EM Toxicology 3 (Antidotes)

Question 1

antidotes that are indicated before cardiopulmonary stabilization

Answer 1

1. naloxone
   - for opiate toxicity
2. cyanide antidotes
   - for cyanide toxicity
   - include amyl nitrite (inhaled), sodium nitrite (IV, 3% sol’n), and sodium thiosulfate (IV, 25% sol’n)
3. atropine
   - for organophosphatepoisoning

Question 2

cocktail in cases of altered mental status [with limited diagnostic resources]

Answer 2

1. supplemental oxygen
2. glucose
3. thiamine
4. naloxone

Question 3

a core temperature of ____ is an indication for active rewarming

Answer 3

<32 C

Question 4

remarks on naloxone

Answer 4

1) opioid antagonist
2) 0.1 to 0.4 mg IV boluses (as much as required
for pedia: 0.01 mg IV
3) used for overdose of opioids and clonidine

4) reverses effects of opioids for 20-60 mins
5) patients should be observed for 2-3 hours after administration of IV naloxone

Question 5

cyanide antidote kit

Answer 5

1. AMYL NITRITE
   - crack vial and inhale over 30 secs, or place in chamber of ventilation bag and use 30 s on / 30 s off
   - pedia: not typically used
2. SODIUM NITRITE, 3% sol’n
   - 10 mL IV
   - also used for hydrogen sulfide toxicity
   - if hgb unknown, assume hgm 12 g/dL, and dose with 0.33 mL/kg IV
3. SODIUM THIOSULFATE, 25% sol’n
   - 50 mL IV
   - pedia: 1.65 mL/kg IV

Question 6

antidote for digoxin

Answer 6

Digoxin Fab
10 vials
pedia: 5-10 vialvs IV

Question 7

Antidote for benzodiazepines

Answer 7

FLUMAZENIL
0.2 mg IV
pedia: 0.01 mg/kg IV

Question 8

Antidote for CCB

Answer 8

CALCIUM GLUCONATE 10%
(9mg/mL elemental Ca)
10-30 mL IV
pedia: 0.5-0.45 mL/kg IV
also used for hypermagnesemia

GLUCAGON
5 mg IV
pedia: 30 mcg/kg IV over 1-2 mins

Question 9

antidote for beta blocker toxicity

Answer 9

GLUCAGON 5 mg IV
pedia: 30-150 mcg/kg over 1-2 mins

Question 10

antidote for nitroprusside toxicity

Answer 10

HYDROXOCOBALAMIN
5 g IV over 15 mins
pedia: 70 mg/kg (max 5g) IV over 15 mins
also used for cyanide toxicity

Question 11

antidote for oxidizing toxin

Answer 11

e.g. nitrites, benzocaine, sulfonamides

METHYLENE BLUE
1 mg/kg IV
pedia: 1 mg/kg IV
neonates: 0.3-1 mg/kg IV

Question 12

Naloxone is used for

Answer 12

opioids and clonidine toxicity
0.1-0.4 mg IV (as much as requried)
pedia: 0.01mg IV (AMAR)

Question 13

Antidoe for isoniazid toxicity

Answer 13

PYRIDOXINE
gram for gram if amount of isoniazid ingested is known.
otherwise:
5 g IV
pedia: 70 mg/kg IV (max 5 g)

Question 14

antidote for sodium channel blocker toxicity

Answer 14

SODIUM BICARBONATE
1-2 mEq/kg IV over 1-2 min followed by 0.3 mEq/kg per hour IV infusion
(same with pedia)
- also used for urinary alkalinization

Question 15

antidote for Wernicke’s syndrome

Answer 15

Thiamine
100 mg IV
pedia: 5-10 mg IV

Question 16

Antidote for Wet beriberi

Answer 16

THIAMINE
100 mg IV
pedia: 5-10 mg IV