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Antidote Administration Guidelines June2010
Antidote Administration Guidelines June2010
Snake bite
ANTIDOTE
Antivenom
STRENGTH ED STOCK
Black 2
LOCATION AT RPH*
PHARMACY
x
ADMINISTRATION
Dilute vial(s) in 500mL normal Dilute one vial 1:10 in Hartmann's saline. Give IV over 20 minutes [1] soln & give by slow IV inj [2] Dilute vial(s) in 500mL normal Dilute one vial 1:10 in Hartmann's saline. Give IV over 20 minutes [1] soln & give by slow IV inj [2] Dilute 1 vial in 500mL normal Dilute one vial 1:10 in Hartmann's saline. Give IV over 20 minutes [1] soln & give by slow IV inj [2] Dilute vial(s) in 500mL normal Dilute one vial 1:10 in Hartmann's saline. Give IV over 20 minutes [1] soln & give by slow IV inj [2] N/A Use polyvalent antivenom
Antivenom
Brown
Antivenom
Death Adder
2 x 4
x x 3
Dilute vial(s) in 500mL normal Dilute one vial 1:10 in Hartmann's saline. Give IV over 20 minutes [1] soln & give by slow IV inj [2]
Spider bite
Antivenom
Redback
10
Give the contents of one vial by IM injection. In life-threatening Dilute one vial 1:10 in Hartmann's situations, it can be given IV - dilute soln & give by slow IV inj [2] vial(s) in 100mL normal saline and give over 20 minutes [1,2] Reconstitute each vial of the freezedried antivenom in 10mL WFI, dilute two ampoules in 100mL Only stocked in pharmacy store normal saline and give IV over 20 fridge. Stock owned by Perth Zoo. minutes. [1] Can be given IM.[2] Call on-call pharmacist if required after-hours. Administer one vial diluted in 500mL normal saline, IV over 20 minutes. [1] Contact on-call pharmacist to arrange supply. Administer one vial for every two spine puncture wounds, undiluted, by IM injection. Alternatively it may be diluted in 100mL normal saline and given IV over 20 minutes [1]
Prepared by N Dowling (Clinical Pharmacist, RPH) 30/06/2010 Reviewed by Dr J Soderstrom (Toxicologist) 30/06/2010
Antivenom
Funnel Web
Pharmacy
Marine bite
Antivenom
Sea Snake
SCGH
Antivenom
Stonefish
INDICATION
ANTIDOTE
STRENGTH ED STOCK
LOCATION AT RPH*
ED CC2 imprest cupboard (bottom shelf)
PHARMACY
ADMINISTRATION Administer 1-2mg/kg (0.1-0.2mL/kg of 1% solution) IV slowly over 5 minutes. Flush with normal saline. Can repeat dose after 30-60 minutes if required.[1,2,3] Administer 12.5g (50mL of 25% solution) IV over 10 minutes (2.55mL/min). [1,4] Reconstitute each vial with 100mL sodium chloride 0.9% solution for injection, using the supplied sterile transfer device. Rock or invert the vial for at least 30 seconds to mix it must NOT BE SHAKEN as the contents may foam. Prime the infusion set provided with the solution. Repeat the procedure with the second vial. Administer as an intravenous infusion over 15 minutes. [5]
ADDITIONAL INFO FOR PHARMACIST G6PD deficiency - lack of NADPH causes methylene blue to be ineffective. Dose adjust in renal impairment.
Drug-induced methaemoglobinemia
Methylene blue
1%, 5mL
10
Cyanide poisoning
Sodium thiosulphate
2.5g/10mL (25%w/v)
10
Hydroxocobalamin
2.5g vial
A second dose may be required if severe poisoning. Rate of infusion for second dose ranges from 15 minutes to 2 hours based on patient condition. Max recommended dose is 10g. [5]
Isoniazid poisoning
Pyridoxine
100mg/mL
50
Can use 5g in 500mL glucose 5% as an infusion. Give 1g pyridoxine Give 5g IV over 30 minutes.[3] Give for every 1g isoniazid ingested. 0.5g/minute until seizures stop or Give 5g if ingested dose unknown. infusion is complete.[1] Repeat dose if seizures persist.[3] IV benzodiazepines are given concomitantly.[1,3]
INDICATION
ANTIDOTE
STRENGTH ED STOCK
LOCATION AT RPH*
PHARMACY
ADMINISTRATION 1. Reconstitute each vial of Digibind with 4mL WFI 2. GENTLY mix the vials 3. Draw up all vial contents 4. Attach 0.22 micron membrane filter to the syringe then attach the needle 5. Push contents into a 100mL sodium chloride 0.9% bag 6. Infuse over 30 minutes [1,2] * can be given as an IV bolus if cardiac arrest is imminent [4]
Digoxin toxicity
38mg
20
10
Dimercaprol (BAL)
100mg/2mL
20
1000mg/5mL
For lead encephalopathy: commence dimercaprol 4 hours before commencing EDTA. Give 4mg/kg by IM injection every 4 hours for 5 days. [1,3] **Contraindicated in peanut allergy Dilute dose in 500mL normal saline or glucose 5% and infuse over 24 hours (starting 4 hours after first dose of dimercaprol).[1] Dilute to 250-500mL with normal saline or glucose 5% and infuse over 8-12 hours.[3,4] Oral capsule. Start at 10mg/kg tds for 5/7 then 10mg/kg bd for 14/7. [1]
Dose for lead encephalopathy: 5075mg/kg d. Dose for symptomatic lead poisoning without encephalopathy: 25-50mg/kg d.
Succimer (DMSA)
100mg
1 x 100
500mg
10
ED CC1
Reduce infusion rate if hypotension Reconstitute 500mg powder with occurs. Rate may be increased up 5mL WFI, dilute to 100mL with to 40mg/kg/hr if life-threatening normal saline or 5% glucose. Infuse toxicity. Avoid prolonged infusion at up to 15mg/kg/hour [1,3,4] >24hours
INDICATION
Organophosphate poisoning
ANTIDOTE
STRENGTH ED STOCK
LOCATION AT RPH*
ED CC2 imprest cupboard (bottom shelf)
PHARMACY
Pralidoxime
500mg/20mL
20
ADDITIONAL INFO FOR PHARMACIST 0.2% sodium chloride solution is Initial dose 2g diluted in glucose 5% another alternative as a diluent. or saline 100mL and given over 15 There are no stability data to support minutes [1,3] use of normal saline. ADMINISTRATION Give IV, no faster than 1mg/minute.[3] Give 0.5-1mg IV Product info photocopied onto back over 5 minutes. [1] Compatible with of blue SAS form. normal saline and 5% glucose. [3] Topical. Can also be prepared by mixing 10mL 10% calcium gluconate solution with 30g/30mL KY gel. [1]
2mg/2mL
2.5%, 50g
20
Calcium gluconate
1g/10mL
20%, 500mL
Start with 1.5mL/kg over 1 minute, then give as a continuous infusion of 0.25mL/kg/min for 30-60 minutes. [6] Toxicologists will generally give a 0.5-1mL/kg bolus then run the rest of the 500mL over 1 hour in rescue situations.
References: 1. Murray L, Daly F, Little M, Cadogan M. Toxicology Handbook. Marrickville (NSW): Elsevier Australia; 2007. 2. UBM Medica. MIMSOnline. UBM Medica; Sydney: 2010. Acessed 24/05/2010. 3. Micromedex 1.0 (Healthcare Series) 4. Burridge N, editor. Australian Injectable Drugs Handbook. Collingwood: The Society of Hospital Pharmacists of Australia; 2009. 5. Product Information: CYANOKIT(R) IV injection, hydroxocobalamin IV injection. Dey LP, Napa CA. 2006. 6. Felice KL & Shumann HM. Intravenous lipid emulsion for local anesthetic toxicity; a review of the literature. Journal of Medical Toxicology. 2008; 4(3):184-191.