Famous poisons
This is used in the Harry Potter World as a universal antidote to most poisons, when in actuality these are very dangerous in patients who have had ingestions.
What is a bezoar?
This blocks alcohol dehydrogenase which inhibits production of toxic metabolites such as formic acid and glycolic acid in ingestions of certain poisons but in a pinch, common ethanol can be substituted.
What is fomepizole
The dose of this antidote depends on the clinical context, for example the empiric amount in cardiac arrest is very different to the amount given if steady state known which is 0.78 x weight (in kg) / 100 OR if known amount ingested which is amount ingested (mg) x 1.6
What is digifab?
You better hope you don't need q1h bloodwork after giving this antidote, because it messes many of them up including Hb, coagulation studies, LFTs and creatinine
What is hydroxycobalamin?
Many features of this antidote make it less than optimal in treating patients with hyperthermia, spontaneous clonus and tachycardia, including it's own anticholinergic properties and the fact that it must be administered orally which is often not feasible in the target population.
What is cyproheptadine?
Samuel L Jackson might want to consider carrying this antidote with him if he does any further flying, especially if the other guests on board have triangular heads or if they have pits between their eyes and nostrils.
What is Crofab or ANAVIP
One of the safest and most well studied antidotes is a somatostatin analog which blocks beta cells in the pancreas from releasing insulin in response to a glucose load.
What is octreotide?
There are multiple ways to administer this antidote with a 21h method of 150 mg/kg in 200ml D5W over 1h then 50 mg/kg in 500ml D5W over 4 hours then 100 mg/kg in 1L D5W over 16h (UTD/Rosens) or the OPC method of 60 mg/kg/h 3% over 4 hours followed by maintenance 6mg/kg/h continuously until stop ordered.... then there's a high dose protocol, a 72h protocol, a two bag protocol...
What is NAC?
This antidote has been found to cause pancreatitis, possibly due to the "H" in IGETSMASHED.
What is intralipid?
Treatment with this drug may exacerbate underlying psychiatric illness, takes up to 72 hours to produce effect and requires oral administration which may be difficult in patients with profound muscular rigidity.
What is Bromocriptine?
While Bond attempted to treat his dysrhythmia with an injection of lidocaine, and then cardioversion (through his Aston Martin) this would have only been a bandaid for the cardiotoxin poison he ingested.
What is digifab?
This rescue therapy bypasses the block of dihydrofolate reductase to ensure that there is enough cofactor available for the synthesis of purine nucleotides used for cell DNA and RNA synthesis.
What is folinic acid?
Starting at 2mg, double this dose until the following endpoints then infuse at 10% total/hour:
Clear chest with no wheeze, dry axillae
HR>80, SBP > 80
What is atropine?
With the possibility of inducing anaphylaxis in at least two people on this rotation, we no longer have to worry about the side effects of this antidote as it was discontinued from production in 2023
What is BAL (dimercaprol)?
Considered a grey zone, this can be considered in lead poisoning for children who have vague symptoms but their levels are positive but not toxic.
What is succimer?
Ra-Ra-Rasputin became famous for surviving a cellular asphyxiant in 1916, despite this antidote not being approved for this use by the FDA until 100 years later
What is hydroxycobalamin
Although used as a last ditch effort in many overdoses, this antidote is best studied for treatment of LAST with some evidence that it works to alter the distribution of fat soluble toxins in the body.
What is intralipid?
Start with a bolus dose of 20% 1.5 ml/kg followed by an infusion of 0.25ml/kg/min (although Goldfranks would suggest repeat bolus doses to max total dose of 10 ml/kg)
What is intralipid?
In a patient with G6PD deficiency, this antidote may paradoxically worsen the clinical picture or cause hemolysis.
What is methylene blue?
Be careful when administering this antidote as it limits your options for treating subsequent seizures in the same patient
What is flumazenil?
Although unlikely that he'd be "Dead in a Minute" like Katniss exclaims, Peeta would benefit from this antidote if he had eaten the small dark berries that can cause tachycardia, seizures and coma.
What is physostigmine
What is pyridoxine?
Dose will depend on clinical picture and type of user to prevent precipitating withdrawal, anywhere from 0.04 mg aliquots to 2 mg in arrest to a continuous infusion for long acting overdoses at 2/3 effective dose/hour to maintain adequate respirations
What is naloxone?
Although in the toolbox for BB and CCB overdose, the dose at which it is beneficial (effectively using up all hospital stores), and the dose dependent and sometimes severe vomiting it induces, makes us reach for other, better tools
What is glucagon?
Although we have a very easy and cheap way to treat these patients in every hospital, you may consider sending them to one of the four places in the province that provide this treatment to prevent long term neurologic sequelae (if you can get them there within 6 hours)
What is hyperbaric oxygen?