Toxins and antidotes

Question 1

Paracetamol

Answer 1

NAC

Question 2

Paracetamol criteria for liver transplantation

Answer 2

Arterial pH < 7.3, 24 hours after ingestion

or all of the following:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy

Question 3

Ethylene glycol

Answer 3

fomepizole, an inhibitor of alcohol dehydrogenase, is now used first-line in preference to ethanol
haemodialysis also has a role in refractory cases

Question 4

Lead

Answer 4

Dimercaprol, calcium edetate

Question 5

organophosphate poisoning

Answer 5

atropine

Question 6

CO

Answer 6

100% high-flow oxygen via a non-rebreather mask

Question 7

Cyanide

Answer 7

supportive measures: 100% oxygen
definitive: hydroxocobalamin (intravenously), also combination of amyl nitrite (inhaled), sodium nitrite (intravenously), and sodium thiosulfate (intravenously)

Question 8

methanol

Answer 8

fomepizole (competitive inhibitor of alcohol dehydrogenase) or ethanol

Question 9

Salicylate

Answer 9

Management
urinary alkalinization with IV bicarbonate
haemodialysis

Question 10

Opioid/opiates

Answer 10

naloxone

Question 11

Benzodiazepines

Answer 11

IV bicarbonate may reduce the risk of seizures and arrhythmias in severe toxicity

Question 12

Lithium

Answer 12

mild-moderate toxicity may respond to volume resuscitation with normal saline
haemodialysis may be needed in severe toxicity

Question 13

Warfarin

Answer 13

Vit K

Question 14

Beta-blockers

Answer 14

if bradycardic then atropine
in resistant cases glucagon may be used

Question 15

Iron

Answer 15

Desferrioxamine, a chelating agent