discussion.

So, without further ado, our list of "must know" poison-antidote combos is below. A couple of quick notes:

1. The information has been taken from the Toxicology Handbook (Murray et al). Depending on which source you read you will see slightly different doses of some antidotes. Where this occurs the precise dose is probably less important than being able to cite the correct drug and an appropriate dose within a range. So, if you have a slightly different answer that's ok.

2. We have used groupings to cover some similar drugs. This makes it easier to remember for us.

So, without further ado, and in no particular order, our list is below.
1. Tricyclic antidepressants
  • Sodium Bicarbonate 8.3% 50-100mmol, indicated by QRS widening >0.12ms
 
2. Heavy metals (arsenic, mercury, lead)
  • Oral intake possible: Succimer (water soluble dimercaprol) 10mg/kg tds
  • Oral intake not possible: Dimercaprol 3-4mg/kg IM Q4H

Specifically for lead in addition to the above:
  • Sodium calcium edetate (EDTA) 25-75mg/kg diluted 500ml saline or dextrose and infused over 24hrs started 4hrs post 1st dose dimercaprol

 3. Beta blockers
  • High dose insulin therapy for euglycaemia and eukalaemia: 1IU/kg insulin stat then 0.5IU titrated upwards
  • Glucagon 5mg IV stat then 5mg/hr infused
  • Adrenaline 10mcg/ml titrated to SBP >90

4. Benzodiazepines
  • Flumazenil 0.1 - 0.2mg IV titrated upwards to conscious state 

5. Local anaesthetics
  • Sodium Bicarbonate 8.3% 50-100mmol
  • Lipid emulsion 20% 1.5ml/kg bolus plus infusion 0.25ml/kg.min titrate upwards
 
6. Citalopram/SSRI toxicity with seritonergic features
  • Cyproheptadine 8mg PO Q8H 

7. Cyanide
  • Thiosulfate 12.5g IV
  • Hydroxocobalamin 2.5g in 100ml over 15 minutes, repeated for total dose 5g
 
8. Digoxin (and oleander and cane toad)

  • Digibind fragments.
 
a) Acute overdose:
  • number of ampoules = ingested dose (mg) X 0.8 x 2
  • if dose unknown give 5-10 ampoules empirically
 
b) Chronic poisoning
  • Number of ampoules = [serum digoxin (ng/ml) x body weight (kg)]/100
 
9. Sulfonylureas
  • Octreotide 50mcg IV then 25mcg/hr
  • Glucose 50ml 50% dextrose bolus repeat for BSL >5 or paeds 5ml/kg 10% dextrose for same endpoint
 
10. Hydrofluouric acid
  • Topical burn: calcium 2.5% gel or local injection of 10% calcium gluconate
  • Systemic toxicity:Calcium gluconate 10% 60ml or calcium chloride 20ml IV stat repeat Q5H until cardiac output restored
 
11. Iron
  • desferrioxamine 15mg/kg titrated up to 40mg/kg for vin rose urine and serum iron <60mcg/ml
 
12. Isoniazid
  • Pyridoxine 1g for each gram of isoniazid ingested IV
  • Adjunct: benzodiazepines for seizure control
 
13. Toxic alcohols
  • ethanol: 3 x 40ml shots of vodka in a 70kg adult
  • fomepizole 15mg/kg in 100ml NaCl plus 10mk/kg infused Q12h
 
14. Methaemoglobinaemia
  • Methylene blue 1-2ml/kg over 5 minutes administered over 30-60 minutes
 
15. Organophosphates
  • Pralidoxime 2g in 100ml NaCl in 15 minutes then infuse 500mg/hr
  • Atropine 50mcg/kg Q5 minutes until secretions dried
 
16. Warfarin
  • Vitamin K 10mg IV for severe bleeding
  • Prothrombin Complex Concentrate 25-50IU/kg
  • FFP 2-4 units IV