0071643192.pdf

TOXICOLOGY

TABLE 6.25. Antidotes for Specific Toxicologic Agents

ANTIDOTE INGESTION/EXPOSURE INDICATIONS FORTREATMENT

Atropine Cholinergic poisoning Symptomatic bradycardia

Excessive secretions

Black widow spider Black widow spider Persistent symptoms despite analgesia

antivenom (Latrodectus) Pregnancy

Very young or elderly

Calcium Hydrofluoric (HF) acid exposure Local symptoms or burns (dermal application)

Hypocalcemia or high-concentration exposure (IV dosing)

CroFab Family Viperidae: Progressive swelling

Rattlesnakes Increased pain

Copperheads Coagulopathy

Water moccasins Systemic symptoms

Cyanide antidote kit Cyanide Suspicion for exposure in patients with acidosis coma,

seizures, and hypotension

Deferoxamine Acute iron intoxication Systemic symptoms

Iron level >500 mcg/dL

Digoxin-specific Fab Digoxin toxicity Ventricular dysrhythmias

Bradycardia unresponsive to therapy

K > 5.0 mEq/dL in acute ingestion

Potentially massive overdose

Flumazenil Benzodiazepine overdose Severe respiratory depression

Contraindicated in: chronic use; if coingestion of

seizure-inducing medication; elevated ICP

Fomepizole Ethylene glycol Metabolic acidosis or known ingestion of a toxic alcohol

Methanol

Glucagon Ca++channel blocker toxicity Symptomatic bradycardia

β-Blocker toxicity Hypotension

Hydroxocobalamin Cyanide Suspicion of exposure in patients with acidosis coma,

seizures, and hypotension

Insulin/glucose Ca++channel blocker toxicity Symptomatic bradycardia

β-Blocker toxicity Hypotension

Methylene blue Methemoglobinemia Levels >30%

Mental status changes

Chest pain

Shortness of breath