Specific Antidotes and Treatments


Call local poison information centre for specific doses and treatment recommendation
Common Antidotes: Initial Dosages and Indications
  Dose

 

Antidote Pediatric Adult Indication
Acetylcysteine 140 mg/kg PO load, followed by 70 mg/kg PO every 4 h for 17 total doses Acetaminophen
or  
150 mg/kg IV load over 60 min, followed by 50 mg/kg IV over 4 h and then 100 mg/kg IV over 16 h
Activated charcoal 1 g/kg PO 50-100 g Most ingested poisons
Antivenom Fab 4-6 vials IV initially over 1 h, may be repeated to gain control of progressive symptoms Envenomation by Crotalidae
Calcium chloride 10% (27.2 milligrams/mL elemental calcium) 0.2-0.25 mL/kg IV 10 mL IV Calcium channel antagonists
CCB
Calcium gluconate 10% (9 milligrams/mL elemental calcium) 0.6-0.8 mL/kg IV 10-30 mL IV Hypermagnesemia
    Hypocalcemia
Cyanide antidote kit
Amyl nitrite Not typically used 1 ampule in oxygen chamber of ventilation bag 30 s on/30 s off Cyanide
Hydrogen sulfide (use only sodium nitrite)
Sodium nitrite (3% solution) 0.33 mL/kg IV 10 mL IV
Sodium thiosulfate (25% solution) 1.65 mL/kg IV 50 mL IV
Deferoxamine 90 mg/kg IM (1 gram maximum) 2 g IM Iron
or or
15 mg/kg/h IV (maximum dose, 1 gram/d) 15 mg/kg/h IV (maximum dose, 6-8 g/d)
Dextrose (glucose) 0.5 g/kg IV 1 g/kg IV Insulin
    Oral hypoglycemics
Digoxin Fab
Acute 1-2 vials IV 5-10 vials Digoxin and other cardioactive steroids
Chronic 1-2 vials IV 3-6 vials IV Cardioactive steroids
Ethanol (10% for IV administration) 10 mL/kg IV over 30 min, then 1.2 mL/kg/h* 10 mL/kg IV over 30 min, then 1.2 mL/kg/h* Ethylene glycol
Methanol
Folic acid/leucovorin 1-2 mg/kg IV every 4-6 h 1-2 mg/kg IV every 4-6 h Methotrexate (only leucovorin)
Fomepizole 15 mg/kg IV, then 10 mg/kg every 12 h 15 mg/kg IV, then 10 mg/kg every 12h Methanol
Ethylene glycol
Disulfiram-ethanol interaction
Flumazenil 0.01 mg/kg IV 0.2 mg IV Benzodiazepines
**Glucagon 50–150 mcg/kg IV 3–10 mg IV
Calcium channel antagonists
β-Blockers
Hydroxocobalamin 70 mg/kg IV (not to exceed 5 grams) over 30 min; can be repeated up to three times Cyanide
Administered in combination with sodium thiosulfate Nitroprusside
IV lipid emulsion 20% 1.5 mL/kg IV bolus over 1 min (may be repeated two times at 5-min intervals), followed by 0.25 mL/kg/min IV 100 mL IV bolus over 1 min, followed by 400 mL IV over 20 min IV bupivacaine
Rescue therapy for calcium channel antagonists and β-blockers
Methylene blue 1–2 mg/kg IV 1–2 mg/kg IV Oxidizing chemicals (e.g., nitrites, benzocaine, sulfonamides)
Neonates: 0.3–1.0 mg/kg  
Octreotide 1 mcg/kg SC every 6 h 50–100 mcg SC every 6 h Refractory hypoglycemia after oral hypoglycemic agent ingestion
Naloxone As much as is needed As much as needed Opioid
Typical starting dose is 0.01 mg IV Typical starting dose is 0.4–2.0 mg IV Clonidine
Physostigmine 0.02 mg/kg IV 0.5–2.0 mg slow IV over 2–5 min Anticholinergic agents (not cyclic antidepressants)
Pralidoxime (2-PAM) 20–40 mg/kg IV over 5–10 min, followed by 20 mg/kg/h infusion 1–2 grams IV over 5–10 min, followed by 500 mg/h infusion Cholinergic agents
Protamine 1 mg neutralizes 100 units of unfractionated heparin, administered over 15 min Heparin
0.6 mg/kg IV (empiric dose) 25–50 mg IV (empiric dose)
Pyridoxine Gram for gram of ingestion if amount of isoniazid is known Isoniazid
70 mg/kg (maximum 5 grams) IV 5 g IV Gyromitra esculenta
Hydrazine
Sodium bicarbonate 1–2 mEq/kg IV bolus followed by 2 mEq/kg/h IV infusion 1–2 mEq/kg IV bolus followed by 2 mEq/kg/h IV infusion Sodium channel blockers
For urinary alkalinization
Thiamine 5–10 mg IV 100 mg IV Wernicke syndrome
Wet beri-beri
Vitamin K1
 
1–5 mg/d PO 20 mg/d PO Anticoagulant rodenticides