Antidote Stocking at Hospitals in North Palestine

Table 3: The current availability of 16 selected antidotes at all hospitals of north
Palestine and comparing it to the consensus guidelines for antidotes stocking in
emergency departments in the US [15]

Antidote	Frequency (n=11)	Poisoning Indication(s)	Presentation*	Dose (70 kg pa- _______tient)_______
N-acetylcystine	2	Acetaminophen	200mg/ml,10 ml _____ampoule____	19.6 g
Snake an- tivenin	1	Snake bites	10 ml/vial	10 vials
Calcium glu- conate	11	Hydrogen fluoride (HF) or calcium _________channel blocker_________	10%,10 ml ampoule	100 mEq
Sodium bicar- bonate	11	1) Tricyclic antidepressant, 2) co- ________caine, 3) salicylates________	8.4%,50 ml vial	500 mEq
Deferoxamine	4	__________________Iron_________________	500 mg/vial	8.4 g
Digoxin specific _____Fab_____	NA	Digoxin, digitoxin, or natural prod- ________ucts (plants, toads)________	38 mg/vial	15 vials
Dimercaprol	1	Acute arsenic, inorganic mercury, ________________lead________________	50 mg/ml,2ml am- _______poule______	280 mg
Atropine	11	Carbamate or organophosphate in- ______________secticide______________	600 mcg/ml,1ml am- _______poule______	75 mg
Cyanide anti- _____dote_____	1	Cyanide	30 mg/ml,10 ml am- _______poule______	1 kit
Ethanol	NA	1) Methanol, 2) ethylene glycol	5ml/ ampoule	90.7 mL ~
Fomepizole	NA	1) Methanol, 2) ethylene glycol	5mg/ml, 20ml am- _______poule______	1.05 g
Glucagon	NA	1) β-adrenergic antagonist, 2) calcium channel blocker	1 mg/vial	50 mg
Methlene blue	3	Methemoglobinemia	10mg/ml, 10ml am- _______poule______	140 mg
Naloxone	11	Acute opioid poisoning	10mg/ml, 10 ml am- _______poule______	15 mg
Obidoxime	4	Organophosphate insecticide	400 mcg/ml,1ml am- _______poule______	1 g
Pyridoxine	1	Isoniazid (INH)	100 mg/1ml, 10 ml _____ampoule____	10 g

NA: not available

* could be available in other different presentations

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Discussion:

Antidotes are therapeutic agents
intended to modify or counteract with
the clinical effects of particular toxic
substances in the human body;
antidote availability may often be life
saving for poisoned individuals.[5]
Although their clinical importance
should not be emphasized over good
supportive care, delayed use or
unavailability of antidotes could result
in catastrophic consequences.[3,20]
For example, the outcome in patients
with severe methemoglobinemia is
poor without intravenous methylene
blue treatment [21]. In cyanide
poisoning, the lack of prompt antidote
treatment with nitrite and thiosulfate
may result in anoxic brain injury or

death.[3] Patients with severe
cholinergic syndrome from
organophosphate or carbamate
insecticide poisoning are likely to die
from respiratory failure without the
early institution of atropine.[22] Since
the timely use of antidotes is
potentially lifesaving in certain
poisonings, maintaining a sufficient
stock of antidotes is a responsibility of
any facility that provides emergency
care. If a poisoned patient requires an
antidote that is not stocked at a
particular hospital, then either the
patient must be transferred or the
antidote must be obtained from
another hospital. This is complicated
by the fact that Palestine has longer

OJHAS Vol 5 Issue 4(4) - Sawalha AF, Sweileh WM, Zyoud SH, Al-Jabi SW. Antidote Stocking at Hospitals in North Palestine

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