Antidotes

ALERT (Updated Nov. 23, 2016): There continues to be a shortage of aqueous activated charcoal used for the decontamination of the poisoned patient. Please read this letter from Dr. Margaret Thompson, Medical Director, OPC for information on alternative treatments.

Attached below is a recommended list of common antidotes for stocking in the Emergency Department. It should be noted that this is not a comprehensive list nor does it replace the usual symptomatic and supportive care necessary for the treatment of a poisoned patient.

This list includes adequate amounts of individual antidotes for the treatment of a single poisoned patient (estimated average weight 70 kg). The Ontario Poison Centre cannot make specific stocking recommendations as it is difficult to predict an individual hospital's needs, especially in the event of a large environmental poisoning.

The list is compiled from the literature referenced below. It should be noted that as medical toxicology knowledge changes, antidotes may change. It should also be noted that more than one antidote may be listed for a particular intoxication.

Please contact the Ontario Poison Centre about all poison exposure patients to ensure they receive the most current evidence-based care available.

Guidelines for Stocking Emergency Antidotes

References:

Dart, R. C., Borron, S.W., Caravati, E. M., Cobaugh, D. J., Curry, S. C., Falk, J. L., et al. (2009). Expert consensus guidelines for stocking emergency antidotes in hospitals that provide emergency care. Annals of Emergency Medicine, 54 (3), 386-394.e1.

Lepik, K. J., Levy, A. R., Sobolev, B. G. Purssell, R. A., DeWitt, C. R., Erhardt, G. D., et al. (2009). Adverse drug events associated with the antidotes for methanol and ethylene glycol poisoning: a comparison of ethanol and fomepizole. Annals of Emergency Medicine, 53 (4), 439-450.e10.

Hall, A., Dart, R., Bogdan, G. (2007). Sodium thiosulfate or hydroxocobalamin for the empiric treatment of cyanide poisoning? Annals of Emergency Medicine, 49 (6), 806-813.

Dart, R. C., Goldfrank, L. R., Chyka, P. A., Lotzer, D., Woolf, A. D. McNally, J., et al. (2000). Combined evidence-based literature analysis and consensus guidelines for stocking of emergency antidotes in the United States. Annals of Emergency Medicine, 36(2), 126-32.

Eddleston, M., Dawson, A., Karalliedde, L., Dissanayake, W., Hittarage, A., Azher, S., et al. (2004). Early management after self-poisoning with an organophosphate or carbamate pesticide - a treatment protocol for junior doctors. The Critical Care Forum. Available online.

Juurlink, D. N., McGuigan, M. A., Paton, T. W., & Redelmeier, D. A. (2001). Availability of antidotes at acute care hospitals in Ontario. Canadian Medical Association Journal, 165(1), 27-30.

Sivilotti, M. L. (2003). Be prepared: Things my scoutmaster never told me. Canadian Journal of Emergency Medicine. Available online.

Sivilotti, M. L., Eisen, J. S., Lee, J. S., & Peterson, R. G. (2002). Can emergency departments not afford to carry essential antidotes? Canadian Journal of Emergency Medicine, 4(1), 23-33.