Hydroxocobalamin is a vitamin B12 (cyanocobalamin) precursor. In high doses, it is an effective chelator of cyanide. It is also the preferred antidote to cyanide poisoning due to its low side effect profile, thus if given to a patient without cyanide poisoning there is low risk of an adverse outcome
Symptomatic hypoglycaemia resulting from toxic exposures must be immediately corrected by administration of glucose. In all but the mildest of cases this is achieved with an intravenous bolus of hypertonic glucose solution
Fomepizole is an alcohol dehydrogenase inhibitor used in management of methanol and ethylene glycol poisoning. It is not currently available in either Australia or New Zealand.
Polypeptide hormone secreted by the alpha-cells of the pancreas. Supra-physiological doses have previously been advocated in the management of beta-blocker and calcium channel blocker poisoning but this practice is now largely abandoned.
Folinic acid is the active form of folic acid. It is routinely used for “folinic acid rescue therapy” following administration of high-doses of parenteral methotrexate in oncologic practice.
Flumazenil is a competitive benzodiazepine antagonist with a limited role in the management of benzodiazepine poisoning. Usually to reverse procedural sedation, accidental paediatric ingestion with compromise, and rarely to help make a diagnosis of benzodiazepine overdose or if a patient's airway is compromised without quick access to intubation equipment
Competitively blocks the formation of toxic metabolites in toxic alcohol ingestion by having a higher affinity for the enzyme Alcohol Dehydrogenase (ADH). Its chief application is in methanol and ethylene glycol ingestion, although it has been used with other toxic alcohols. Ethanol is now regarded as the second choice antidote in those countries with access to the specific ADH blocker, fomepizole.
Benztropine is the first line agent for the treatment of acute dystonic reactions. See how to administer and dose this drug.
Desferrioxamine is an effective iron chelator that is used to treat systemic iron toxicity or prevent the development of systemic toxicity following acute iron overdose. It should ideally be given before iron moves intracellularly and systemic toxicity develops.
This rarely used intramuscular chelator is the most toxic of all chelating agents, and is reserved for the treatment of severe poisoning from lead, inorganic arsenic and mercury, if possible EDTA or Succimer should be used instead.
Dicobalt edetate was developed as a cyanide antidote based on the known ability of cobalt to form stable complexes with cyanide.
A 5 year-old boy is 'off his face' after drinking what looked like a nice bottle of cordial. It was actually radiator coolant. You are called for advice.