Universal antidote from the group of vitamin preparations. Classification of antidotes used in poisoning. Antidotes against bacterial and animal toxins
Poisoning with any substance adversely affects the state of the body. Specific antidotes are often used to reduce the effects of the toxin. A list of the most popular of them can be seen below.
Antidotes for chemical toxins
poisonous substance | Antidote | Mode of application |
Potassium permanganate, nitrites, hydrogen sulfide compounds, carbon monoxide | methylene blue | It is administered intravenously up to two milliliters of the substance with the addition of a glucose solution. Not used in children under one year old, in children under the age of sixteen, the level of the substance is calculated depending on the number of years |
Salt compounds of metals mercury, arsenic, copper, lead | Magnesium or sodium sulfate | It is used to cleanse the stomach in a one percent concentration. In children, it is used intramuscularly based on body weight. |
Bromine, hydrocyanic acid, iodine, mercury, arsenic, benzene | Sodium thiosulfate | Injected into a vein using droppers up to two hundred milliliters of a substance, in a child the allowable amount is calculated based on the age reached |
Arsenic, bismuth compounds, cardiac glycosides, substances with chromium or mercury in the composition, salts of heavy metals | Unithiol | It is used for intravenous administration every six hours based on the condition of the victim; for children, the dosage is selected based on the age of the victim. It is acceptable to inject the drug into the muscle. |
Magnesium salts, oxalic acid, salt compounds of fluoric acid | Chloride or calcium gluconate | Applied inside a vein, 10 ml for an adult and 5 ml for children. At the same time, gastric emptying and forced diuresis are carried out. |
Paracetamol, dichloroethane | Acetylcysteine | The introduction is oral, the amount reaches one hundred and forty milligrams initially, after some time, seventy milligrams per kilogram of weight with a frequency of four hours |
Sarin, substances that kill insects and cause paralysis of the nervous system | Atropine | Used for intravenous administration, the amount of the drug is selected depending on the severity of poisoning. If necessary, the volume of the drug is increased. Then used for infusion, adjusting the amount based on the condition of the patient. |
zoocoumarin | Vikasol, Dicinon | Use intramuscularly or intravenously (through a dropper). The amount of the substance depends on the body weight and age of the victim. |
Pilocarpine, clonidine, organophosphorus compounds | Diazepam | Injected into a vein at a dose of up to 10 mg, based on the condition, weight and age of the poisoned person |
Methyl alcohol | ethanol | The patient is allowed to take one hundred ml of thirty percent ethyl alcohol or a liquid is injected into the body through a vein, the procedure is carried out under medical supervision |
Painkillers of a narcotic nature | Naloxone | It is used for injection into a muscle, vein or eye. The volume of the drug is calculated by a specialist |
Silver nitrate compounds | Sodium chloride | Thoroughly wash the gastrointestinal tract with a two percent liquid |
Salts of copper, mercury, lead | Penicillamine | Reception is carried out at 250 mg three times a day in adults, in children the dosage is 25 mg per kilogram of weight |
Tetanus toxins | Tetanus toxoid | Used for a single injection into the deep layers of the skin |
Mercury, silver, cobalt, antimony | Strzhizhevsky's specific solution | Used for administration directly into the stomach, if necessary, use a probe |
Thallium, cesium | Prussian blue | Used orally, the amount of the drug is calculated by physicians depending on the weight and number of years of the patient |
Formaldehyde | ammonia, ammonium chloride | Used to cleanse the stomach while taking sodium sulfate |
Potassium cyanide | Nitroglycerin, sodium nitrite, methylene blue | Methylene blue, sodium nitrite injected into a vein, if necessary, add a glucose solution |
Chlorine | Oxygen, morphine, atropine | Provide the victim with access to clean air, morphine or atropine is injected into the subcutaneous layer of the epidermis in the required amount |
ethanol | Atropine, caffeine | Can be administered subcutaneously or intravenously |
ethylene glycol | Calcium gluconate or chloride, ethyl alcohol | Medicines are administered through a vein using droppers, ethanol is taken orally |
Drug poisoning is not uncommon, in such cases specific antidotes are also used to help reduce the toxic effects.
Antidotes for drug poisoning
Medication | Antidote | Scheme of use |
Anestezin | methylene blue | It is used for intravenous administration, the volume is calculated based on the mass of a person, an additional glucose solution is injected |
Atropine | Pilocarpine | Apply subcutaneously in the absence of a symptom of arousal |
Barbiturates | Bemegrid | In a volume of 10 ml is injected into the vein of the victim |
Heparin preparations | Protamine sulfate | Five milliliters of the substance is used for intravenous administration |
Diazepam | Aneksat | Use once in a volume of 0.2 mg, repeat if necessary |
Isoaniside | Vitamin B6 | Applied inside the muscle at 20 mg per kilogram of body weight |
Insulin | Stress hormones, adrenaline | 0.1% solution is administered orally in a volume of one milliliter |
Pilocarpine | Atropine | Apply in the subcutaneous layer or intravenously |
Teturam | Ascorbic acid, sodium bicarbonate | It is administered using droppers in a slow way together with a glucose solution |
Plants are often toxic and can cause serious overdoses. There are several substances that can help with such intoxications.
Antidotes of plant toxins and alkaloids
Substance | Antidote | Reception scheme |
Hemlock, Nicotine | The combination of glucose and novocaine | The mixture is administered using droppers, very slowly, regardless of the age of the patient |
cardiac glycosides | Digibind | Used for slow administration through a dropper, the amount of the drug depends on the degree of poisoning |
cannabiol | Aminazine, haloperidol | Medicines are administered in turn into the muscle under the supervision of a medical specialist |
Lily of the valley | Atropine | Used intravenously or subcutaneously in an amount of up to three milliliters |
Quinine | Tannin | It is used to wash the stomach, then sorbents and preparations are used to relax the intestines |
Mushroom poisoning is not uncommon. It is almost impossible to cope with such intoxication on your own. As antidotes, special substances are often used that neutralize the effect of the poison.
Antidotes for mushroom poisoning
Poisons | Antidote | How to apply |
Pale grebe, Muscarine, Fly agaric, Orellanin (bitter cobweb) | Atropine | It is administered subcutaneously or intravenously, the dosage is selected based on the poisonous substance and the patient's condition |
Anticholinergic toxic substances | Physostigmine | Used for intravenous injection, the amount depends on the degree of poisoning |
hallucinogenic substances | Diazepam | Intravenous administration of the drug in a dosage depending on the severity of the victim's condition |
Stitches (gyromitrin) | Vitamin B6 | Apply intramuscularly, the amount of the drug is calculated based on the weight of the person |
Often, intoxication occurs as a result of ingestion of poisons of animal origin. If necessary, specific antidotes are also used to help normalize the condition of the victim.
Antidotes for animal and bacterial toxins
toxins | Antidote | Application |
snake poison | Heparin, Antivenin | Both drugs are injected simultaneously into a vein, the amount of the drug is calculated based on the degree of poisoning |
Bee or wasp venom | adrenaline, prednisolone, ephedrine | Prednisolone is administered intravenously in an amount of up to 180 mg, adrenaline or ephedrine in a volume of up to 0.3 ml. |
Poison karakurt | Calcium chloride, antivenin, magnesium sulfate | All funds are used for intravenous administration using a dropper |
scorpion sting | Atropine, ergotamine | Used subcutaneously in dosages up to one milliliter |
Antidotes are always available in medical institutions, therefore, if signs of poisoning occur, it is necessary to provide the doctor with all the information about the toxic substance.
Video: antidotes
Vladyka A.S., Vegerzhinsky A.G., Sitnik A.G., Rodoslav L.S., Feldman A.V.
Odessa
“Anyone who drinks this remedy gets well ... except those who are not helped by it, and they die. Therefore, it is clear that it is ineffective only in incurable cases.
Modern pharmacology is dynamic and reflects the progress of biomedical and pharmaceutical sciences. Every year, dozens of new original medicines, hundreds of drugs with new trade names in a variety of dosage forms enter the pharmaceutical market. As the number of medicines increases, it becomes more and more difficult to provide care to patients. It must be remembered that drugs, along with a therapeutic effect, can cause a number of side effects, ranging from trivial (mild nausea and vomiting) to fatal (aplastic anemia, anaphylactic shock, and others that can lead to the death of the patient). Mortality in hospitalized patients due to side effects or drug overdose of less than 1% (WHO Chronicle). However, drugs are becoming readily available to the general consumer without medical education, resulting in about 5% of emergency hospitalizations for poisoning due to the development of side effects of drugs.
In case of poisoning with certain drugs and various chemicals, symptomatic therapy is carried out, while the most appropriate is the use of antidotes for adequate elimination of the poison from the body. Antidotes are designed to change the kinetic properties of toxic substances, their absorption or removal from the body, reduce the toxic effect on receptors and, as a result, improve the functional and life prognosis of poisoning. Specific antidotes exist for only a few groups of medicinal substances, and there are also two more groups of antidotes: antidotes that are pharmacological antagonists and antidotes that accelerate the biotransformation of poison into non-toxic metabolites. According to the classification proposed by Luzhnikov E.A. There are 4 main groups of antidotes:
The development of methods of resuscitation and symptomatic therapy has made significant changes in the tactics of treating acute poisoning and has increased the role of antidotes in clinical toxicology.
The table below contains a list of antidotes and their synonyms that are necessary for the most common poisonings. We hope that it will become a convenient reference tool for practitioners and students of medical universities.
The drug that caused poisoning (synonym) |
(synonym) |
Notes |
Barbiturates: Hexenal Thiopental- sodium Phenobarbital (Luminal) Cyclobarbital (Fanodorm) Cyclobarbitan+ Diazepam (Reladorm) |
Bemegrid (Ahypnon, Etimid, Eukraton, Glutamisol, Malysol, Megimide, Mikedimide, Megibal, Zentraleptin) Naloxone flumazenil |
10 ml 0.5% solution intravenously slowly, 3-4 injections until reflexes are restored. Has a stimulating effect on the central nervous system, effective in respiratory and circulatory depression of various origins. Effective only in cases of poisoning in the lungs degree. In case of severe poisoning, it does not exclude the need for cardiopulmonary resuscitation, against which it is contraindicated, like other CNS stimulants (caffeine, corazole, cordiamine, etc.). |
Benzodiazepines Alprazolam (Alzolam, Cassadan) Diazepam (Seduxen, Sibazon, Relanium) Mezapam Rudotel) Phenazepam Nitrazepam (Eunoctin, Radedorm) Oxazepam (Nozepam, Tazepam) -Chlordiazepoxide (Chlosepides, Elenium), etc. |
flumazenil (Aneksat) |
It is a competitive benzodiazepine antagonist with a short duration of action. The drug is administered intravenously 0,2 mg over 30 seconds for a total dose of 3-5 mg. Contraindicated in patients with epilepsy, with severe mixed poisoning with benzodiazepines and proconvulsants (aminophylline, amitriptyline). |
Narcotic analgesics: Buprenorphine (Norfin) Butorphanol (Moradol) hydrocodone diamorphine (Heroin) Codeine Methadone Morphine Nalbufin Omnopon Pentazocine Pyritramide Tramadol (Tramal) Trimeperidine (Promedol) Fentanyl Estocin ethylmorphine (Dionin), etc. |
Naloxone Nalmefene Naltrexone Naltrexone, hydrochloride, Trexan) Levorphanol Nalorfin (Antorfin, Anarcon, Lethidron, Nalorphine hydrochloride, |
Introduced intravenously 0,4-2 mg (can be intramuscularly, endotracheally), if necessary, this dose is administered repeatedly every 2-3 minutes until a clinical effect is achieved. It is also effective in alcoholic coma and various types shock, which is connected, see to my mother, with activation during shock and some forms of stress of the endogenous opioid system, and the ability of naloxone to reduce hypotension. Assign 0.25 mcg / kg intravenously every 2-5 minutes (not exceeding 1 mcg / kg). Also used in postoperative respiratory depression. Compared to naloxone, it is more active; effective when taken orally action when taken orally occurs through 1-2 hours and lasts 24-48 hours. They are weak agonist-antagonists they themselves can activate opiates receptors (e.g. sigma receptors, with triggered by hallucinations) so they are used rarely. Enter 1-2 ml of a 0.5% solution, in the absence the effect of the injection is repeated at intervals of 10- 15 minutes, the maximum dose is 0.04 mg (8 ml of 0.5% r-ra. |
ethylene glycol |
30% solution 50-100 ml orally, 5% solution 100-400 ml intravenously |
|
M-anticholinergics Atropine Besalol Metacin iodide Platifillina hydrotartrate -Scopalomina g / x, etc. |
Physostigmine salicylate Galantamine (Nivalin Aminostigmine |
0.5-2 mg IV within 5 minutes under ECG control. Facilitates the conduction of excitation in Neuromuscular synapses and restores neuromuscular conduction blocked curare-like drugs antidepolarizing action (tubocurarine, diplacin, etc.), the action of depolarizing substances (ditilina) strengthens. Enter 2 mg intravenously. |
warfarin |
Protamine sulfate Vitamin K 1 |
1 mg protamine sulfate neutralizes 1 mg heparin. Administered intravenously drip or bolus (slowly) at a dose of 50 mg, if necessary, after 15 minutes, the administration can be repeated, the maximum dose is 150 mg. Effective in certain types of hemorrhages, associated with heparin-like clotting disorders. In rare cases idiopathic and congenital hyperheparinemia, with the introduction of protamine sulfate, may observed "paradoxical" effect - strengthening bleeding. 10 mg IV(in / m, n / c), within 20 minutes. 5-10 mg IV |
Paracetamol |
Acetylcysteine (Fluimucil) Methionine (Acimetion, Athinon, Banthionine, Meonine, Metione, Thiomedon) |
Prevents the transformation of the hepatotoxic metabolite - benzoquinoneimine, 140 mg / kg orally. Orally. It is one of the essential amino acids needed to support growth and nitrogen balance in the body. Possesses lipotropic effect (removal of excess fat from the liver), participates in the synthesis of adrenaline, creatine, etc. biologically important compounds. By methylation and transsulfonation, methionine neutralizes toxic products. |
cardiac glycosides Digitalis |
Digibind |
A vial of Digibind contains 38 mg of purified digoxin-specific fab- fragments that bind approximately 0.5 mg of digoxin. The required amount of the drug is calculated by the formula: concentration of digitoxin in serum (ng/ml) X body weight (kg) : 1000 The drug is administered intravenously drip. |
Anti-tuberculosis drugs: Hydrazine Isoniazid Ftivazid |
Vitamin B 6 |
Intravenously drip, no more than 5 g for 30-60 minutes. |
Iron preparations -Ferrous fumarate (Heferol, Ferronat) -Zhektofer (Ektofer) Ferrous sulfate (Ferro-gradumet, Tardiferon) Iron-dextran (Ferrolek-plus) Iron saccharate (Ferrum Lek) |
Deferoxamine (Desferal, Desferal, Deferoxaminum methansulfonat, Desferan, Desferex, Desferin, Desferrioxamin, DFOM) |
10-15 mg/kg/h. Do not inject more than 6 g per day! When introduced into the body, it helps to remove iron from iron-containing proteins (ferritin and hemosiderin), but not from hemoglobin and iron. |
Heavy metal salts Bismuth Arsenic Mercury Lead Chromium -copper and its compounds -A mixture of uranium fission products Plutonium |
(Dimaval, Unitiol) Complexing connections (desferal, artamine, bianodyne, etc.) Sodium thiosulfate Sodium-calcium edetate (Helaton, EDTA, Mozatil, Tetracemin, Tetacin-calcium) Kuprenil (penicillamine) Ethylenediaminetetra-acetic acid disodium salt (Trilon B, EDTU, Calsol, Dinatriumedetal, Endrate, Irgalon, Kalex, Prochelate, Questrex, Tetracemindinatriumi, Titriplex, Trilon B, Tyclarosol Versene) Pentacin (Calcii trinatrii pentetas, Calcium trisodium pentetate, Penthamil, calcium trisodium pentetate, pentamil) |
Less active in lead poisoning. 5% - 10 ml, then 5 ml every 3 hours within 2-3 days. 10% solution 10-20 ml intravenously 30%-100.0 IV Intravenously administered by drip in isotonic sodium chloride solution or 5% glucose solution. The single dose is 2.0, the daily dose is 4.0. With the introduction of 2 times a day, the interval between injections should be at least three hours. Can be administered in parallel with unithiol. Sometimes used to treat some forms of ectopic arrhythmias, especially those that occur in associated with an overdose of cardiac glycosides. With rapid administration of the drug physiological mechanisms fail eliminate low serum calcium levels and acute tetany may develop. Does not have a noticeable effect on the removal of uranium, polonium, radium and radioactive strontium and lead. The drug does not affect the content of potassium in the blood. A single dose is 0.25 g of the drug (5 ml of a 5% solution). In acute cases, a single dose can be increased to 1.5 g. It is administered intravenously, slowly, observing the state of the cardiovascular system. |
Potassium permanganate |
Vitamin C methylene blue |
5%-10.0 IV 1%-100.0 intravenously |
Dichloroethane |
N-acetylcysteine |
Accelerates dechlorination of dichloroethane, neutralizes its toxic metabolites. inside 140 mg/kg. |
organic acids |
Magnesium sulfate Hydroxide aluminum Almagel Almagel-A |
20-25 g per 200 ml of water inside. 4% 20-25 ml, 4-6 times a day 2-4 teaspoons 4-6 times a day. 250 ml Do not give bicarbonate, dangerous due to with the formation of CO 2 ! |
Tetacin-calcium Sodium thiosulfate |
10%-10,0 in 300 ml of 5% glucose solution, intravenously 30%-100.0 IV |
|
Carbon monoxide (carbon monoxide) |
Hyperbaric oxygen therapy Vitamin C Eufillin |
1-1.5 atm, 40 min. 5% solution, 20-30 ml intravenously 5%-500.0 intravenously 2.4%-10.0, intravenously |
Akrikhinin |
Tetraethylammonium (Uotropin) |
Introduced intravenously on 40% glucose, 10 ml |
Organophosphorus compounds |
dipyroxime (Trimedoxini bromidum, Trimedoxini bromide, Pralidoxime (Pralidoxime) Isonitrazine |
Cholinesterase reactivator. Apply in combination with anticholinergic drugs (atropine, aprofen, etc.) in case of FOS poisoning. Enter subcutaneously or intravenously, 1 ml of a 15% solution. If necessary, enter repeatedly with an interval between injections of 1-2 hours in total up to 6-8 ml. Do not use until the completion of primary resuscitation and the introduction of atropine to suppress excess secretion of the bronchi. Administer diluted to 5% intravenously over 5 minutes. If muscle weakness persists, you can enter a second dose after 60 minutes. Intramuscularly, 3 ml of a 40% solution is required in combination with atropine. In case of severe poisoning, it is administered repeatedly every 30-40 minutes in total up to 10 ml. |
sodium nitrite amyl nitrite Sodium thiosulfate (sodium hyposulfite, sodium hyposulfurosum, Natrium thiosulfuricum) Chromospan Hydroxycobalamin Ethylenediamine- tetraacetate |
6 mg / kg for 3-5 minutes. intravenously 0.3 ml inhalation twice with an interval of 3 minutes Cause the formation of methemoglobin. 250 mg/kg intravenously. Activates the conversion of cyanides to thiocyanates. They have antitoxic, anti-inflammatory and desensitizing effects. They form non-toxic cyanohydrins with cyanides. 40% solution intravenously Causes immediate cyanide detoxification. Forms direct chelates with cyanide (directly chelates cyanide). |
|
Hydrocyanic acid |
amyl nitrite propyl nitrite |
Forms methemoglobin in the blood, which binds CN ion, and prevent defeat tissue respiratory enzymes. Used by inhalation. |
Mushrooms are poisonous type of poisoning: Gyromitrin Muscarinic - anticholinergic - hallucinogenic |
Pyridoxine Physostigmine Diazepam |
25 mg/kg i.v. Therapy aimed at overcoming liver failure 0,01 mg/kg i.v. If necessary, re-introduction. 0.5-1 mg IV 5-10 mg IV |
snake bites Spider karakurt "black Widow" |
Antivenin Antivenin (Latrodectus mactans) |
10 thousand units in / in 20-40 ml in / in the minimum degree of poisoning 50-90 ml in / in the average degree of poisoning 100-150 ml IV severe poisoning 2,5 ml in / in (in / m), after testing for hypersensitivity |
Given that the antidotes used to treat the same poisoning different groups have a different mechanism of action and the bulk of antidotes, with the exception of toxicotropic and antitoxic immunopreparations, do not have a direct effect on the poison, complex antidote therapy is recommended in the form of sequential use of drugs. The use of antidotes does not exclude the need for therapy aimed at the accelerated removal of poison from the body.
To conduct effective detoxification of the body, it is necessary to timely carry out post-syndromic resuscitation correction of vital disorders. important functions organism (toxic shock, acute respiratory failure, etc.).
It is necessary to remember about possible adverse reactions and complications from the side of the antidote itself, the likelihood of which increases with the thoughtless use of these therapeutic agents. With the erroneous administration of an antidote in a large dose, its toxic effect on the body may appear.
Antidote therapy retains its effectiveness only in the toxigenic (early) phase of acute poisoning, the duration of which depends on the toxicokinetic characteristics of a given toxic substance; the quality of the treatment carried out at this stage has a decisive influence on the prognosis and outcome of the disease.
The effectiveness of antidote therapy is significantly reduced in the terminal stage of acute poisoning with the development of severe disorders of the circulatory system and gas exchange, which requires simultaneous resuscitation aimed at detoxifying the body and restoring homeostasis of the body as a whole.
Bibliography
Bratash V.I. Diagnosis, clinic and treatment of critical conditions in acute poisoning and endotoxicosis. - M.: Medicine, 1998. - pp.112 -124.
Don H. Decision making in intensive care. - M.: Medicine, 1995. - ss. 24-25
Ershov A. F. Clinical picture, diagnosis, pathogenesis and treatment of acute poisoning with barbituric acid derivatives. (Clinical and experimental study). Abstract dis. … dr. med. Sciences - M., 1984.
Zaichik A.Sh., Churilov A.P. Fundamentals of pathochemistry. - St. Petersburg, 2000. - 687 p.
Komarov B.D., Luzhnikov E.A., Shimashko I.I. Surgical methods for the treatment of acute poisoning, M .: Medicine, 1981. - pp.21-24
Compendium. Medicines 1999/2000 - Kyiv, 1999. - 1200 p.
Koposov E.S. // in book. Tsybulyaka G.N. (ed.): Resuscitation - M. Medicine. 1976. - ss. 217 - 242.
Ludevich R., Klos K. Acute poisoning. - M.: Medicine, 1983. - 560 p.
Luzhnikov E. A. // in the book. Golikova S.N. (ed.): Emergency care for acute poisoning. - M.: Medicine, 1977. - ss. 72-81.
Luzhnikov E. A. Modern principles of detoxification therapy for acute poisoning. // Anest. and resuscitation. - 1988. - No. 6. - ss. 4-6.
Luzhnikov E.A. Clinical toxicology. - M., 1994. - ss. 113-118
Luzhnikov E.A., Goldfarb Yu.S., Musselius S.G. Detox therapy. - St. Petersburg, 2000.-192 p.
Marino P. L. Intensive care (translated from English supplemented), - M., 1998. - 639 p.
Mikhailov I.B. Fundamentals of rational pharmacotherapy. - St. Petersburg, 1999. - 480 p.
Negovsky V.A. Fundamentals of resuscitation. - Tashkent: Medicine, 1977. - 590 p.
Emergency conditions in children // Sidelnikov V.M., Kiev: Health, 1983. - pp225-241
Pal Chiki // in the book. Peter Varzh et al. (ed.): Theory and practice of intensive care, - Kyiv: Health, 1983. - pp.646 - 650.
Resuscitation // Tsibulnyak G.N., M.: Medicine, 1976., - ss. 217-242
Savina A.S. Acute drug poisoning. - M., 1992. - pp.73-79
Smetnev A.S., Petrova L.I. Emergency conditions in the clinic of internal diseases. - M.: Medicine, 1977. - ss. 158-179
Handbook VIDAL, 1995. - 1168 p.
Handbook VIDAL, 1998. - 1600 p.
Handbook on first aid measures and prevention of poisoning associated with the carriage of dangerous goods by sea // Lobenko A.A., Vladyka A.S., Borozenko O.V., Novikov A.A., Papenko A.V., Oleshko A. .BUT. - Odessa, 1992. - 82 p.
Handbook of resuscitation. ed. Klyavzunika I.V. - Minsk: Belarus, 1978. - ss. 133-155
Susla G.M., Mazur G., Kunnon R.E., Saffredini E.F., Orzhiben F.P., Hoffman V.D., Shelhamer D.G. Pharmacotherapy emergency conditions. - SPb.- M., 1999. - 633 p.
Treshchinsky A.I., Zabroda G.S. // in book. Budnastyan (ed.): Handbook of anesthesiology and resuscitation. - M. Medicine, 1982. - ss. 310 - 317.
Tarakhovsky M.L., Kogan Yu.S., Mizyukova I.G., Svetly S.S., Terekhov I.T. Treatment of acute poisoning. - Kyiv: Health, 1982. - 231 p.
Fried M., Grines S. Cardiology in tables and charts. - M., 1996. - 736 p.
Chepkiy L.P., Pity-Titarenko V.F. Anesthesiology and resuscitation. - K. Vishcha school, 1984. - ss. 327-338.
Tsybulnyak G.N. Resuscitation at the prehospital stage, - L .: "Medicine", 1980. - 232 p.
Poisonous substances that can be poisoned lie in wait at every step - they are found in plants, animals, medicines and various substances that surround people in everyday life. Most poisons are lethal. To neutralize their effects, antidotes are used for poisoning, a table with the classification of which is presented in this article.
General information about antidotes for poisoning
Like any strong medicine, antidotes given in case of poisoning have their own pharmacological properties, which evaluate the different specifics of the drugs. These include in particular:
- time of receipt;
- efficiency;
- dose of application;
- side effects.
Depending on the period and severity of the disease, the value of antidote therapy may vary. In this way, treatment of poisoning with antidotes is effective only at an early stage called toxicogenic.
The duration of the stage is different and depends on the substance that caused the poisoning. The longest duration of this phase is 8-12 days and relates to the effects of heavy metals on the body. The shortest time refers to poisoning by cyanides, chlorinated hydrocarbons and other highly toxic and rapidly metabolized compounds.
Antidote therapy should not be used if there are doubts about the reliability of the diagnosis and type of poisoning, since due to the certain specificity of this type of treatment, double harm can be done to the body, because often an antidote is no less toxic than the object of intoxication itself.
If the first stage of the disease is missed and severe disorders in the circulatory system develop, then, in addition to antidote therapy, the effectiveness of which will now be reduced, an urgent resuscitation action is necessary.
Antidotes are indispensable in conditions of irreversibility of delayed or acute poisoning, but in the second phase of the disease, called somatogenic, they cease to have a therapeutic effect.
All antidotes according to the mechanism of action can be divided into three groups:
- etiotropic - weaken or eliminate all manifestations of intoxication;
- pathogenetic - weaken or eliminate those manifestations of poisoning that correspond to a specific pathogenetic phenomenon;
- symptomatic - weaken or eliminate some manifestations of poisoning, such as pain, convulsions, psychomotor agitation.
In this way, effective antidotes, which are most helpful in poisoning, have high level toxicity. Conversely, the safer the antidote, the less effective it is.
Classification of antidotes
Types of antidotes developed by S. N. Golikov- it is his version of the classification that is often used by modern medicine:
- local action of antidotes, in which the active substance is absorbed by the tissue of the body and the poison is neutralized;
- the general resorptive action is based on the effect of a chemical conflict between the antidote and the poison;
- the competitive action of antidotes, in which the poison is displaced and bound by harmless compounds on the basis of chemical identity between the antidote and enzymes, as well as other elements of the body;
- physiological action is based on the opposite between the behavior of poison and antidote in the body, which allows you to remove violations and return to normal;
- the immunological effect consists in vaccination and the use of a specific serum that acts in case of a specific poisoning.
Antidotes are also classified and divided according to their nature. Separately, antidotes are distinguished:
- from animal / bacterial poisoning;
- from fungal toxins;
- from vegetable and alkaloid;
- with drug poisoning.
Depending on the type of poison, poisoning can be food and non-food.. Any poisoning leading to a deterioration in the patient's condition should be neutralized with antidotes. They prevent the spread and poisoning of poisons in organs, systems, biological processes, and also inhibit functional disorders caused by intoxication.
food poisoning
A condition with acute indigestion that occurs after eating poor-quality foods or drinking is called food poisoning. It occurs when eating spoiled food contaminated with harmful organisms, or in which dangerous chemical compounds. The main symptoms are nausea, vomiting, diarrhea.
There are infectious and toxic poisonings: the sources of the first are all kinds of bacteria, microbes, viruses and simple unicellular organisms that enter the body with food. Toxic poisonings are called poisons of heavy metals, inedible plants and other products with a critical content of toxins that have entered the body.
Manifestations of the disease develop within 2-6 hours after infection. and are characterized by rapid onset of symptoms. Among infectious poisonings, meat and dairy products are the most dangerous for infection, which, if contaminated and undercooked, can cause serious harm, as they are an ideal breeding ground for bacteria and other organisms.
Methods for identifying hazardous products
Externally, a fresh and tasty product can also be dangerous, since the microorganisms that initially got into it multiply gradually, but their very presence threatens to spoil the functionality of the gastrointestinal tract. That's why the first and most important rule of food consumption is safety control. Food products can only be bought in specially designated places, they must be sold by people who have medical books. Food must be kept in premises that have passed sanitary checks, are registered in the system and have the right to appropriate activities. Of course, various eateries with shawarma, street pies and other dubious food outlets are not included in this list.
Infectious poisoning is extremely dangerous for others and can lead to their infection.. Freshly cooked food has a minimal chance of being contaminated, but stale food becomes potentially dangerous after a few hours.
In addition to the expiration date, which should always be checked, even if the purchase is made in a large retail chain, signs that may indicate that the food has been out of date include the following:
- broken packaging, traces of defects on the pack, which led to a violation of its integrity;
- atypical, too pungent odor or, conversely, its absence;
- stratification of the consistency, its heterogeneity;
- any bubbles when stirred, unless it is a mineral water;
- the color and smell do not correspond to the proper - especially if it is meat, eggs, milk;
- the presence of sediment, opacity, any suspicious changes in the usual appearance of the goods.
The presence of these characteristics should stop you from buying a similar product and choose one that is beyond doubt.
Symptoms
A toxin or microbe that has entered the body can act in different ways, but there are characteristic general symptoms that occur most often. This fever, general weakness, disruption of the gastrointestinal tract. Also, doctors often note the patient's loss of appetite, nausea, pain and bloating in the abdomen. The patient is weak, appears pale, may have cold sweats and low blood pressure.
In case of toxic poisoning, the symptoms and disorders are more serious: the patient shows signs of dehydration, vision is impaired - he sees a bifurcation of objects, temporary blindness may occur. Salivation, hallucinations, paralysis, loss of consciousness, convulsions, coma are possible.
The risk group is young children, pregnant women and the elderly. For them, the signs may be more severe, the disease has an unfavorable prognosis.
Primary symptoms of poisoning with some toxins can appear within an hour and grow up to several days. It is important to identify the disease as early as possible and begin treatment.
Treatment
Need to call immediately ambulance and start providing first aid to the victim: gastric lavage with soda or potassium permanganate, the use of enterosorbents, taking a large number liquids. In this condition, it is necessary to wait for an ambulance and not take other treatment. Antibiotics, bifidobacteria, any antiemetic or alcohol-containing drugs, as well as any drugs that will be given without a confirmed diagnosis and if poisoning is suspected, can adversely affect a person and significantly complicate treatment.
All further measures should be carried out in a hospital under the supervision of specialists. With timely treatment, the prognosis is often favorable.
Antidotes for acute poisoning
At the first signs of acute poisoning, it is first necessary to diagnose the nature of intoxication. This will require anamnesis data, various physical evidence - the remains of containers with traces of the use of a poisonous liquid, and more. It is also worth paying attention to the presence of a specific smell, which can determine the nature of the substance that caused the poisoning. All data on the clinical manifestation of the poisoned person's symptoms should be immediately recorded and transferred to the doctors.
The toxicogenic phase of poisoning is the very first stage of intoxication, in which the poison has not yet managed to infect the entire body, and its maximum concentration in the blood has not yet been reached. But already at this stage, the body is damaged by toxins with characteristic manifestations of toxic shock.
Treatment is important to start as soon as possible. As a rule, the doctor will apply assistance in the first toxicogenic phase on the spot, before the patient is hospitalized. Since it is at this stage of the provision or non-provision of assistance that the entire further forecast is decided.
First of all, gastric lavage is used, enterosorbents and laxatives are administered, then antidotes are administered.
For certain types of poisoning, gastric lavage should only be done through a tube, so such issues should be discussed with a doctor.
Symptomatic treatment consists in maintaining and controlling the life support functions of a person. If the airway is blocked, it should be released in the necessary way. Analgesics are used for pain relief, but only before the process of gastric lavage, glucose and ascorbic acid are introduced.
Table of the most common poisonings with antidotes
Acute poisoning requires urgent hospitalization to the intensive care unit and intensive care unit. The doctor continues washing the gastrointestinal tract, artificial ventilation of the lungs, treatment with diuretics, antidotes and antagonists.
But the most effective results are achieved with the help of artificial detoxification, consisting of hemosorption, hemodialysis, plasmapheresis, peritoneal dialysis. With these steps, more intensive elimination of poisons and toxins occurs.
General table of antidotes for poisoning with toxins and poisons
It is necessary to take antidotes, not only to prevent poisoning of the body by toxic substances, but also to stop certain symptoms that develop against the background of poisoning. It is necessary to develop and apply the correct scheme, which will be effective in each individual case, to prevent intoxication. Some types of poisoning have a delayed onset and their manifestations can be sudden and immediately turn into a clinical picture.
Group of toxins | Antidotes |
Cyanides, hydrocyanic acid | Amyl nitrite, propyl nitrite, anticyan, dicobolt EDTA, methylene blue, sodium nitrite, sodium thiosulfate |
iron salts | Desferioxamine (Desferal) |
Narcotic analgesics | Naloxone |
blue vitriol | Unithiol |
Iodine | Sodium thiosulfate |
Opiates, morphine, codeine, promedol | Nalmefene, naloxone, levarphanol, nalorphine |
Arsenic | Unithiol, sodium thiosulfate, cuprenil, disodium salt |
Silver nitrate | Sodium chloride |
Mercury vapor | Unithiol, Cuprenil, Sodium thiosulfate, Pentacin |
Ethanol | caffeine, atropine |
Potassium cyanide | Amyl nitrite, chromospan, sodium thiosulfate, methylene blue |
hydrogen sulfide | Methylene blue, amyl nitrite |
The method of application, dosage forms and dosage of antidotes for poisoning should be agreed with the attending physician, it is also necessary to confirm the diagnosis with the help of tests in order to properly conduct therapy.
Any antidote is the same chemical substance, careless handling of which can also harm the body. The effect of the antidote is achieved due to the chemical reaction that occurs when it interacts with the source of poisoning.
Table of antidotes for poisoning with substances of different nature
From animal/bacterial intoxication
For drug poisoning
Herbal and alkaloid antidotes
Antidotes for mushroom toxins
Details of therapy for some poisonings
Consider antidote therapy for the most common and dangerous poisonings detail:
- Chlorine. Its vapors are capable of reflexively stopping breathing, causing a chemical burn and pulmonary edema. In severe poisoning, death occurs within a few minutes. If the toxin lesion is of moderate or mild severity, effective therapy is prescribed. First of all, the victim is taken out to fresh air., in severe cases, they do bloodletting, wash their eyes with novocaine, give antibiotics of the penicillin group, and cardiovascular drugs. Treat with morphine, atropine, ephedrine, calcium chloride, diphenhydramine, hydrocortisone.
- Salts of heavy metals. Plentiful drink, diuretics, enterosorbents are necessary. When washing the stomach, use a probe, introduce unithiol through it. Use a laxative.
- Phosphorus organic compounds. These are household and medical pesticides, which are used everywhere as a class of FOS. In case of poisoning with these toxins, the skin and mucous membranes are primarily affected. Antidote are calcium gluconate, lactate. Use a mixture of egg white and milk. It is necessary to wash the stomach with saline or soda solution.
Conclusion
To date, urgent measures have been developed for a timely response to poisoning of varying degrees in order to effectively eliminate all the consequences. In addition to the use of an antidote, measures aimed at preventing and treating intoxication are classified as follows:
- emergency measures that are washing the gastrointestinal tract, mucous membranes, skin.
- Accelerated measures, in which various diuretic drugs are used that absorb toxins, sorbents and other processes aimed at removing toxins from the body.
- Restorative measures aimed at the therapy of the vital functions of the body systems and individual organs.
- The process of oxygen saturation necessary for a poisoned organism.
Subject to the rules of hygiene, careful attention to the food and water consumed, vigilance regarding chemicals and household utensils, prevention of poisoning is most effective. But if the poisoning did occur, it is necessary to take immediate measures, the first of which is calling an ambulance. It should be remembered that the effectiveness of treatment increases many times with a timely and competent approach.
Specific antidote therapy belongs to the active methods of emergency detoxification of the body in case of acute poisoning. Its purpose is to bind the poison circulating in the body with appropriate substances (antidotes). In addition, in order to significantly limit the effect of the poison on the corresponding receptors, drugs are used that exhibit antagonistic, i.e. competitive for a toxic agent, the effect on these receptors (pharmacological antagonists). Antidotes for poisoning and pharmacological antagonists are used only when it is precisely established which substance caused acute poisoning.
The existing opinion that there are antidotes for any toxic substance is not supported by reality. Relatively selective effective antidotes exist for only a few classes of toxic substances. The main antidotes and antagonists are presented in the table.
The main antidotes for poisoning
The main antidotes and pharmacological antagonists used in acute poisoning with chemical agents - table
1 | 2 | 3 |
Alox | FOS (thiophos, chlorophos, karbofos, armin, etc.) | Subcutaneously 2-3 ml of a 0.1% solution of atropine sulfate in combination with Alox (intramuscularly at 1 mg / kg) repeatedly. In severe intoxication - intravenous atropine sulfate 3 ml repeatedly, until signs of "atropinization" appear, + Alox 0.075 g intramuscularly every 13 hours |
amyl nitrite | Cyanic acid and its salts (cyanides) | Inhalation content 2-3 ampoules |
Anticholinesterase agents (physostigmine salicylate, ozerin, etc.) | Atropine, amitriptyline, tubocurarine | Subcutaneously, 1 ml of a 0.1% solution of physostigmine salicylate or 1 ml of a 0.05% solution of prozerin. Contraindications: poisoning with tricyclic antidepressants |
Antidote, pharmacological antagonist | Name of the toxic agent | Doses and methods of use of antidotes and pharmacological antagonists |
1 | 2 | 3 |
Atropine sulfate | Pilocarpine and other m-cholinergic receptor mimetics, anti-cholinesterase agents, FOS (chlorophos, karbofos, thiophos, metaphos, dichlorvos) | Subcutaneously, 2-3 ml of a 0.1% solution repeatedly. In the second stage of poisoning with organophosphate insecticides - intravenously, 3 ml of a 0.1% solution (with glucose solution) again, to eliminate bronchorrhea and the appearance of dry mucous membranes in stage III - intravenously drip in 30-50 ml of a 0.1% solution per day until disappearance of bronchorrhea |
Acetylcysteine | Paracetamol | Inside 140 mg / kg (loading dose), then 70 mg / kg every 4 hours (up to 17 doses or until the level of paracetamol in plasma becomes zero). |
Bemegre | Barbiturates, anesthetics (for mild intoxication) | Intravenously slowly 2-5 ml of 0.5% solution 1-3 times a day or drip for 12-15 minutes to 5070 ml of 0.5% solution. At emergence of spasms of extremities introduction stops. |
Vikasol | Anticoagulants of indirect action (neodicoumarin, phenylin, etc.). | Intravenously slowly 5 ml of a 1% solution (under the control of prothrombin time). |
activated carbon | All toxic substances except cyanides, iron compounds, lithium | Inside, 3-5 tablespoons or more, in the form of a water slurry. |
Activated carbon "SKN" | Inside, 10 g 3 times a day in between meals. Children under 7 years old - 5 g, from 7 to 14 years old - 7.5 g per reception | |
Deferoxamine | Iron preparations | To bind iron that is not absorbed in the stomach - inside 5-10 g of deferoxamine dissolved in water, repeatedly (30-40 g), to remove iron Absorbed - intramuscularly 10-20 ml of a 10% solution every 3-10 hours . 100 mg deferoxamine binds 8.5 mg iron |
Antidote, pharmacological antagonist | Name of the toxic agent | Doses and methods of use of antidotes and pharmacological antagonists |
1 | 2 | 3 |
Dietixim | When the first manifestations of intoxication appear - intramuscularly 3-5 ml of a 10% solution, with moderate severity - 5 ml of a 10% solution 2-3 times a day until a persistent increase in cholinesterase activity in the blood. In severe cases, the dose increases. Treatment is carried out in combination with atropine | |
Dimercaprol | Arsenic, mercury, gold, lead compounds (in the presence of encephalopathy) | Intramuscularly, first 5 mg / kg, then 2.5 mg / kg 1-2 times a day for 10 days. It is advisable to combine with tetacin-calcium and penicillamine |
dipyroxime | FOS (Chlorophos, karbofos, metaphos, dichlorvos, etc.) | In the initial stage of poisoning - intramuscularly 1 ml of a 15% solution, if necessary, repeatedly, in case of severe intoxication - intravenously 1 ml of a 15% solution after 1-2 hours (up to 3-4 ml), and in severe cases - up to 7-10 ml 15% solution. Should be combined with atropine sulfate |
Enterosorbent "SKN" | Alkaloids, glycosides, salts of heavy metals | Inside, 10 g 3-4 times a day in between meals |
Carbolong | Alkaloids, glycosides, salts of heavy metals | Inside, 5-10 g 3 times a day in between meals |
Oxygen | Carbon monoxide, cyanide, chromium, phosgene, etc. | Inhalation, with the help of special masks, catheters, pressure chambers, etc. |
Naloxone | Narcotic analgesics | Intramuscularly or intravenously, 0.4-0.8 mg (contents of 1-2 ampoules) repeatedly, until breathing normalizes |
Naltrexone | Narcotic analgesics | Inside, 0.25 g daily |
sodium bicarbonate | Acids, ethyl alcohol, tricyclic antidepressants, quinidine, etc. | Intravenous drip up to 1500 ml of 4% solution per day |
Antidote, pharmacological antagonist | Name of the toxic agent | Doses and methods of use of antidotes and pharmacological antagonists |
1 | 2 | 3 |
Sodium thiosulfate | Compounds of mercury, arsenic, lead, iodine, cyanide acid and its compounds | In case of poisoning with metal salts - intravenously 5-10 ml of a 30% solution, in case of poisoning with cyanide acid and cyanides - intravenously 50-100 ml of a 30% solution (after the introduction of methylene blue or sodium nitrite) |
Sodium chloride | Silver nitrate | Gastric lavage with 2% solution |
Penicillamine | Salts of copper, mercury, lead, arsenic, gold | Inside 1 g per day before meals |
Pyridoxine | Isoniazid and other derivatives of isonicotinic acid hydrazide | Intravenously, 10 ml of a 5% solution 2-4 times a day |
Protamine sulfate | Heparin | Intravenous drip 1-5 ml of a 1% solution (1 ml neutralizes it with 1000 IU of heparin) |
Ethanol | Methyl alcohol, ethylene glycol | Intravenously 10 ml of a 30% solution by stream or drip of a 5% solution (1 ml / kg per day) orally 100-150 ml of a 30% solution |
Succimer | Mercury, lead, arsenic | Inside 0.5 g 3 times a day for 7 days intramuscularly 0.3 g 2 times a day for 7 days |
Activated charcoal tablets "KM" | All toxic substances except cyanides, iron compounds, malathion, DDT | Inside, 1-1.5 g 2-4 times a day 1-2 hours after meals |
Tetacin-calcium | Salts of lead, nickel, cobalt, mercury, cardiac glycosides | In case of acute intoxication intravenously, 10-20 ml of a 10% solution in 250-500 ml of 0.9% sodium chloride solution or 5% glucose solution per day for chronic intoxication - inside 0.25 g 8 times a day or 0, 5 g 4 times a day, in 1-2 days (treatment course 20-30 days) |
Antidote, pharmacological antagonist | Name of the toxic agent | Doses and methods of use of antidotes and pharmacological antagonists |
1 | 2 | 3 |
Trimefacin | uranium, beryllium | Intravenous or inhalation as a 5% solution or 2.5% solution in calcium chloride solution |
Ferocin | Radioisotopes of cesium and rubidium, as well as uranium fission products | Inside, 1 g in the form of an aqueous suspension (in 1/2 glass of water) 2-3 times for 10 days |
Unithiol | Arsenic compounds, salts of mercury, bismuth and other heavy metals, cardiac glycosides, anaprilin, amitriptyline, etc. | Subcutaneously, intramuscularly or intravenously, 5-10 ml of a 5% solution (1 ml per 10 kg of body weight): on the 1st day - every 6-8 hours, on the 2nd day - after 8-12 hours, subsequent days - 1-2 injections per day for 6-7 days or more |
Cytochrome C | sleeping pills, carbon monoxide | Intravenously drip 20-40 ml of a 0.25% solution in 250-500 ml of isotonic sodium chloride or glucose solution (after a biological test - 0.1 ml of a 0.25% solution intradermally) |
Table of the main antidotes and equated drugs for the treatment of poisoning
Complexons
Complexones (chelate compounds) should be considered the most effective antidotes for metal poisoning. Due to the presence in their structure of such functional groups as OH, -SH and -NH, they can donate electrons for bonding with metal cations, i.e. form covalent bonds. In this form, toxic compounds are excreted from the body.
The effectiveness of a chelate compound is largely determined by the amount of ligand in its base capable of binding to the metal. The more of them, the more stable and less toxic the metal chelate complex. It should be remembered that complexones as antidotes have a low selectivity of action. Along with toxic agents, they can bind endogenous ions necessary for the body, such as calcium and zinc.
The end result of such an interaction is determined by the affinity of toxic exogenous and essential (endogenous) metals in chelate compounds. In order for a significant decrease in the level of endogenous metals to occur, their affinity with chelators must exceed their affinity for endogenous ligands. In turn, the relative rate of metal exchange between endogenous ligands and chelate compounds should exceed the rate of elimination of chelators in complexes with metals. If complexones are cleared faster than the metalloendogenous ligand complex, its concentration may not reach the level required to effectively compete with endogenous binding sites.
This factor is especially significant in the case when the withdrawal is carried out through the formation of a ternary complex, i.e. endogenous ligand-metal exogenous complex.
Complexes include:
- deferoxamine,
- tetacin-calcium,
- dimercaprol,
- penicillamine,
- unitiol, etc..
Deferoxamine (desferal)- a complexone that actively binds iron, to a small extent - essential trace elements. Can be used to accelerate the excretion of aluminum from the body in renal failure. Competing for weakly bound iron in such iron-containing proteins as hemosiderin and ferritin, deferoxamine is not able to compete for the iron contained in biological chelate complexes: microsomal and mitochondrial cytochromes, hemoproteins, etc.
feroxamine(iron complex with deferoxamine) is presented to demonstrate its functional groups. Here, iron is actively contained in a closed system. Dimercaprol, by succimer, captures the metal (m) in a stable heterocyclic ring by a covalent bond.
Two molecules of penicillamine are capable of binding one molecule of copper or another metal.
Metabolic products of deferoxamine are excreted by the kidneys, staining the urine dark red. In the process of treatment with deferoxamine, allergic reactions (urticaria, skin rash), collapse (with rapid introduction into a vein), deafness, visual impairment, clouding of the lens may occur. There is also coagulopathy, liver and kidney failure, intestinal infarction.
Tetacin-calcium- an effective complexing agent for many di- and trivalent heavy metals and rare earth elements, in particular for lead, cadmium, cobalt, uranium, yttrium, cesium, etc. Relatively poorly penetrates through cell membranes, therefore it more effectively binds extracellular metal ions. The highly polar ionic properties of tetacin-calcium prevent its more or less enteral absorption, so it is used mainly for slow intramuscular or intravenous administration.
In thetacin-calcium, calcium is replaced only by ions of those metals and rare earth elements that form a stronger complex (lead, thorium, etc.) than calcium itself. Barium and strontium, whose stability constant of the complex is lower than that of calcium, do not react with thetacin-calcium. The use of the thetacin-calcium antidote for mercury mobilization is also ineffective, apparently due to the insignificant intake of this complexone in those tissues where mercury is concentrated, as well as due to its less successful competition with bound calcium.
In large doses, tetacin-calcium can cause damage to the kidneys, especially their tubules.
Pentacin- calcium-trisodium salt of diethylenetriamine-pentaoic acid is also effective as a chelating agent. Unlike thetacin-calcium, it does not affect the release of uranium, polonium, radium and radioactive strontium. With prolonged administration, the elimination of metals from the body decreases.
After the introduction of pentacin, dizziness, headache, pain in the chest and limbs, kidney damage are possible.
Dimercaprol (2,3-dimercaptopropanol, British antilewisite, BAL). Available as a 10% solution in peanut butter; administered intramuscularly, injections are painful. With its SH-groups, dimercaprol forms strong chelate complexes with mercury, arsenic, lead and gold ions, accelerates their excretion from the body and the restoration of functional proteins suppressed by the poison. The effectiveness of this antidote increases with the minimum period of its use after poisoning. It is ineffective if treatment is carried out after 24 hours or more.
Therefore, it is believed that the therapeutic effects of BAL are more due to the prevention of metal binding to the components of cells, blood and tissue fluid, and not to the removal of already bound poison.
Some derivatives of dimercaprol turned out to be less toxic, in particular succimer (dimercaprol succinate) and 2,3-dimercapropane-1-sulfonate. They are more polar than BAL; are distributed mainly in the extracellular fluid, therefore, to a lesser extent damage cell structures blood and tissues.
Penicillamine - D-3,3-dimethylcysteine hydrochloride (cuprenil)- a water-soluble product of the metabolism of penicillin. Its D-isomer is relatively non-toxic. Resistant to metabolic degradation. It is mainly used for poisoning with copper compounds or to prevent their accumulation, as well as for the treatment of Wilson's disease.
As an adjuvant, penicillamine is sometimes used in the treatment of lead, gold, and arsenic poisoning. Like gold preparations, this antidote inhibits the progression of bone and cartilage destruction, therefore it is used in the treatment of rheumatoid arthritis. May cause allergic reactions, dyspepsia, thrombocytopenia, leukopenia, anemia, etc.
Sodium thiosulfate- sulfur-containing antidote. Unlike previous preparations, it does not form complex compounds with metals. Neutralizes halides, cyanides, compounds of arsenic, mercury, lead.
As antidotes, oxidizing agents and adsorbents are also widely used. Weak solutions of acids, usually organic, were previously widely used to neutralize alkalis, and meadows (sodium bicarbonate, magnesium oxide) were used for acid poisoning. Now the advantage is given not to neutralize acids and alkalis, but to dilute them.
Potassium permanganate effective in case of poisoning with morphine and other alkaloids, phosphorus; tannin - alkaloids and heavy metals. Activated charcoal is widely used for oral poisoning with various medicines, as well as alkaloids, salts of heavy metals, bacterial toxins, etc. It does not adsorb iron, lithium, potassium, and only to a small extent - alcohol and cyanides. It is completely ineffective in case of poisoning with acids and alkalis, boric acid, tolbutamide, etc.
Repeated doses of activated charcoal every 4 hours are effective for poisoning with carbamazepine, digitoxin, theophylline, etc.
Enterosorbents
In recent years, in order to eliminate exogenous (as well as endogenous) intoxication, enterosorbents have begun to be used. These drugs tend to absorb (keep on their surface) toxic agents that are in the lumen of the gastrointestinal tract. Toxic substances can enter here from outside, be released by diffusion from the blood, be in the composition of digestive juices and bile, or be formed here. Enterosorbents, not being fully antidotes, help to reduce the level of intoxication, thereby protecting the body from poison damage.
In addition, enterosorbents improve digestion in the stomach and intestines, as they contribute to a more rational action digestive enzymes on food elements, especially proteins. They contribute to the neutralization of toxic agents in the liver, improve oxidative processes, the processes of decomposition of peroxide compounds, etc. They have been proven to be highly effective in acute intoxication with microbial toxins, atropine, sibazon, mushrooms, and gasoline.
In medical practice, mainly carbon and polymer sorbents are used as antidotes, in particular carbon SKN (saturated spherical carbonite) and silicon - Polysorb, enterosgel.
Clinical experience shows that enterosorption is effective in food, drug, industrial poisoning. Enterosorbents are also effective in diseases accompanied by endotoxicosis, in particular, the digestive system, cardiovascular, respiratory and endocrine systems, allergic diseases, toxicoses of pregnancy.
Pharmacological antagonists of many drugs
In particular, in case of poisoning with drugs that have a depressing effect on the central nervous system, CNS stimulants and analeptics are used:
- caffeine sodium benzoate,
- ephedrine hydrochloride,
- cordiamine,
- bemegrid,
- cytiton, etc.
In case of intoxication with poisons that excite the central nervous system, drugs with an inhibitory type of action are used as antagonists, in particular ether for anesthesia, often barbiturates, sibazon, etc. and in case of poisoning with atropine and gangliolyticam - anticholinesterase drugs (especially prozerin).
- The antagonist of morphine and other narcotic pain relievers is naloxone;
- carbon monoxide, hydrogen sulfide, carbon disulfide, etc. - oxygen in inhalation.
Naloxone is prescribed at an initial dose of 1-2 mg parenterally. Doses are increased for codeine and fentanyl intoxication. The use of physostigmine salicylate is contraindicated in case of poisoning with tricyclic antidepressants.
Antidotes are substances that are able to neutralize or suspend the action of poison in the human body. The effectiveness of antidotes depends on how accurately the poison / toxin that entered the body was determined, and how quickly medical assistance was provided to the victim in case of poisoning.
Universal antidotes:
Most often, the following antidotes are used for acute poisoning:
Antidotes in folk medicine
Traditional medicine involves the use of medicinal plants for food poisoning or chemical compounds. The following agents are actively used as antidotes:
In addition, actively ethnoscience used for poisoning baking soda and table salt.
Please note: in no case should you trust funds from the category of traditional medicine, because even the most effective medicinal plants in most cases, they can not have the desired effect. Only after consulting a doctor is it allowed to use some folk remedies.
Any use of antidotes must be agreed with doctors - self-use can lead to a deterioration in the health of the victim. In addition, an incorrectly administered dose of antivenom or an incorrect course of treatment can aggravate the situation, leading to lethal outcome. Do not forget that some antidotes can provoke the development of side effects - they also negatively affect the patient's health.
Tsygankova Yana Alexandrovna, medical observer, therapist of the highest qualification category
okeydoc.ru
Table of antidotes for intoxication
The table of antidotes for poisoning is used to provide emergency care. Helps in choosing the right means to save the life of the victim. You can get poisoned by various compounds. They meet at home, at work, in the forest. This group also includes animal and plant toxins. Intoxication can lead to death.
Poisons and their antidotes
The classification of antidotes includes 3 groups: non-specific, pharmacological, chemical. The former are always used, they include sorbents. The latter are competitors for receptors. The latter change the metabolism of the xenobiotic.
Antidote or effective drugs | ||
Azides (sodium and potassium). Widely used in the chemical industry, metallurgy. Contained in airbags. | Nicotinamide, Riboflavin. | Inject 1 ml in 5% glucose solution |
Antiseptics and disinfectants | Sodium chloride | In combination with other therapy. 0.9% 800 ml drip. |
Ammonia, acrolein | Naphthyzinum, adrenaline | According to indications. |
Arsine. It is used in metallurgy and electronic industry. | Unithiol | 0.5 mg per 1 kg of body weight. Dilute 400 ml in glucose solution. |
Barium. Salts are used in the production of ceramics, textiles. Included in epilators. | Potassium chloride | Into a vein at the rate of 1015 mcev/kg |
Dichloroethane. It is a universal organic solvent. | Levomycetin hemisuccinate | 0.1 g intravenously diluted in 10 ml of 0.9% sodium chloride solution |
Copper and its salts: oxide, acetate, carbonate, chloride, nitrate, sulfate, cyanide | Penicillamine |
|
Arsenic | Penicillamine |
|
Methyl alcohol. Widely used in the paint industry. | ethanol Fomepisol folinic acid. |
|
Methemoglobin formers: nitro and amino compounds, cyanides | methylene blue Vitamin C. |
|
Nitrites, nitrates | Methylthioninium chloride Vitamin C |
|
Carbon monoxide (CO, carbon monoxide) | Hyperbaric oxygen therapy Cytoflavin |
|
Hydrocyanic acid | Sodium thiosulfate | 30ml in 30% solution |
Pentachlorophenol, dinitrophenol. Used as pesticides, defoliants. | Acetylcysteine | 20% 10 ml intravenously |
Mercury metal and its salts | Unithiol | 0.3 mg/kg by infusion |
waist | potassium chloride |
|
Phosphorus white or yellow | Sodium thiosulfate calcium gluconate Magnesium sulfate |
It is administered intravenously under the control of blood pressure |
FOS (organophosphorus insecticides) | Atropine. It is one of the main antidotes. Acts on cholinergic receptors. Cholinesterase reactivators |
|
Hydrofluoric acid | calcium gluconate | 10% 20 ml intravenously slowly |
Chlorine | oxygenation |
|
Ethyl alcohol or alcohol in large doses | Glucose Thioctic acid Vitamin B1, B6 |
|
ethylene glycol | ethanol calcium chloride | Through a tube of 30 ml. 10% intravenously, 10 ml. |
Antidotes for drug poisoning
Antidotes are used to reduce the harmful effects on the body. On the other hand, they help speed up the elimination. Drug poisoning can occur from almost any drug. It all depends on the amount of the dose taken. Drug intoxication occurs more often in a child, without parental supervision.
The table shows the main types of antidotes and their methods of application.
Medicine | ||
Cardiodepressants | Adrenalin | Infusion. 1 mcg in 0.9% sodium chloride solution, after the administration of glucagon. |
Diphenhydramine | Aminostigmine | 1 mg per muscle |
Paracetamol | Acetylcestin | May be used in pregnant women. Inside, 150 mg / kg, which is equal to 10%. Together with water or juice. |
Chloroquine | Diazepam | Dilute in 20 ml glucose solution. 0.1 microns/kg is used. |
Sedative neuroleptics, antidepressants, ganglion blockers | dopamine | Diuretic dose of 0.5 to 1 mc / kg / min. |
Calcium channel blockers | calcium gluconate | Slowly in / in 20 ml of a 10% solution. If ineffective, repeat after 10 minutes. |
Psychotropic, tranquilizers | Haloperidol | With psychosis and arousal. Inside once for 2 mg. |
Gliquidone, gliclazide and other hypoglycemic drugs | Glucose | 25% 10 ml in a vein |
Cardiac glycosides, Eufillin, antidepressants | Lidocaine | Intravenous bolus at the rate of 1 mg per 1 kg. Time 1 minute. |
Clonidine | metoclopramide | 2 tablets for 1 dose. |
Narcotic analgesics (opiates) | Naloxone | In / in drops of 0.8 per hour. Dilute in glucose solution. |
Heparin sodium | Protamine | As soon as possible after the introduction of heparin. 1 mg for every 100 IU. |
Carbamazepine, Haloperidol | Riboxin | The calculation is 1 g per 1 g of the drug taken. |
Cytostatics | Thioctic acid | To be administered separately from all other drugs 300 mg is added to 250 ml of glucose or sodium chloride solution. Speed no more than 1 ml for 2 minutes. |
benzodiazepine | flumazenil | Intravenously at 0.2 mg / min. If ineffective, repeat after 2 minutes. |
Chloramphenicol | Cytoflavin | 40 ml IV drops per 400 ml 10% glucose |
Antidotes of plant toxins and alkaloids
The table lists the main types of toxins commonly ingested. Antidotes should be used immediately after the onset of symptoms of intoxication.
Antidotes for mushroom poisoning
Antidotes for animal and bacterial toxins
poisonous substance | Antidote/active drug | Application scheme |
Snake bites: sea, asp family, vipers. | calcium gluconate | 10% 5 ml IV |
lizard | Not | Symptomatic treatment |
scorpions | Atropine Novocaine |
|
Spiders (Argiopin) | Calcium gluconate | 20 ml 10% IV slowly |
ant reaper | Not | The area on the skin is pierced with Lidocaine |
Bees (apitoxin) | Prednisolone epinephrine |
|
Staphylinids | Not | According to indications: anticonvulsant, antiemetic |
Botulinum toxin | Not | The therapy is carried out in a hospital. Give Phenazepam. |
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Table of antidotes and antidotes
Toxins and poisons | Antidotes and antidotes | Application Description |
Aniline | methylene blue | 1-2 milliliters of 1% solution together with 5% glucose solution intravenously, repeatedly. |
Barium | Magnesium or sodium sulfate | Gastric lavage with 1% solution of magnesium sulfate. |
Benzene | Sodium thiosulfate | Intravenously up to 200 ml, drip. |
White phosphorus | Sulphate copper | Assigned internally, 0.3–0.5 grams dissolved in half a glass of water. Gastric lavage with a 0.2% solution. |
Potassium bichromate | "Unithiol" | 10 milliliters of a 5% solution is injected intravenously. |
DDT | calcium chloride, calcium gluconate | These antidotes are administered intravenously in 10 ml of a 10% solution. In parallel, gastric lavage and artificial diuresis are carried out. |
Dichloroethane | "Acetylcysteine" | 50 mg per kilogram of body weight, per day. |
dimethylmercury | "Unithiol" | "Unithiol" is administered intramuscularly or intravenously, 5 ml each. |
Sarin | Atropine, athens, diazepam | Usually - 1 ml of a 0.1% solution of atropine, intravenously or intramuscularly. |
zoocoumarin | "Dicinon", "Vikasol" | The drugs are administered intramuscularly. |
Soman | Atropine, athens, diazepam | Atropine 1 ml 0.1% solution, intravenously or intramuscularly. Diazepam is administered according to the standard scheme for relieving emotional anxiety. |
Mustard gas | There is no antidote | In case of contact with the skin, treat it with an individual anti-chemical package. |
Iodine | Sodium thiosulfate | This antidote is used for intravenous drip injections, up to 300 ml of a 30% solution. |
Potassium permanganate (potassium permanganate) | methylene blue | 50 ml of a 1% solution of methylene blue is injected intravenously. |
Lewisite | "Unithiol", dimercaptopropanol | "Unithiol" is used intravenously or intramuscularly. Dimercaptopropanol is used in oily solutions. |
Methyl alcohol | Ethanol | 100 ml of a 30% ethanol solution - inside, 50 ml - every two hours. In total - up to five times. In an unconscious state - a 5% solution of ethyl alcohol, intravenously at the rate of 1 ml of alcohol per kilogram of body weight per day. |
blue vitriol | "Unithiol" | 10 ml of a 5% solution, then, after three hours, 5 ml. |
Morphine | "Naloxone" | "Naloxone" is administered intramuscularly, intravenously or intranasally. |
Arsenic, lead salts | Sodium thiosulfate | The antidote is administered intravenously, 5-10 ml. The concentration of the drug is 30%. |
Silver nitrate (lapis, silver nitrate) | Sodium chloride | 2% sodium chloride solution is used for massive gastric lavage. |
Phosphorus oxychloride | Atropine, isonitrosine | Atropine is administered in 1 ml of a 1% solution. Isonitrosin is administered intravenously or intramuscularly. |
Oxides and other lead compounds | Calcium salt of ethylenediaminetetraacetic acid | Applied orally, capsule twice a day according to the standard scheme. |
Mercury vapor | "Unithiol" or "Dimercaptopropanol" | "Unithiol" is administered intravenously or intramuscularly in 5 ml. "Dimercaptopropanol" is also administered subcutaneously or intravenously. |
hydrogen sulfide | Amyl nitrite, methylene blue | Artificial respiration, inhalation of amyl nitrite vapors, 50-100 ml of a 1% solution of methylene blue are injected intravenously. |
Salts of copper, lead | "Penicillamine" | Penicillamine is administered orally, one tablet once a day. |
Hydrocyanic acid | "Sodium thiosulfate" | Intravenous administration of sodium thiosulfate, artificial induction of vomiting. Give the patient activated charcoal to drink. |
Chromium compounds | "Unithiol", sodium thiosulfate | Sodium thiosulfate is administered intravenously, drip in the form of a 10% solution of 10-20 ml. "Unithiol" 5% is injected once 10 ml, then 5 cm3 after three hours again. |
Tetanus toxin | Tetanus toxoid | It is injected subcutaneously, deeply. Single dose - 0.5 mg. |
Strychnine | Has no antidote | Gastric lavage with a suspension of activated charcoal. In the presence of convulsions - intravenously 20 mg of diazepam. |
Corrosive sublimate | Composition of Strzhizhevsky (solution of sodium chloride, sodium bicarbonate, caustic soda in a supersaturated solution of hydrogen sulfide) | Strizhevsky's solution is injected into the stomach after washing in an amount of 80-100 ml. If it is impossible to swallow the solution, it is administered through a probe. The patient should also be given warm milk to drink. |
Thallium | Prussian blue | The drug is administered orally. |
Tetraethyl lead | "Antidote of Strzhizhovsky" | The stomach is washed with Strzhizhovsky's solution, and this solution is also administered orally. Glucose, B vitamins, magnesium sulfate are also prescribed intravenously. In collapse, cardiac remedies. |
Phenol | Sodium thiosulfate | Intravenously, drip - 100 ml of a 30% solution. |
Formaldehyde (formalin) | ammonium chloride | Gastric lavage with ammonium chloride solution. Sodium sulfate is also prescribed inside. |
Phosgene | There is no antidote | There is no specific treatment. |
Hydrogen fluoride (hydrofluoric acid) | There is no specific antidote | Fresh air, warm soda inhalations; inside codeine, dionin (0.015 g each), calcium preparations, Dimedrol. Calming agents. In severe cases, intravenous calcium chloride (10 ml of a 10% solution). Heart remedies. |
Potassium cyanide | Methemoglobin formers (nitric oxides, nitroglycerin, amyl nitrite, methylene blue), amyl nitrite, sodium nitrite | Amyl nitrite is dripped onto a cotton swab and allowed to be sniffed every 2 minutes. Sodium nitrite is administered intravenously in the form of a 2% solution. Methylene blue 1% solution in 25% glucose solution intravenously. |
Chlorine | Oxygen, morphine, atropine | The victim must first be removed from the affected area to fresh air. Under the skin - a solution of atropine (1 ml of a 0.1% solution), 1 ml of a 5% solution of ephedrine, 1 ml of 1% morphine is injected. |
Chlorophos, thiophos | "Dipiroxim" | At the beginning of poisoning, 1 ml of a 15% solution is injected intramuscularly. In severe cases, the same dose is given 1 to 2 hours apart. In especially severe cases, the dose increases to 3-4 ml. |
Ethylmercuric chloride | "Unithiol" | The drug is taken in the same way as in case of poisoning with other mercury compounds. |
ethyl alcohol | Atropine, caffeine | 1 ml of a 0.1% solution of atropine subcutaneously. Caffeine - 2 ml of 20% solution. |
ethylene glycol | Gluconate or calcium chloride, ethanol | A 10% solution of these compounds is administered intravenously in doses of 10–20 ml. Inside - 30 ml of 30% ethanol solution. |
Medicine | Antidotes and antidotes | Application Description |
"Anestezin" | methylene blue | Introduced 1-2 cm3 per kilogram of weight 1% solution, intravenously, with 10% glucose solution. |
Pilocarpine | In the absence of excitation - 1 cu. cm 1% solution, subcutaneously. |
|
Barbiturates | Bemegrid | Bemegrid is a barbiturate antagonist. It is advisable to use up to 10 cm3 of a 0.5% solution, intravenously. In case of respiratory disorders, artificial ventilation of the lungs is used. |
Heparin | Protamine sulfate | Up to 5 ml of a 1% solution of protamine sulfate is administered intravenously. |
"diazepam" | Anexat (Flumazenil) | Flumazenil is a benzodiazepine antagonist. It is administered intravenously at 0.2 mg. The total dose is 3–5 mg. |
Isoniazid | Pyridoxine Hydrochloride (Vitamin B6) | It is administered intramuscularly up to 20 mg per kilogram of body weight. |
Insulin | Adrenaline, stress hormones | In coma - 1 ml of a 0.1% solution of adrenaline. |
There is no specific antidote | ||
Pilocarpine | Atropine | Subcutaneously or intravenously, 2–3 cm3 of a 0.1% solution of atropine is injected. |
"Teturam" | Ascorbic acid, sodium bicarbonate | 40% glucose solution, 10 cc 5% ascorbic acid solution, 200 ml of 4% sodium bicarbonate solution is administered intravenously, drip. |
Toxins and alkaloids | Antidotes and antidotes | Application Description |
hemlock | A mixture of glucose, novocaine | |
Cardiac glycosides | "Digibind" | It is administered intravenously, drip. The amount of the drug is calculated depending on the amount of glycosides consumed. |
cannabinol | "Aminazin", "Haloperidol" | "Aminazin" - 2.5% solution 4-5 ml intramuscularly. "Haloperidol" - 0.5% solution 2-3 ml intramuscularly. |
Lily of the valley | Atropine | 1 ml of 0.1% solution subcutaneously. |
Nicotine | A mixture of glucose, novocaine | A mixture of 0.5 l of 5% glucose solution, 20–50 ml of 1% novocaine solution is administered intravenously, drip. |
Quinine | Tannin | Gastric lavage with a solution of tannin, the use of activated charcoal, laxatives. |
Mushrooms and toxins | Antidotes and antidotes | Application Description |
Anticholinergic toxins | Physostigmine | Intravenously, 0.5-1 milligram. |
Death cap | Atropine | Subcutaneously - 0.1% 1 ml solution every hour until the symptoms of poisoning disappear. Physiological solution - up to 1 liter per day, drip. |
hallucinogenic toxins | Diazepam | Intravenously, 5-10 milligrams. |
Gyromitrin (contained in lines) | Pyridoxine (Vitamin B6) | It is administered intravenously at the rate of 25 mg per kilogram of body weight. |
Muscarine (an alkaloid found in mushrooms) | Atropine | 1 cm3 of 0.1% atropine is administered subcutaneously or intramuscularly. |
fly agaric | Atropine | Subcutaneously - 0.1% 1 ml solution every hour until the symptoms of poisoning disappear. |
Orellanin (found in cobweb bitter) | Atropine | Introduction of 1 cm3 of 0.1% atropine under the skin or intramuscularly. |
Toxins and poisons | Antidotes and antidotes | Application Description |
Botulinum toxin | There is no antidote | |
snake bites | Heparin, antivenin | Heparin - intravenously, 10000 IU. Antivenin - from 20 to 150 ml intravenously, depending on the severity of the poisoning. |
Bee or wasp toxins | Adrenaline, Prednisolone, Methasone | Adrenaline is injected subcutaneously. It is also necessary to inject a solution of adrenaline. Metazone solution is administered by drip intravenously. Adrenaline can be replaced with ephedrine. |
Karakurt toxin | Magnesium sulfate, calcium chloride, antivenin. | Enter intravenously, re-a solution of magnesium chloride (25%), as well as calcium chloride (10%). Antivenin - 2.5 cm3 intravenously or intramuscularly. |
scorpion toxin | Atropine, ergotamine | Subcutaneously injected 0.5–1 cm3 of a 0.1% solution of atropine, or 0.5–1 cm3 of a 0.05% solution of ergotamine. |
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Antidotes for poisoning
An unequivocal answer to the question of what an antidote is does not exist to date. Translated from Greek, antidotes are substances “given against”. In other words, these are substances that inactivate poisons that bind to them in the body through direct physicochemical or chemical interaction, as well as substances that eliminate the effects of poisons on biological structures.
As in the case of drugs, taking into account the specifics of the use of antidotes, the following criteria for their evaluation are distinguished:
- pharmacological properties;
- duration - the time of the therapeutic effect of the drug in victims, is used in relation to antidotes for medical care;
- protection coefficient - is determined by the time from the moment of the 1st intake of the antidote to poisoning, during which they can be warned Clinical signs intoxication (for example, chlorine);
- single and daily doses of application;
- teratogenic, mutagenic effects, etc.
Types of antidotes
IN medical literature There are several classifications of antidotes, but the most satisfying modern requirements the classification of antidote drugs according to S.N. Golikov (1972). These are the antidotes:
- local action - neutralize poisons by tissue resorption in the process of physical or chemical interaction;
- general resorptive action - the application is based on the reactions of chemical antagonism between the antidote and the toxicant or deposited metabolites circulating in the blood and lymph;
- competitive action - they displace poisons, binding them into harmless compounds with a pronounced chemical affinity of the antidote with the enzyme, structural elements of cells, receptors;
- immunological - involve the use of vaccines and sera in case of poisoning with poisons;
- physiological (opposite in the action of the poison) - allow you to eliminate the damage caused by the poison (for example, chlorine) in the body, normalize the functional state.
Where and what are antidotes used for?
The use of antidotes is explained by the need, on the one hand, to prevent the effects of toxic substances on the body, on the other hand, to slow down (normalize) the developing adverse symptoms of functional changes in various organs and systems of the body.
The development of the correct scheme for the use of a particular drug is the most important moment at the stage of choosing an antidote. Due to the fact that some types of intoxication are not so common in everyday life, sometimes a lot of time passes before it is possible to form optimal strategy follow-up therapy in the clinic.
About the dosage forms in which there are antidotes for poisoning, as well as the schemes for the use of some antidotes, information is presented in table 1.
Antidotes | Toxicants | Dosage form | Mode of application |
Amyl nitrite, propyl nitrite | cyanides | ampoules of 0.5 ml | for inhalation |
Antician | cyanides | ampoules of 0.75 and 1.0 ml 20% solution | intravenous, intramuscular |
Atropine sulfate | phos, carbamates | ampoules of 1.0 ml 0.1% solution | intravenously, intramuscularly in case of intoxication with phosphorus, the initial dose is 2–8 mg, then 2 mg every 15 minutes. before pereatropinization |
Desferioxamine (Desferal) | iron sol | powder 500 mg in a vial for the preparation of rad for injection | in case of severe iron salt poisoning, 15 mg/kg/h is administered intravenously |
Digoxin-specific FAB antibodies | powder in vials | contents of the vial binds 0.6 mg digoxin | |
dipyroxime | phos | ampoules of 1.0 ml 15% solution | intramuscularly, intravenously, repeat the introduction every 3-4 hours, or provide a constant intravenous infusion of 250-400 mg / h. |
Wild Bolt SaltEDTA | cyanides | ampoules of 20 ml 1.5% solution | intravenously, drip slowly |
Dimercaprol (BAL) | arsenic, lead, mercury | ampoules of 3 ml 10% solution | intramuscularly administer 3-5 mg/kg every 4 hours for 2 days, then 2-3 mg/kg every 6 hours for 7 days |
methylene blue | cyanides, methemoglobin-forming agents (aniline, nitrites, nitrobenzene) | 20 ml ampoules or 50-100 ml vials of 1% solution in 25% r-reglucose | intramuscularly |
Naloxone | relapses of manifestations of poisoning with narcotic analgesics | ampoules of 1.0 ml 0.1% solution | intravenous, intramuscular, subcutaneous initial dose of 1-2 mg |
Sodium nitrite | cyanides | ampoules of 10-20 ml 2% solution | intravenously, drip |
Sodium thiosulfate | cyanides, mercury, arsenic compounds, methemoglobin-forming agents | Ampoules 10-20 ml 30% solution | intravenously |
penicillamine | lead, arsenic | capsules 125-250 mg, tablets 250 mg | 1 g per day, divided into 4 doses inside before |
Pyridoxine hydrochloride | hydrazine | ampoules of 3-5 ml 5% solution | intramuscularly, intravenously |
Pralidoxime (2-PAM) | phos | ampoules of 1.0 ml 15% solution | continuous intravenous infusion of 250-400 mg/h. |
Thetacin calcium (DTPA) | mercury, arsenic, lead | ampoules of 20 ml 10% solution | intravenous drip 5% glucose solution |
Unithiol | arsenic, mercury, lewisite | 5 ml ampoules of 5% solution | intramuscularly, 1 million 10 kg of body weight every 4 hours for the first 2 days, every 6 hours for the next 7 days |
Physostigmine | relapses of manifestations of poisoning with M-anticholinergic drugs | solution 1 mg/ml | intramuscularly, intravenously initial dose 1 mg |
Flumazenil | benzodiazepine | ampoules 500 mcg 5 ml | intravenous initial dose of 0.2 mg, maximum total dose of 3 mg, the dose is repeated until consciousness is restored Do not administer to patients with convulsive syndrome and overdose of tricyclic antidepressants! |
ethanol | methanol, ethylene glycol | ampoules 5% and 30% solution | intravenously in the form of a 5% solution, the initial dose is calculated upon reaching the level of ethanol in the blood of at least 100 mg / 100 ml (42 g / 70 kg) - in the form of a 30% solution orally, 50-100 ml |
EDTA-Sa | lead cider metals | intramuscularly or intravenously administer 50-75 mg / kg / day in 3-6 doses for 5 days; after a break in the course of therapy, repeat |
Table page 4 As can be seen from Table 1, any of the antidotes is the same chemical substance, in fact, as the toxicant against which antidote therapy is being developed for poisoning. Accordingly, untimely administration or incorrect calculation of the dose of the antidote, as well as not quite the correct scheme of application, can adversely affect general condition the victim.
Therapy for chlorine poisoning
In case of severe chlorine poisoning in high concentrations, the antidote may no longer be useful, because the victim dies in a few minutes. In other cases, with mild and moderate chlorine poisoning, the victim is prescribed effective therapy.
An antidote for chlorine poisoning, as an option, can serve as an ordinary oxygen bag.
Therapy for poisoning with salts of heavy metals
Symptoms of poisoning with salts of heavy metals (silver, copper, zinc) are similar to poisoning with mercury salts, therefore, the general principles of therapy for poisoning are similar. So, silver ions form poorly soluble chemical compounds with chlorine, therefore, with such poisoning, the victim’s stomach is washed with 1-2% sodium chloride solution, after which castor oil is prescribed as a laxative.
Therapy for organophosphorus poisoning
The distribution of phos is due to the widespread use of these substances as household pesticides with insecticidal action (chlorophos, karbofos, etc.). In addition, the number of phos-medicines used for medicinal purposes in ophthalmology, neuropathology, and surgery has increased. Many phos are used in the chemical industry as products of organic synthesis.
Unlike chlorine poisoning, the symptoms of phos poisoning are characterized by the irritating effect of the substance on the skin and mucous membranes.
An antidote for phosphorus poisoning is: calcium gluconate or lactate, or 2 egg whites mixed with 1 tbsp. milk. However, in case of poisoning with phosphorus substances, urgent gastric lavage with 2% soda or 0.5% saline solution is first required.
In custody
Modern practical toxicology demonstrates many urgent measures (let's call them non-specific therapy) for the prevention and treatment of various degrees of intoxication (including chlorine).
Without referring specifically to the indications for such events, we will briefly list them. This:
- Emergency (immediate) termination of the process of absorption of poisons into the internal environment of the body by organ washing digestive system, as well as neutralization of their action in case of contact with the eyes, mucous membranes and skin.
- The accelerated process of excretion of poisons absorbed into the body and their toxic metabolites (forced diuresis, increased bile formation, hemodialysis, hemosorption).
- Restorative therapy of vital systems and organs (respiration, central nervous system, blood circulation, excretory systems, as well as the humoral environment of the body).
- Oxygen saturation of the body of the victim, as a method of preventing hypoxic conditions that occur with all types of acute intoxication (with the same chlorine).