Antidote policy and treatment of specific poisonings.key PDF
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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 • 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) • Obidoxim (Toxogonin®) 250 mg Amp. (OP poisoning - reactivation of AChE) • 4-DMAP 250 mg Amp. (Cyanide poisoning) • Sodium-thiosulfate 10% Inf. (Cyanide poisoning) • Biperiden (Akineton®) 5 mg Amp. (Anticholinergic agent to treat extrapyramidal tardive dyskinesia) • Flumacenil (Anexate®) 0.5 mg Amp. (BZD-Antagonist) • Naloxon (Narcanti®) 0.4 mg Amp. (Opioide-Antagonist) • Physostigmine (Anticholium®) 2 mg Amp. (CAS-Syndrome) • 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 ! ! ! 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 • 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 • Aim: To describe clinical features, complications and differences between Dimethyl- or Diethyl-OP compounds as well as differences between survivors and fatalities • Reactivation by oximes, influence on RBC-AChE and NMF were beyond the scope of this study Methods • Retrospective single centre study on OP poisoned patients admitted between January 2000 - December 2012 • Tertiary university hospital (1100 beds) • Computerized search of an electronic database (Oracle) using the search code „organophosphate“ or the ICD-10 code T60.0, respectively • Inclusion criteria: • Acute ingestion of OPs requiring admission to ICU (e.g. coma, seizures, need for mandatory ventilation, or cardiovascular support) • Signs of cholinergic syndrome calling for treatment with atropine and/or obidoxime, respectively • Exclusion criteria: • Patients under the age of 18 • Carbamate ingestion
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