Antidotes

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

<references>

  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
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