Toxicity

Barbiturate
Benzodiazepin

Anti Depressant
noncyclic
Anti Depressant
tricyclic

Amphetamine
Cannabis ,
Marjuana

Methanol

Ethanol

Cocaine

Salicylate (aspirin)

Antidote
X
Flumazenil 0.1-0.2 mg I.V
Max :3mg ( drawback: side sever
effect )
For suspected serotonin syndrome
- Cyproheptadine 4mg PO every
hr for 3doses
- Methysergid 2mg PO every hr
for 3doses
- QRS interval prolongation
sodium bicarbonate 1-2 mEq/kg
- Hyperventilation induce
respiratory alkalosis
- Physostigmine used in past but
withdraw for sever side effect
X
Agitation : Diazepam 10 mg I.V
HTN: Phentolamine
X
Physiological disturbance :
Use : lorazepam , diazepam
Bicarbonate 400-600 mmol during
first hrs (reserve visual impairment)
1ml/kg of 5fold diluted alcohol 96%
0.16ml/kg/hr maintenance dose oraly
Fomepizole : 15mg/kg loading dose
10mg/kg 4bolus every 12hrs
Abnormal mental status
glucose 25-50g , Naloxone 2mg ,
Thiamine 100mg
Seizures lorazepam 2mg
Disulfiram : 12hr before off alcohol
Orally 250-500mg/day
Acamprosate : 666mg/d 3doses
X
HTN: phentolamine
HTN, Agitation :Dizepam 5-10mg
MI: diazepam,aspirin 325mg
,nitroglycerin 0.4 mg SL
Phentolamaine :1-5mg I.V
X

Decontamination

Elimination

AC (1g/kg) ,
MDAC (15-20g ever 6h)

+ Alkalinization (PH > 7.5 )

only in phenobarbital

AC (chance of aspiration so
protect airway ),
Gastric emptying may useful
AC , do not induce emesis

X
(Extensive protein binding , large
volume distribution)

AC , do not induce emesis

Gastric lavage for large
ingestion 20-30mg/kg

AC , do not induce emesis

AC , Ipecac induced
vomiting
May be useful (prehospital)

(EPB,LVD)

X , renal elimination by
acidification of urine but not
recommended due to nephrotoxicity
X

(LVD)

Haemodialysis
X

Folic acid/ Folinic acid

50mg I.V every 4hrs for 24hrs
Magnesium

Gastric lavage
In case of
Ethanol ingestion 1g/kg
Or co-ingestant suspected

Haemodialysis
(but invasive procedure)
Not routinely recommended

AC , do not induce emesis

X
Whole-bowel irrigation ,
cocaine-filled candoms
ingestion
AC , very efficacious
Each gm absorb 550g of drug

Alkalinize with sodium bicarbonate

1-2mEq/kg I.V push
150mEq/kg in1liter D5W maintenace
Haemodialysis vey effective