Antidote policy and treatment of specific poisonings.key

41 Pages·2014·2.6 MB·English

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Technische Universität München
Klinikum rechts der Isar
Antidote Policy and
treatment of specific
poisonings
Florian Eyer

Toxikologische Abteilung

Klinikum rechts der Isar

Technische Universität München

[email protected]
Antidote policy in Clinical Toxicology in
Germany (Munich)
Pragmatic classification of antidotes

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supportive antidotes - “nice to have - but
usually not life-saving” - should be
available in hospitals

•
life-saving antidotes - should be available
both in the preclinical (e.g. paramedics)
and clinical setting (ED, ICU)
Antidotes available in the preclinical German
emergency physician system
•
Atropin 1% (OP poisoning - cholinergic crisis)

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Obidoxim (Toxogonin®) 250 mg Amp. (OP poisoning - reactivation of
AChE)

•
4-DMAP 250 mg Amp. (Cyanide poisoning)

•
Sodium-thiosulfate 10% Inf. (Cyanide poisoning)

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Biperiden (Akineton®) 5 mg Amp. (Anticholinergic agent to treat
extrapyramidal tardive dyskinesia)

•
Flumacenil (Anexate®) 0.5 mg Amp. (BZD-Antagonist)

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Naloxon (Narcanti®) 0.4 mg Amp. (Opioide-Antagonist)

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Physostigmine (Anticholium®) 2 mg Amp. (CAS-Syndrome)

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Diazepam (Valium®) 10 mg Amp. (e.g. Cocaine-intoxication)
Life-saving antidotes
Poison Antidote Trading name Dose
Chloroquine Diazepam Valium® 1-2 mg/kg
Ethylenglycol Ethanol / 4-MP Ethanol 0.6 g/kg
Insulin / Sulfonylurea Glucose 25 g
CO Oxygen 100 %
Met-Hb-building agents Toloniumchloride Toluidinblau® 2-4 mg/kg
1-20 mg bzw. 250mg/
Organophosphates Atropin /Obidoxime 1% Atropin
750 mg/24h
Tricyclic AD Sodium bicarbonate NaBic 8.4% 1-2 mval/kg
4-DMAP or 4-DMAP 250 mg
Cyanide
Hydroxocobalamin Zyanokit® 5-10 g
Supportive Antidotes
Poison Antidote Trading name Dose
Anticholinergic agents
Physostigmine Anticholium® 2-4 mg i.v.
Antihistamines
Benzodiazepines Flumazenil Anexate® 0.5-1 mg
Neuroleptic overdose Biperiden Akineton® 2.5-5 mg
Organophosphates Obidoxime Toxogonin® 250 mg / 750 mg
Opiates Naloxon Narcanti® 0.4 mg
Irritant gas (chlorine, Junik®
Corticosteroides 250 mg i.v.
phosgene, NOx) Ventolair®
Cyanides Sodium thiosulfate S-Hydril® 7 g
Life-saving antidotes - Hospital
Poison Antidote Trading name Dose
Digitalis- Digi-Fab®
Digitalis glycosides 40-80 mg bolus dose
Antitoxin Digi-Bind®
Iron poisoning Desferoxamin Desferal® 15 mg/kg/h
150 mg / 1 h
Paracetamol N-Acetylcysteine Fluimucil® 50 mg / 4 h
100 mg / 16 h
Dimercaptopropansulfonate Dimaval®
Heavy metals 250 mg alle 3 h
Dimercaptosuccinic acid Succimer®
Supportive antidotes - Hospital
Poison Antidote Trading name Dose
ß-blocking agents Glucagon Glucagon® 7 mg
Hydrofluoric acid Calciumgluconate Ca-Braun 10%® 1-2 g i.a. / s.c.
Heparin Protamine Protamin® 10 mg für 1000 IE
Isoniacid Pyridoxine Pyridoxal® 5 g
Amatoxines Silibinin Legalon-Silibinin® 20 mg/kg
OAK (Cumarines) Phytomenadion Konakion® 25 mg / d oral
Thallium Prussian blue Antidotum Thalli-Heyl® 3 g oral
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Technische Universität München
Klinikum rechts der Isar
Organophosphate poisoning in the
developed world - a single centre
experience from here to the
millennium
Florian Eyer

Toxikologische Abteilung

Klinikum rechts der Isar

Technische Universität München

[email protected]
Background
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OP poisoning is still associated with high morbidity and
mortality, both in resource-poor settings and in developed
countries

•
Despite large-sized studies with sufficient statistical power,
individual details of OP-poisoned patients are rarely reported

•
We therefore conducted a retrospective study on patients
with OP poisoning admitted to our ICU

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Aim: To describe clinical features, complications and
differences between Dimethyl- or Diethyl-OP compounds
as well as differences between survivors and fatalities

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Reactivation by oximes, influence on RBC-AChE and NMF
were beyond the scope of this study
Methods
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Retrospective single centre study on OP poisoned patients admitted
between January 2000 - December 2012

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Tertiary university hospital (1100 beds)

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Computerized search of an electronic database (Oracle) using the
search code „organophosphate“ or the ICD-10 code T60.0,
respectively

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Inclusion criteria:

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Acute ingestion of OPs requiring admission to ICU (e.g. coma,
seizures, need for mandatory ventilation, or cardiovascular support)

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Signs of cholinergic syndrome calling for treatment with atropine
and/or obidoxime, respectively

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Exclusion criteria:

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Patients under the age of 18

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Carbamate ingestion