Anecdotes About Antidotes
This antidote is given IV to replenish glutathione stores and prevent hepatotoxicity from acetaminophen overdose
What is N-acetylcysteine (NAC)?
This toxidrome, remembered by the mnemonic "SLUDGE/BBB" (Salivation, Lacrimation, Urination, Defecation, GI distress, Emesis / Bradycardia, Bronchospasm, Bronchorrhea), is caused by organophosphates and nerve agents
What is the cholinergic toxidrome?
This adsorbent, dosed at 1 g/kg in adults, is most effective when given within 1 hour of ingestion and is contraindicated in patients without a protected airway
What is activated charcoal?
Fomepizole works as an antidote for toxic alcohol poisoning by competitively inhibiting this specific enzyme, which is also the target of ethanol co-administration
What is alcohol dehydrogenase?
Sodium bicarbonate is the first-line treatment for cardiac toxicity (QRS widening, hypotension) caused by overdose of this class of antidepressants
What are tricyclic antidepressants (TCAs)?
This antidote, dosed at 1 U/kg bolus followed by infusion, is recommended for life-threatening beta-blocker and calcium channel blocker poisoning
What is high-dose insulin (with dextrose)?
"Hot as a hare, blind as a bat, dry as a bone, red as a beet, mad as a hatter" describes this toxidrome, classically caused by diphenhydramine or jimsonweed
What is the anticholinergic toxidrome?
Multiple-dose activated charcoal enhances elimination of a limited list of drugs. Name one of the six drugs for which it is specifically recommended.
What is carbamazepine, dapsone, phenobarbital, quinine, salicylates, or theophylline?
Methanol toxicity is not caused by methanol itself but by its toxic metabolite, which is also secreted from certain species of ants, formed via alcohol dehydrogenase, which causes retinal toxicity and metabolic acidosis with an elevated anion gap
What is formic acid (formate)?
Digoxin toxicity presenting with life-threatening bradycardia or hyperkalemia is treated with this antidote, dosed based on the estimated total body digoxin load
What is digoxin-specific antibody fragments (Digibind/DigiFab)?
This vitamin-derived antidote is the preferred first-line treatment for cyanide poisoning and causes transient hypertension and red discoloration of urine
What is hydroxocobalamin?
Hyperthermia, clonus, hyperreflexia, agitation, and diaphoresis following an overdose or drug interaction characterize this syndrome
What is serotonin syndrome (serotonergic toxidrome)?
Urine alkalinization with sodium bicarbonate to a target urine pH ≥ 7.5 enhances renal elimination of this common analgesic; hypokalemia must be corrected first because it prevents urine alkalinization
What is salicylate (aspirin)?
At therapeutic doses, salicylate is ~90% protein-bound with a half-life of 2–4 hours. In overdose, protein binding saturates, and the half-life extends to 15-30 hours, shifting from first-order to this type of kinetics
What are zero-order kinetics?
A QTc interval greater than 500 ms in a drug overdose patient significantly increases the risk of Torsades de Pointes. The first-line pharmacologic treatment for Torsades is this electrolyte given IV
What is magnesium (magnesium sulfate)?
This 20% emulsion is specifically recommended for cardiac arrest caused by bupivacaine or other local anesthetic systemic toxicity (LAST).
What is intravenous lipid emulsion (Intralipid)?
A patient presents with miosis, respiratory depression, and decreased level of consciousness. This toxidrome is the leading cause of cardiac arrest due to poisoning in North America.
What is the opioid toxidrome?
The three most commonly dialyzed poisons share pharmacokinetic properties of low molecular weight, low volume of distribution, and low protein binding. Name two of the three.
What are salicylates, toxic alcohols (methanol/ethylene glycol), and lithium?
Acetaminophen hepatotoxicity occurs when this reactive metabolite, normally detoxified by glutathione conjugation, accumulates and binds to hepatocellular proteins
What is NAPQI (N-acetyl-p-benzoquinone imine)?
In cocaine-associated chest pain, beta-blockers are historically considered relatively contraindicated due to the risk of "unopposed alpha stimulation." This class of medications is recommended as first-line treatment instead
Daily Double: Cocaine overdose can produce ST elevation mimicking acute MI. Unlike standard STEMI protocols, this class of antiarrhythmics is contraindicated due to additive sodium channel blockade
What are benzodiazepines?
Daily Double: What are class Ia and Ic antiarrhythmics (e.g., procainamide, flecainide)?
This antidote, strategically stockpiled by the US government in local hospitals reactivates acetylcholinesterase in organophosphate poisoning but must be given before enzyme "aging" occurs; it is dosed at 2 g IV over 15–30 minutes in adults
What is pralidoxime (2-PAM)?
Lead-pipe rigidity, hyperthermia, altered mental status, and autonomic instability following antipsychotic use describe this life-threatening condition, which is treated with dantrolene and bromocriptine
What is neuroleptic malignant syndrome (NMS)?
Whole bowel irrigation with polyethylene glycol solution is specifically considered for ingestions of sustained-release formulations, body-packed illicit drugs, and overdoses of this element whose tablets are radiopaque and not adsorbed by activated charcoal
What is iron?
In acetaminophen hepatotoxicity, mitochondrial dysfunction leads to translocation of endonuclease G and apoptosis-inducing factor to the nucleus, causing this event considered the "point of no return" for hepatocyte death
What is nuclear DNA fragmentation?
Doxorubicin causes dose-dependent cardiotoxicity. This iron-chelating agent is the only FDA-approved medication to prevent anthracycline-induced cardiomyopathy and is considered when cumulative doxorubicin doses exceed 300 mg/m²
What is dexrazoxane?