostigmine, Benzo, Cooling

Question 26

Salicylates Toxidrome

Answer 26

AMS, Tachypnea, Metabolic acidosis, tinnitus, tachycardia

Tx Activated Charcoal, alkalinize urine, K repletion, dialysis

Question 27

Sed-hypnotic Toxidrome

Answer 27

Depressed LOC, Slurred speech, ataxia

Question 28

hypoglycemic toxidrome

Answer 28

AMS, Diaphoresis, tachycardia, hypertension

Tx Glucose, octreotide

Question 29

Hallucinogenic Toxidrome

Answer 29

Hallucinations, dysphoria, anxiety

Tx supportive

Question 30

Serotonin Toxidrome

Answer 30

AMS, increased muscle tone, hyperreflexia, hyperthemia

Tx Cooling, Benzo, Support, ?Cyproheptadine

Question 31

Extrapyramidal Toxidrome

Answer 31

Dystonia, torticollis, tremor, muscle rigidity

Tx: Benadryl, Benztropine, Benzos