antidote administration guidelines june2010

7/27/2019 Antidote Administration Guidelines June2010

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INDICATION ANTIDOTE STRENGTH ED STOCKLOCATION AT

RPH*PHARMACY ADMINISTRATION

ADDITIONAL INFO FOR

PHARMACIST

Snake bite Antivenom Black 2 xDilute vial(s) in 500mL normal

saline. Give IV over 20 minutes [1]

Dilute one vial 1:10 in Hartmann's

soln & give by slow IV inj [2]

AntivenomBrown 4 4

Dilute vial(s) in 500mL normal




Antivenom Death Adder 1 xDilute 1 vial in 500mL normal




Antivenom Polyvalent 2 xDilute vial(s) in 500mL normal




Antivenom Taipan x x N/A Use polyvalent antivenom

Antivenom Tiger 4 3Dilute vial(s) in 500mL normal




Spider bite Antivenom Redback 10Fridge in ED Critical

Care6

Give the contents of one vial by IM

injection. In life-threatening

situations, it can be given IV - dilute

vial(s) in 100mL normal saline and

give over 20 minutes [1,2]



Antivenom Funnel Web x Pharmacy 4

Reconstitute each vial of the freeze-

dried antivenom in 10mL WFI,

dilute two ampoules in 100mL

normal saline and give IV over 20

minutes. [1] Can be given IM.[2]

Call on-call pharmacist if required

after-hours.

Only stocked in pharmacy store

fridge. Stock owned by Perth Zoo.

Marine bite Antivenom Sea Snake 2 SCGH x

Administer one vial diluted in

500mL normal saline, IV over 20

minutes. [1] Contact on-call

pharmacist to arrange supply.

RPH will stock this when SCGH

stock expires (07/11)

Antivenom Stonefish 2Fridge in ED Critical

Care

x

Administer one vial for every two

spine puncture wounds, undiluted,

by IM injection. Alternatively it may

be diluted in 100mL normal salineand given IV over 20 minutes [1]

Fridge in ED Critical

Care

* ED CC1 DD safe is in ED critical care pod near bed CC15SAS drugs - complete Category A form. Prepared by N Dowling (Clinical Pharmacist, RPH) 30/06/2010

Reviewed by Dr J Soderstrom (Toxicologist) 30/06/2010


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ADDITIONAL INFO FOR

PHARMACIST

Drug-induced

methaemoglobinemiaMethylene blue 1%, 5mL 10

ED CC2 imprest

cupboard (bottom

shelf)

3

Administer 1-2mg/kg (0.1-0.2mL/kg

of 1% solution) IV slowly over 5

minutes. Flush with normal saline.

Can repeat dose after 30-60

minutes if required.[1,2,3]

G6PD deficiency - lack of NADPH

causes methylene blue to be

ineffective. Dose adjust in renal

impairment.

Cyanide poisoning Sodium thiosulphate2.5g/10mL

(25%w/v)10

ED CC2 imprest

cupboard (bottom

shelf)

3

Administer 12.5g (50mL of 25%

solution) IV over 10 minutes (2.5-

5mL/min). [1,4]

Repeat after 30 minutes if

necessary. [1]

Hydroxocobalamin 2.5g vial 2ED CC1 DD safe

(SAS)x

Reconstitute each vial with 100mL

sodium chloride 0.9% solution for

injection, using the supplied steriletransfer device. Rock or invert the

vial for at least 30 seconds to mix -

it must NOT BE SHAKEN as the

contents may foam. Prime the

infusion set provided with the

solution. Repeat the procedure with

the second vial. Administer as an

intravenous infusion over 15

minutes. [5]

A second dose may be required if

severe poisoning. Rate of infusion

for second dose ranges from 15

minutes to 2 hours based on patient

condition. Max recommended dose

is 10g. [5]

Isoniazid poisoning Pyridoxine 100mg/mL 50ED CC1 DD safe

(SAS)x

Give 5g IV over 30 minutes.[3] Give

0.5g/minute until seizures stop or

infusion is complete.[1]

Can use 5g in 500mL glucose 5%

as an infusion. Give 1g pyridoxine

for every 1g isoniazid ingested.

Give 5g if ingested dose unknown.

Repeat dose if seizures persist.[3]

IV benzodiazepines are givenconcomitantly.[1,3]




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ADDITIONAL INFO FOR

PHARMACIST

Digoxin toxicityDigoxin immune fab

(Digibind)38mg 20

Fridge in ED Critical

Care10

1. Reconstitute each vial of

Digibind with 4mL WFI

2. GENTLY mix the vials

3. Draw up all vial contents

4. Attach 0.22 micron membrane

filter to the syringe then attach the

needle

5. Push contents into a 100mL

sodium chloride 0.9% bag

6. Infuse over 30 minutes [1,2]

* can be given as an IV bolus if

cardiac arrest is imminent [4]

Heavy metal poisoning Dimercaprol (BAL) 100mg/2mL 20ED CC1 DD safe

(SAS)3

For lead encephalopathy:

commence dimercaprol 4 hours

before commencing EDTA. Give

4mg/kg by IM injection every 4

hours for 5 days. [1,3]

**Contraindicated in peanut

allergy

Formulated in peanut oil -

contraindicated in peanut allergy

Calcium disodium

versenate (EDTA-Ca)

(sodium calcium

edetate)

1000mg/5mL 6

ED CC2 imprest

cupboard (bottom

shelf)

3

Dilute dose in 500mL normal salineor glucose 5% and infuse over 24

hours (starting 4 hours after first

dose of dimercaprol).[1] Dilute to

250-500mL with normal saline or

glucose 5% and infuse over 8-12

hours.[3,4]

Dose for lead encephalopathy: 50-

75mg/kg d. Dose for symptomatic

lead poisoning without

encephalopathy: 25-50mg/kg d.

Succimer (DMSA) 100mg x

Main Pharmacy

(SAS) 1 x 100

Oral capsule. Start at 10mg/kg tds

for 5/7 then 10mg/kg bd for 14/7. [1]

Iron overload/ poisoning Desferrioxamine 500mg 10 ED CC1 3

Reconstitute 500mg powder with

5mL WFI, dilute to 100mL with

normal saline or 5% glucose. Infuse

at up to 15mg/kg/hour [1,3,4]

Reduce infusion rate if hypotension

occurs. Rate may be increased up

to 40mg/kg/hr if life-threatening

toxicity. Avoid prolonged infusion

>24hours




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ADDITIONAL INFO FOR

PHARMACIST

Organophosphate

poisoningPralidoxime 500mg/20mL 20

ED CC2 imprest

cupboard (bottom

shelf)

3

Initial dose 2g diluted in glucose 5%

or saline 100mL and given over 15

minutes [1,3]

0.2% sodium chloride solution is

another alternative as a diluent.

There are no stability data to support

use of normal saline.

Anticholinergic delirium Physostigmine 2mg/2mL 4ED CC1 DD safe

(SAS)3

Give IV, no faster than

1mg/minute.[3] Give 0.5-1mg IV

over 5 minutes. [1] Compatible with

normal saline and 5% glucose. [3]

Product info photocopied onto back

of blue SAS form.

Hydrofluoric acid burns Calcium gluconate gel 2.5%, 50g 20

ED CC2 imprest

cupboard (bottom

shelf)

3

Topical. Can also be prepared by

mixing 10mL 10% calcium

gluconate solution with 30g/30mLKY gel. [1]

Calcium gluconate 1g/10mL 3ED assessment

drug room3

Fat emulsion (Intralipid)Lipid soluble drug

overdose 20%, 500mL 1

ED CC2 imprest

cupboard (bottomshelf)

3

Start with 1.5mL/kg over 1 minute,

then give as a continuous infusion

of 0.25mL/kg/min for 30-60

minutes. [6] Toxicologists

will generally give a 0.5-1mL/kg

bolus then run the rest of the

500mL over 1 hour in rescue

situations.

References:

1. Murray L, Daly F, Little M, Cadogan M. Toxicology Handbook. Marrickville (NSW): Elsevier Australia; 2007.

2. UBM Medica. MIMSOnline. UBM Medica; Sydney: 2010. Acessed 24/05/2010.

3. Micromedex 1.0 (Healthcare Series)4. Burridge N, editor. Australian Injectable Drugs Handbook. Collingwood: The Society of Hospital Pharmacists of Australia; 2009.

5. Product Information: CYANOKIT(R) IV injection, hydroxocobalamin IV injection. Dey LP, Napa CA. 2006.

6. Felice KL & Shumann HM. Intravenous lipid emulsion for local anesthetic toxicity; a review of the literature. Journal of Medical Toxicology. 2008; 4(3):184-191.



antidote administration guidelines june2010

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