antidote_chart_2012.pdf

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California Poison Control System

ANTIDOTE CHART(Suggested Stocking Level is based on dose to treat a single 100 kg patient for 8 hours and

for 24 hours.* Large medical centers who may receive large numbers of patients in a single

incident must stock larger amounts of antidotes or have an effective and efficient drug

sharing/transfer procedure in place to rapidly obtain additional antidotal supplies.)Generic/ Name

Brand Toxin NotesSuggestedStocking

Level

Atrop ine

Organophosphate/carbamate insecticidepoisoning and othercholinesterase inhibitors (eg,warfare agents); bradycardia

induced by a variety oftoxins

May require large amounts insevere cholinesterase inhibitorpoisoning. Also stocked in theStrategic National Stockpilebut will need supplies for first

48 hours. Coordinate with localHomeland Security office.

8 Hours: 100 mg or13vials (0.4 mg/mL, 20 mLeach)24 hours: 200 mg or26vials (0.4 mg/mL, 20 mLeach)Use preservative freeproduct

Antivenom, CrotalidaePolyvalent Immune-FAB(ovine)/ Cro-Fab

Rattlesnake envenomation8 hours: 18 vials24 hours: 36 vials

Antivenom, Black WidowSpider/ Antivenom(Latrodectus Mactans)

Black Widow Spiderenvenomation

Equine base risk of allergichypersensitivity

8 hours: 1 vial24 hours: 1 vial

BAL(Dimercaprol)/ BAL in

oil 10% Heavy metal poisoning IM administration only

8 hours: 600 mg or2 amps(100 mg/mL, 3 mL each)24 hours: 1800 mg or6amps (100 mg/mL, 3 mL)

Calcium Chloride injectionCalcium channel blockerpoisoning; hypocalcemiainduced by various agents

Can cause tissue necrosis ifextravasation occurs use

large vein for infusion ORusecalcium gluconate (see below)

8 hours: 10 gms or10 vials(10%, 10 mL)

24 hours: 10gms or 10vials (10%, 10 mL)

Calcium Gluconate Powder Hydrofluoric acid For manufacture of topical gel

8 hours: 1 x 100 gmpowder bottle24 hours: 1 x 100 gmpowder bottle

Calcium Gluconate injection

Hydrofluoric acid skinexposure or poisoning;hypocalcemia induced byvarious agents

8 hours: 30 gms or30 vials(10%, 10 mL)24 hours: 30 gms or30vials (10%, 10 mL)

Calcium Gluconategel/Calgonate 2.5% gel

Hydrofluoric acid dermalburns

For topical burns8 hours: 6 x 25 gm tubes24 hours: 10 x 25 gm tubes

Carnitine (L-Carnitine)/

Carnitor

Hyperammonemia from

valproic acid toxicity

8 hours: 10gms or 10x 1gm vials

24 hours: 20 gms or20 x 1gm vials

Cyanide Antidote Kit (fromAkorn)

Cyanide;Sodium nitroprusside toxicity

Conventional cyanide antidotekit: contains 2-10mL (3%)amps of sodium nitrite, 2-50mL (25%) vials of sodiumthiosulfate, 12 amyl nitriteinhalant ampules

2 kits for small hospitals, 6kits for major medicalcenters orstock separatesupplies of sodiumthiosulfate and sodiumnitrite vials ORstock theCyanokit(hydroxycobalamin)antidote kit (see below)


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Sodium Nitrite CyanideRisk of methemoglobinemiawith use

30 x10 mL (3%) amps(Less expensive: Stockinstead of the AkornCyanide antidote kit)

Sodium ThiosulfateCyanide;Sodium nitroprusside toxicity

30 x 50 mL (25%) vials(Less expensive: Stockinstead of the AkornCyanide antidote kit)

Cyanokit/

HydroxycobalaminCyanide poisoning

Newer, safer and easier to usethan the conventional cyanideantidote kit.

8 hours: 10 g or2 kits24 hours:10 g or2 kits(ORstock the Akorncyanide antidote kit or theindividual kit components)

Deferoxamine/ Desferal Iron poisoning IV use only

8 hours: 12 gms or6 x 2gm vials24 hours: 36 gms or 18 x 2gm vials

Digoxin Immune FAB

(ovine)/ Digibind orDigiFab

Digoxin poisoning; othercardiac glycosides (eg,oleander, foxglove)

Consult with poison centerregarding dosing, especiallyfor cardiac glycosides thandigoxin.

8 hours: 15 vials of eitherproduct24 hours: 20 vials of eitherproduct

DMSA (Succimer)/ Chemet Heavy metal poisoning

8 hours: 1 gm or10 x 100mg capsules24 hours: 3 gms or30 x100 mg capsules

DTPA-Calcium(Diethylenetriaminepentaacetate)/ PentetateCalcium Trisodiuminjection)

Dirty bomb agents:radioactive plutonium,americium and curium

Stocked in the StrategicNational Stockpile but willneed supplies for first 48hours. Coordinate with localHomeland Security office.

8 hours: 1 x 1 gm amp24 hours: 1 x 1 gm amp

DTPA-Zinc(Diethylenetriaminepentaacetate)/ PentetateZinc Trisodium inj ection)

Dirty bomb agents:radioactive plutonium,americium and curium


8 hours: 1 x 1 gm amp24 hours: 1 x 1 gm amp

EDTA-Calcium/ Versenate Heavy metal poisoning

8 hours: 1 gm or1 1000mg/5mL amp24 hours: 3 gms or3 1000mg/5mL amps

Ethanol IV 10% with 5%Dextrose

Ethylene glycol or methanolpoisoning

Note: IV 10% ethanol productno longer manufactured.Fomepizole easier to dose andmonitor than ethanol.

8 hours: 2 x 1 liter24 hours: 4 x 1 liter(Can be prepared using95% ethanol product)

Ethanol (oral) / VodkaEthylene glycol or methanolpoisoning

Fomepizole easier to dose andmonitor than ethanol. Oralethanol can be used in anemergency situation.

8 hours: one pint24 hours: 750mL

Flumazenil/ Romazicon Benzodiazepine poisoning

Use small initial dose to avoidabrupt awakening/ delirium. Donot use in patients on chronicbenzodiazepine therapy aswithdrawal seizures mayoccur. Also use with caution inmixed drug overdoses.

8 hours: 6 mg or6 x1mg/10 mL vials24 hours: 12 mg or12 x 1mg/10 mL vials

Fomepizole (4-MP)/ AntizolPreferred antidote forethylene glycol or methanolpoisoning

Manufacturer will replaceexpired stocks.

8 hours: 1.5 g or1 x 1.5mL(1g/mL) vials24 hours: 6.0 g or4 x 1.5mL (1g/mL) vials

GlucagonBeta blocker/calciumchannel blocker poisoning

Anticipate nausea andvomiting.

8 hours: 90 mg or90 x 1mg kits24 hours: 250 mg or250 x1 mg kits

Methylene Blue Methemoglobinemia

8 hours: 400 mg or4 x 10mL (10 mg/mL) amps24 hours: 600 mg or6 x 10mL (10 mg/mL) amps


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N-Acetylcysteine (NAC)

Mucomyst or genericAcetaminophen poisoning(oral preparation)

Use orally. Dilute at least by a3:1 ratio.

8 hours: 28 g or5 x 30mL(20%) vials24 hours: 56 g or10 x 30mL (20%) vials

N-Acetylcysteine (NAC)Acetadote

Acetaminophen poisoning(IV preparation)

Loading dose should beinfused slowly over 45-60minutes. Generic N-acetylcysteine can be used if

Acetadote is not available(consult with poison center andadminister via a microporefilter).

8 hours:24 g or4 x 30 mL(20%) vials24 hours: 30 g or5 x 30mL (20%) vials

Naloxone/ Narcan Opioid overdose Use small initial dose to avoidabrupt awakening/withdrawal.

8 hours: 20 mg or50 x 0.4mg/2mL amps or2 x 10mg/10mL vials24 hours: 40 mg or4 x 10mg/mL vials

Octreotide acetate/

Sandostatin Oral sulfonylurea poisoningAvoid long-acting depotproducts.

8 hours: 200 mcg or2 x1mL (0.1mg/mL) amps24 hours: 1000 mcg or1 x5mL (0.2mg/mL) MultidoseVial

Physostigmine/ AntiliriumAnticholinergic poisoning,especially antimuscarinicdelirium.

Administer at low dose (0.5mg) and slowly, over 2-5minutes to avoid severe

adverse reactions includingbradycardia, asystole andseizures. (Contraindicated inTCA or similar poisoning withwidened QRS intervals.)

8 hours: 4 mg or2 x 2mL

(1mg/mL) amps24 hours: 20 mg or10 x 2mL (1 mg/mL) amps

Pralidoxime(2-PAM)/

ProtopamCholinesterase Inhibitorpoisoning (organophosphateor nerve gas)

Also stocked in the StrategicNational Stockpile but willneed supplies for first 48hours. Coordinate with localHomeland Security office.

8 hours: 7 g or7 x 1 gm(20 mL) vials24 hours: 18 g or18 x 1gm (20 mL) vials

Prussian Blue/Radiogardase

Dirty bomb agents:radioactive cesium andthallium and non-radioactivethallium


Minimum order is 25 bottles(30 capsules each)

Pyridoxine (Vitamin B6) Isoniazid (INH) poisoning

Large amounts needed forpoisoning: 5 grams is theminimum antidotal dose usedin an ingestion of an unknownamount. Note: the 100 mg in 1mL vials contain thepreservative chlorobutanol. A 5gram dose requires 50 ofthese vials and will deliver atoxic dose of the preservative.

8 hours: 9 g or3 vials (100mg/mL, 30 mL each) ortheequivalent (Usepreservative free product.)24 hours: 24 g or8 vials(100 mg/mL, 30 mL each)or the equivalent

Vitamin K1(Phytonadione)/

Mephyton orAquaMephyton

Warfarin, warfarin-basedanticoagulants and super-warfarin based rodenticide

poisoning

If patient is actively bleedinguse fresh frozen plasma orFactor VII concentrate.

8 hours: 50 mg or10 x 5mg tabs or5 x 10 mg/mLamps24 hours: 200 mg or40 x 5

mg tabs or20 x 10 mg/mLampsExpert advice regarding use of antidotes and treatment of poisoning and overdose is

available 24 hours a day, 7 days a week from the California Poison Control System.

Health Professionals, call 1-800-411-8080

Members of the public, call 1-800-222-1222*Adapted from Dart RC et al. Annals of Emergency Medicine. 2009; 54(3):386-394.

Note: List is not all-inclusive but reflects agents used more exclusively as antidotes

or antidotal agents used infrequently.Updated: 3-6-2012

antidote_chart_2012.pdf

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