Give an antidote (if available) when there is reasonable certainty of a specific diagnosis (Table 38–3). Be aware that some antidotes themselves may have serious side effects. The indications and dosages for specific antidotes are discussed in the respective sections for specific toxins.
Table Graphic Jump Location Table 38–3.Some toxic agents for which there are specific antidotes (listed in alphabetical order).1 ||Download (.pdf) Table 38–3. Some toxic agents for which there are specific antidotes (listed in alphabetical order).1
|Toxic Agent ||Specific Antidote |
|Acetaminophen ||N-Acetylcysteine |
|Anticholinergics (eg, atropine) ||Physostigmine |
|Anticholinesterases (eg, organophosphate pesticides) ||Atropine and pralidoxime (2-PAM) |
|Benzodiazepines ||Flumazenil (rarely used)2 |
|Carbon monoxide ||Oxygen (hyperbaric oxygen of uncertain benefit) |
|Cyanide ||Sodium nitrite, sodium thiosulfate; hydroxocobalamin |
|Digitalis glycosides ||Digoxin-specific Fab antibodies |
|Heavy metals (eg, lead, mercury, iron) and arsenic ||Specific chelating agents |
|Isoniazid ||Pyridoxine (vitamin B6) |
|Methanol, ethylene glycol ||Ethanol (ethyl alcohol) or fomepizole (4-methylpyrazole) |
|Opioids ||Naloxone, nalmefene |
|Snake venom ||Specific antivenin |
|Sulfonylurea oral hypoglycemic drugs ||Glucose, octreotide |
et al. Expert consensus guidelines for stocking of antidotes in hospitals that provide emergency care. Ann Emerg Med. 2018;71:314.
M. Chemical warfare agents. Classes and targets. Toxicol Lett. 2018;293:253.