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)
citalopram
  • cyproheptadine, benzodiazepines for serotonin toxicity
  • (see Toxicology Conundrums 017 and 024)
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)
warfarin
  • vitamin K
  • (see Toxicology Conundrums 015, 016 and 021)

LITFL Toxicology Challenges


CLINICAL CASES

Toxicology Conundrum

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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