Antidotes: Difference between revisions

Latest revision as of 20:45, 22 September 2019

TOXIN	ANTIDOTE
Acetaminophen	N-Acetylcysteine 150mg/kg IV load over 60min; followed by 50mg/kg IV over 4hr and then 100mg/kg IV over 16hr
Anticholinergics	Physostigmine
Arsenic	Dimercaprol (BAL)
Benzodiazepines	Flumazenil Adult: 0.2mg IV Peds: 0.01mg/kg IV
Beta blockers	Glucagon Adult: 3-10mg IV Peds: 50-150mcg/kg IV
Ca channel blockers	Calcium chloride 10% Adult: 10 mL IV Peds: 0.2-0.25 mL/kg IV High Dose Insulin (1 unit/kg/hr)
Clonidine	Naloxone Adult: 0.4-2mg IV Peds: 0.1mg/kg IV (max 2mg)
Cyanide	Hydroxocobalamin OR Cyanokit (Amyl Nitrite, Sodium Nitrite, and Sodium Thiosulfate)
Dabigatran	Idarucizumab 5mg IV
Digoxin	Dig Immune Fab
Ethylene glycol	Fomepizole 15mg/kg IV; then 10mg/kg q12h
Factor Xa Inhibitor (e.g. apixaban, rivaroxaban	Andexanet alfa 4-factor PCC
Fluoride	Calcium gluconate
Heparin	Protamine sulfate Adult: 25-50mg IV (empiric dose) over 10 minutes Peds: 0.6mg/kg IV (empiric dose) Note: Rapid protamine infusion causes hypotension^[1]
Iron	Deferoxamine
Isoniazid (INH)	Pyridoxine (Vit B6) Adult: 5gm IV Peds: 1gm/kg regardless of age ^[2]
Lead	EDTA, succimer
Mercury	Dimercaprol (BAL)
Methanol	Fomepizole 15mi/kg IV; then 10mg/kg q12h
Methemoglobinemia	Methylene blue
Methotrexate toxicity	Glucarpidase
Opioids	Naloxone
Organophosphates	Atropine + Pralidoxime
Sulfonylurea	Octreotide Adult: 50–100mcg SC q6hr Peds: 1mcg/kg SC q6hr
Tricyclic (TCA) Toxicity	Bicarbonate 1-2mEq/kg IV bolus followed by 2mEq/kg/hr IV infusion
Valproate	L-carnitine
Warfarin	Vitamin K, FFP, Prothrombin complex concentrate

References

↑ Hirsh J. et al. "Parenteral anticoagulants: ACCP Evidence-Based Clinical Practice Guidelines. Chest 2008; 133
↑ Minns, A. et al. Isoniazid-Induced Status Epilepticus in a Pediatric Patient After Inadequate Pyridoxine Therapy. Pediatric Emergency Care. 2010:26(5)380-381

Authors:

[1] Hirsh J. et al. "Parenteral anticoagulants: ACCP Evidence-Based Clinical Practice Guidelines. Chest 2008; 133

[2] Minns, A. et al. Isoniazid-Induced Status Epilepticus in a Pediatric Patient After Inadequate Pyridoxine Therapy. Pediatric Emergency Care. 2010:26(5)380-381

[1]

[2]

@@ Line 45: / Line 45: @@
 '''OR'''
 [[Cyanokit]] (Amyl Nitrite, Sodium Nitrite, and Sodium Thiosulfate)
+|-
+| [[Dabigatran]]
+| [[Idarucizumab]] 5mg IV
 |-
 | [[Digoxin Toxicity|Digoxin]]
@@ Line 54: / Line 56: @@
 [[Fomepizole]]
 *15mg/kg IV; then 10mg/kg q12h
+|-
+| Factor Xa Inhibitor (e.g. [[apixaban]], [[rivaroxaban]]
+| [[Andexanet alfa]]
+-factor [[PCC]]
 |-
 | Fluoride
@@ Line 60: / Line 66: @@
 | [[Heparin (Unfractionated)|Heparin]]
 |
-[[Protamine Sulfate]]
+[[Protamine sulfate]]
 *Adult: 25-50mg IV (empiric dose) over 10 minutes
 *Peds: 0.6mg/kg IV (empiric dose)
@@ Line 93: / Line 99: @@
 | [[Glucarpidase]]
 |-
-| [[Opioid Overdose|Opiods]]
+| [[Opioid Overdose|Opioids]]
 | [[Naloxone]]
 |-
@@ Line 112: / Line 118: @@
 |-
 | [[Valproic acid toxicity|Valproate]]
-| [[L-Carnitine]]
+| [[L-carnitine]]
 |-
 | [[Warfarin (Coumadin) Reversal|Warfarin]]