Antidotes: Principles and Clinical Applications

343 Pages·2001·2.71 MB·English

by  Robert Flanagan

Antidotes
Cover illustration: Ceremonial preparation of Theriac in Strasbourg at the beginning of the
sixteenth century (hand-coloured woodcut from Hieronymus Brunschwig’s Liber de arte
distillandi, 1512) (courtesy of the Deutscher Apotheker Verlag, Stuttgart).
Antidotes
Robert J Flanagan PhD FRCPath
Consultant Biochemist
Alison L Jones MD FRCP(E)
Consultant Physician and Consultant Clinical Toxicologist
Guy’s and St Thomas’ Hospital Trust, London
With a section on Antidotes and Chemical Warfare by
Timothy C Marrs MD DSc FATS MRCP FRCPath
Food Standards Agency
and
Robert L Maynard CBE MRCP FRCPath
Department of Health, London
London and New York
First published 2001
by Taylor & Francis
11 New Fetter Lane, London EC4P 4EE
Simultaneously published in the USA and Canada
by Taylor & Francis Inc,
29 West 35th Street, New York, NY 10001
Taylor & Francis is an imprint of the Taylor & Francis Group
This edition published in the Taylor & Francis e-Library, 2002.
© 2001 Robert J Flanagan, Alison L Jones
All rights reserved. No part of this book may be reprinted or
reproduced or utilised in any form or by any electronic,
mechanical, or other means, now known or hereafter invented,
including photocopying and recording, or in any information
storage or retrieval system, without permission in writing from
the publishers.
Every effort has been made to ensure that the advice and information
in this book is true and accurate at the time of going to press.
However, neither the publishers nor the authors can accept any legal
responsibility or liability for any errors or omissions that may be
made. In the case of drug administration, any medical procedure or
the use of technical equipment mentioned within this book, you are
strongly advised to consult the manufacturer’s guidelines.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data
A catalog record for this book has been requested.
ISBN 0–748–40965–3 (Print Edition)
ISBN 0-203-48507-6 Master e-book ISBN
ISBN 0-203-79331-5 (Adobe eReader Format)
[Hermes to Odysseus] Look; here is a drug of real virtue that you must take with
you into Circe’s palace to save yourself from disaster. But I must explain how she
works her black magic. She will begin by mixing you a pottage, into which she will
put her poison. But even with its help she will be unable to enchant you, for this
antidote that I am going to give you and describe will rob it of its power. When
Circe strikes you with her long wand, you must draw your sword from your side
and rush at her as though you meant to take her life. She will shrink from you in
terror and invite you to her bed. Nor must you hesitate to accept the goddess’
favours, if you want her to free your men and treat you kindly. But make her swear
a solemn oath by the blessed gods not to try on you any more of her tricks, or when
she has you stripped she may rob you of your courage and your manhood.
Then the Giant-killer handed me a herb he had plucked from the ground,
and showed me what it was like. It had a black root and milk-white flower. The
gods call it Moly, and it is an awkward plant to dig up, at any rate for a mere
man. But the gods, can do anything.
Homer, The Odyssey. Translated by EV Rieu.
London: Penguin Books, 1946, p. 163

Contents
ACKNOWLEDGEMENTS ix
PREFACE x
FOREWORD xi
ANTIDOTE NOMENCLATURE AND DOSAGE xii
LIST OF ABBREVIATIONS xiii
CHAPTER 1
General Introduction 1
CHAPTER 2
Agents Used to Treat Poisoning with Toxic Metals and
Organometallic Compounds 35
CHAPTER 3
Immunotherapy 95
CHAPTER 4
Metabolic Antidotes 125
CHAPTER 5
Pharmacological Antidotes 165
CHAPTER 6
Antidotes to Carbon Monoxide, Cyanide and Hydrogen Sulphide 221
CHAPTER 7
Antidotes to Chemical Warfare Agents 245
CHAPTER 8
Antidotal Treatment of Paraquat Poisoning 269
CHAPTER 9
Antidote Interference in Toxicological Analyses 279
APPENDIX 1
Which Antidote for Which Poison? 287
APPENDIX 2
Dosage and Dosage Form of Some Commonly Used Antidotes 289
CONTENTS
APPENDIX 3
Decision Trees to Aid Treatment of Paracetamol Poisoning 301
APPENDIX 4
Guide to the Interpretation of Analytical Toxicology Results
and Mass/Amount Concentration Conversion Factors for
Some Metals and Trace Elements 307
INDEX 311
viii (cid:1)
Acknowledgements
We thank Dr Tim Marrs and Dr Bob Maynard for contributing Chapter 7 and for help
with parts of Chapters 5 and 6, and Helaina Checketts (Medical Toxicology Unit
Librarian), the staff of the Wellcome Library for the History of Medicine, Dr Jenny
Pronczuk de Garbino (World Health Organization), Dr Paul Dargan, Dr Roy Goulding,
Dee Cook (Archivist to the Society of Apothecaries), John Ramsey, Lynn Saliba and the
staff of the British Library, John Trestrail, Dr Katherine Watson, Dr Paul Wax and Dr
David Zuck for assistance.