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
Recommended