Toxicity Antidote Decontamination Elimination Barbiturate

X

AC (1g/kg) , MDAC (15-20g ever 6h)

+ Alkalinization (PH > 7.5 ) only in phenobarbital

Benzodiazepin

Flumazenil 0.1-0.2 mg I.V Max :3mg ( drawback: side sever effect )

AC (chance of aspiration so protect airway ), Gastric emptying may useful

X

Anti - Depressant noncyclic

For suspected serotonin syndrome - Cyproheptadine 4mg PO every

hr for 3doses - Methysergid 2mg PO every hr

for 3doses

AC , do not induce emesis

X (Extensive protein binding , large volume distribution)

Anti - Depressant tricyclic

- QRS interval prolongation sodium bicarbonate 1-2 mEq/kg

- Hyperventilation induce respiratory alkalosis

- Physostigmine used in past but withdraw for sever side effect

AC , do not induce emesis Gastric lavage for large ingestion 20-30mg/kg

X (EPB,LVD)

Amphetamine

X Agitation : Diazepam 10 mg I.V HTN: Phentolamine

AC , do not induce emesis

X , renal elimination by acidification of urine but not recommended due to nephrotoxicity

Cannabis , Marjuana

X Physiological disturbance : Use : lorazepam , diazepam

AC , Ipecac induced vomiting May be useful (prehospital)

X (LVD)

Methanol

Bicarbonate 400-600 mmol during first hrs (reserve visual impairment) 1ml/kg of 5fold diluted alcohol 96% 0.16ml/kg/hr maintenance dose oraly Fomepizole : 15mg/kg loading dose 10mg/kg 4bolus every 12hrs

X

Haemodialysis Folic acid/ Folinic acid 50mg I.V every 4hrs for 24hrs Magnesium

Ethanol

Abnormal mental status glucose 25-50g , Naloxone 2mg , Thiamine 100mg Seizures lorazepam 2mg Disulfiram : 12hr before off alcohol Orally 250-500mg/day Acamprosate : 666mg/d 3doses

Gastric lavage In case of Ethanol ingestion 1g/kg Or co-ingestant suspected

Haemodialysis

(but invasive procedure) Not routinely recommended

Cocaine

X HTN: phentolamine HTN, Agitation :Dizepam 5-10mg MI: diazepam,aspirin 325mg ,nitroglycerin 0.4 mg SL Phentolamaine :1-5mg I.V

AC , do not induce emesis Whole-bowel irrigation , cocaine-filled candoms ingestion

X

Salicylate (aspirin)

X

AC , very efficacious Each gm absorb 550g of drug

Alkalinize with sodium bicarbonate 1-2mEq/kg I.V push 150mEq/kg in1liter D5W maintenace Haemodialysis vey effective