Sodium Calcium Edetate (EDTA) is an intravenous heavy metal chelating agent. EDTA is primarily used in the treatment of severe lead poisoning with or without lead encephalopathy or an asymptomatic/mildly symptomatic patient with a serum lead level >70 microgram/dL (3.38 micro mol/L).
Intravenous pyridoxine is used in high doses to control the metabolic acidosis and seizures associated with isoniazid overdose and poisoning from other hydrazine compounds (Gyromitra mushrooms and jet/rocket fuel). It is also used as a adjunct to ethylene glycol toxicity
Pralidoxime reactivates acetylcholinesterase only if irreversible binding to the OP has not already occurred ("ageing"). The acetylcholinesterase enzyme has two parts to it. In organophosphate poisoning, an organophosphate binds to just one end of the acetylcholinesterase enzyme (the esteric site), blocking its activity.
A reversible acetylcholinesterase inhibitor useful in the treatment of central anticholinergic delirium that is not easily controlled by benzodiazepine sedation and there is high risk for aspiration and excessive sedation. Only for those patients who have an isolated anticholinergic agent toxicity (not the polypharmacy overdose).
Long-acting synthetic octapeptide analogue of somatostatin useful in the control of sulfonylurea-induced hypoglycaemia (BSL <4 mol/L) either from overdose or an iatrogenic source. It is also useful in hypoglycaemia induced from Quinine.
Potent oral chelating agent for a broad range of heavy metals. Agent of choice in very few scenarios due to poor side-effect profile and the existence of better tolerated and more efficacious agents. If possible EDTA or Succimer should be used instead.
This opioid antagonist is a useful adjunct in the management of opioid intoxication, particularly if there is CNS or respiratory depression. Caution is advised in those who are opiate-dependant and naloxone should only be used if there is significant CNS (GCS <12) and respiratory depression (RR <8).
N-acetylcysteine (NAC) is the most widely used sulfhydryl donor in the treatment of paracetamol poisoning. Standard therapy consists of a series of three infusions given over 20 hours.
Methylene Blue is the treatment of choice for symptomatic drug-induced methaemoglobinaemia (signs of hypoxia with chest pain, dyspnoea or confusion) or consider in asymptomatic patients with methaemoglobin (MetHb) levels >20%.
Intravenous lipid emulsion (IVLE) is a sterile emulsion of soyabean oil in water, used in parenteral nutrition. It is a novel antidote which requires further study but may have a role to play in the resuscitation of patients with refractory cardiac arrest induced by local anaesthetics that are resistant to standard protocols.
High-dose insulin therapy is a novel therapeutic intervention that produces a significant inotropic response in severe calcium channel blocker (CCB) overdose and occasionally in beta blocker overdose.
Idarucizumab is the antidote to dabigatran. Perhaps the hardest thing about it is saying its name. Eye-da-roo-ciz-oo-mab or praxbind until to comes off label. It is a humanised monoclonal antibody fragment (Fab) that binds to dabigatran with very high affinity (340x fold more than dabigatran binds to thrombin).