The Antidote Challenge
aka Toxicology Conundrum 031
OK. You’ve survived the Australian elapid snakebite envenoming challenge, took the toxidrome challenge in your stride, and simply brushed aside the ‘sniff a poison’ challenge.
What’s next?…the antidote challenge.
For each of the poisons listed below see if you can name the appropriate antidote(s), click on the link to show/hide the answer.
The Antidote Challenge
Amanita mushrooms (amatoxin)
- silibinin, penicillin
amitriptyline
- sodium bicarbonate
- (see Toxicology Conundrum 022)
arsenic
- dimercaprol/ BAL (British Antilewisite)
beta blockers
- glucagon, high-dose insulin euglycaemic therapy (HIET)
- (see Toxicology Conundrum 044)
benzodiazepines
- flumazenil
- (see Toxicology Conundrum 044)
benzodiazepines
- flumazenil
- (see Toxicology Conundrum 049)
bupivacaine
- sodium bicarbonate, intralipid
cesium
- prussian blue
- (actually not an antidote, but a specific agent used for gastrointestinal decontamination and enhanced elimination)
copper
- penicillamine
cyanide
- thiosulfate, hydrocobalamin (also – dicobalt edetate)
- (see Toxicology Conundrum 038)
digoxin
- digoxin specific immune Fab fragments
glipizide
- glucose, octreotide
- (see Toxicology Conundrum 037)
heparin
- protamine
hydrofluoric acid
- calcium
hyoscine
- physostigmine
iron
- desferrioxamine
- (see Toxicology Conundrum 034)
isoniazid
- pyridoxine
magnesium
- calcium
methanol, ethylene glycol
- ethanol, fomepizole (4-methylpyrazole)
- (see Toxicology Conundrum 035)
methemoglobinemia
- methylene blue
- (see Toxicology Conundrum 053)
methotrexate
- folinic acid
mercury (inorganic salt)
- dimercaprol (aka British Antilewisite, BAL)
- (see Toxicology Conundrum 002)
Oleander poisoning
- digoxin specific immune Fab fragments
organophosphate
- atropine, pralidoxime
opiates
- naloxone
- (see Toxicology Conundrum 006)
lead
- dimercaprol (aka British Antilewisite, BAL) and EDTA, or succimer (DMSA) if mild or asymptomatic with high levels
- (see Toxicology Conundrum 006)
paracetamol
- n-acetylcysteine (NAC)
- (see Toxicology Conundrum 001)
thallium
- prussian blue (actually not an antidote, but a specific agent used for gastrointestinal decontamination and enhanced elimination)
verapamil
- calcium, high-dose insulin euglycaemic therapy
- (see Toxicology Conundrum 028)
LITFL Toxicology Challenges
- Toxidrome Challenge
- ‘Sniff a poison’ challenge
- Snakebite Envenoming Challenge
- The Antidote Challenge
CLINICAL CASES
Toxicology Conundrum
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
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