The Agent/Antidote Game
Sean Patrick Nordt, MD, PharmD, and Stuart Swadron, MD
Background
- Several contaminants have well-known antidotes
Clinical Findings
- Varying presentations based on contaminant
Management
- Varying based on contaminant
- Acetaminophen → N-acetylcysteine
- Aspirin → sodium bicarbonate and hemodialysis (HD)
- Organophosphates → atropine, pralidoxime, diazepam (for seizures)
- Carbamates → atropine, diazepam
- Warfarin → vitamin K, prothrombin complex concentrate (PCC)
- Digoxin → Fab fragments
- Ethylene glycol → fomepizole or ethanol, HD
- Hydrofluoric acid → calcium, magnesium
- Isoniazid → pyridoxine
- Methanol → fomepizole or ethanol, HD
- Tricyclic antidepressants → sodium bicarbonate
- Carbon monoxide → oxygen and hyperbaric oxygen
- Beta blocker → glucagon, calcium, high-dose insulin, intralipid = controversial
- Calcium channel blockers → calcium, glucagon, high-dose insulin, intralipid = controversial
- Heavy metals → chelators - British anti-Lewisite (BAL), then calcium disodium EDTA (lead, mercury, arsenic)
- Iron → chelator deferoxamine
- Cyanide → hydroxocobalamin, sodium nitrate, amyl nitrate, sodium thiosulfate
