Antidotes

Antidotes such as atropine, pralidoxime, and vitamin K are rare. In China, studies have demonstrated that the use of antidotes brought people near death when they didn't have a pesticide injury. Atropine and pralidoxime are useful as antidotes in organophosphate and carbamate poisoning when they are used to treat bradycardia and hypotension, and in drying up copious secretions (Table 13.5) (4,17,20).

Table 13.5. Antidotes and specific treatments.

Atropine

Organophosphate

Adults: 2-4 mg every 10-15 minutes

or carbamate poisoning

to symptoms, i.v.

Children: 0.015 to 0.5 mg/kg every

15 minutes to symptoms, i.v.

Pralidoxime

Organophosphate and

Adults: 4 mg/kg over 4 to 6 hours or

(2PAM)

carbamate poisoning

8 to 10 mg/kg/hr, i.v.

Protopam™

(cholinesterase

or 1 to 2 g over 15 to 30 minutes, i.v.,

reactivant)

repeated every 1 to 2 hours by

symptoms

Children: 25 mg/kg loading dose,

followed by 20 mg/kg/hr until

symptoms have abated

Vitamin K

Coumadin (Rodenticide)

Adults: 10 to 25 mg/kg p.o. or 2

Phytonadione

to 5 mg p.o.

Mephyton™

2.5 to 25 mg s.q. or i.m. (or rarely up

AquaMephyton™

to 50 mg) every 6 hours to

symptoms

Children: 5 to 10 mg/kg p.o. or 2.5 to

25 mg s.q. or i.v. every 6 hours adjusted

to severity of symptoms

Physostigmine

Muscarinic effects of

Adults: 2 mg i.v. and 1 to 2 mg every

anticholinesterase

20 minutes until response

chemicals; use in

Children: 0.02 mg/kg i.v.

situations of severe

poisoning and excessive

agitation, long-lasting

seizures, and cardiac

arrhythmias

Table 13.S. Antidotes and specific treatments. (continued)

Diazepam

Seizures in cholinesterase

Adults: 5 to 10 mg i.v., s.q., or rectally

and carbamate poisoning

Children: 1 to 5 mg, i.v., s.q., or rectally

Perchlorperazine

Antiemetic

Adults: 5 to 10 mg, p.o. every 6 to

Compazine™

8 hours, 5 to 10 mg i.m. every 6

to 8 hours,

2.5 to 10 mg i.v. every 6 to 8 hours

to symptoms

Children: Not indicated under 2 years.

Over 2 years of age: 0.06 mg/lb every

6 to 8 hours

Promethazine

Antiemetic

Adults: 25 mg p.o. or i.m. every

(Phenergan)

4 to 6 hours

Children: 0.5 mg/lb every 4 to 6 hours

i.m. or p.o.

Source: Data from Tordoir et al. (4) and Ellenhorn et al. (17).

Source: Data from Tordoir et al. (4) and Ellenhorn et al. (17).

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