You are called to see a 16-year-old girl in the Emergency Department.  She was brought in by ambulance after being found unconscious by her parents.  She was last seen alive and well 12 hours ago.  Several empty bottles of tablets were found beside her.

(c)        What “antidotes” are available for patients after drug overdose?

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College Answer

(c)        What “antidotes” are available for patients after drug overdose?

Many antidotes are available but obviously their relevance depends on the clinical scenario and the specifics of the drugs ingested. Specific antidotes for commonly used agents (eg. naloxone for opioids, flumazenil for benzodiazepines, beta-agonists for beta-blockers, Ca for calcium channel blockers, protamine for heparin, atropine for organophosphates, and physostigmine for anticholinergics). Less commonly used specific antidotes include:
digibind for digoxin, and desferrioxamine for iron. Other indirectly acting antidotes include: Fresh Frozen Plasma and Vitamin K for warfarin, N-acetyl cysteine for paracetamol, glucagon for beta- and calcium channel blockers, glucose for insulin, ethanol for methanol, sodium bicarbonate for tricyclic antidepressants and praladoxime for organophosphates.

Discussion

c)

This question closely resembles Question 28.1 from the second paper of 2009, as well as Question 14.2 from the first paper of 2008 and Question 2 from the first paper of 2007. There are so many lists of antidotes available that I see no point in repeating this answer endlessly.

References

References

The website of the American Academ of Clinical Toxicology has several position statements which might be useful to the fellowship candidate:

 

Ipecac Syrup

Single-Dose Activated Charcoal

Multi-Dose Activated Charcoal

Cathartics

Whole Bowel Irrigation

Gastric Lavage

Urine Alkalization