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 |
Poisoning Indication(s) |
Presentation* |
Dose (70 kg pa- |
|
N-acetylcystine |
2 |
Acetaminophen |
200mg/ml,10 ml |
19.6 g |
|
Snake an- |
1 |
Snake bites |
10 ml/vial |
10 vials |
|
Calcium glu- |
11 |
Hydrogen fluoride (HF) or calcium |
10%,10 ml ampoule |
100 mEq |
|
Sodium bicar- |
11 |
1) Tricyclic antidepressant, 2) co- |
8.4%,50 ml vial |
500 mEq |
|
Deferoxamine |
4 |
__________________Iron_________________ |
500 mg/vial |
8.4 g |
|
Digoxin specific |
NA |
Digoxin, digitoxin, or natural prod- |
38 mg/vial |
15 vials |
|
Dimercaprol |
1 |
Acute arsenic, inorganic mercury, |
50 mg/ml,2ml am- |
280 mg |
|
Atropine |
11 |
Carbamate or organophosphate in- |
600 mcg/ml,1ml am- |
75 mg |
|
Cyanide anti- |
1 |
Cyanide |
30 mg/ml,10 ml am- |
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- |
1.05 g |
|
Glucagon |
NA |
1) β-adrenergic antagonist, |
1 mg/vial |
50 mg |
|
Methlene blue |
3 |
Methemoglobinemia |
10mg/ml, 10ml am- |
140 mg |
|
Naloxone |
11 |
Acute opioid poisoning |
10mg/ml, 10 ml am- _______poule______ |
15 mg |
|
Obidoxime |
4 |
Organophosphate insecticide |
400 mcg/ml,1ml am- |
1 g |
|
Pyridoxine |
1 |
Isoniazid (INH) |
100 mg/1ml, 10 ml |
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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