INTRODUCTION
www.japi.org
881
Main Indication
Other Applications
N-Acetylcysteine
Atropine
Calcium salts
Dantrolene
Desferrioxamine
Dicobalt edetate
Digoxin specific antibody fragments
Dimercaprol
Ethanol
Flumazenil
Glucagon
Glucose
Hydroxocobalamin
4, Methylpyrazole (fomepizole)
Naloxone
Oximes
Oxygen
Oxygen (Hyperbaric) tetrachloride
Penicillamine
Physostigmine
Phytomenadione (Vitamin K)
Potassium hexacyanoferrate
(Prussian Blue)
Protamine sulfate
Pyridoxine
Sodium nitrite
Sodium thiosulfate
Succimer (DMSA)
Paracetamol
Cholinergic agents
Oxalates, fluorides
Malignant hyperthermia
Iron, aluminium
Cyanide
Digitalis glycosides
Arsenic
Methanol, ethylene glycol
Benzodiazepines
Beta blockers
Insulin
Cyanide
Ethylene glycol, methanol
Opiates
Organophosphates
Cyanide, carbon monoxide, hydrogen sulfide
Carbon monoxide
Copper
Central anticholinergics
Coumarin derivatives
Thallium
Amanitin
Calcium antagonists
Malignant neuroleptic syndrome
Paraquat
Disulfiram, coprin
Heparin
Isoniazid
Cyanide
Cyanide
Lead, mercury
882
www.japi.org
Agent
Indication
Agent
Indication
Activated charcoal
Benztropine
Chlorpromazine
Diazepam
Diphenhydramine
Dopamine
Epinephrine
Furosemide
Haloperidol
Heparin
Lidocaine
Mannitol
Pancuronium
Promethazine
Salbutamol
Sodium bicarbonate
Copper sulfate
Cysteamine
Diethyldithiocarbamate
Fructose
Levallorphan
Nalorphine
Silibinin
Tocopherol
Universal antidote
Phosphorus
Paracetamol
Thallium
Ethanol
Opiates
Opiates
Amanitin
Paraquat
Ingested poisons
www.japi.org
883
www.japi.org
www.japi.org
885
www.japi.org
www.japi.org
887
www.japi.org
REFERENCES
1.
2.
3.
4.
5.
6.
Holt LE, Holz PH. The black bottle: A consideration of the role
of charcoal in the treatment of poisoning in children. J Pediatr
1963;63:306-14.
7.
Howland MA, Weisman R, Sauter D, Goldfrank LR. Nonavailability of poison antidotes. N Engl J Med 1986;314:
927-8.
8.
9.
G o p a u l S V, Fa r r e l l K , A b b o t t F S . I d e n t i f i c a t i o n a n d
characterization of N-acetylcysteine conjugates of valproic
acid in humans and animals. Drug Metab Dispos 2000;28:
823-32.
10. Wong CK, Ooi VE, Kim C. Protective effects of N-acetylcysteine against
carbon tetrachloride and trichloroethylene-induced poisoning in rats.
Environ Toxicol Pharmacol 2003;14:109-116.
11. Llobet JM, Domingo JL, Corbella J. Comparative effects of repeated
parenteral administration of several chelators on the distribution
and excretion of cobalt. Res Commun Chem Pathol Pharmacol
1988;60:225-33.
www.japi.org
889
33. Hall AH, Kulig KW, Rumack BH. Suspected cyanide poisoning in smoke
inhalation: Complications of sodium nitrite therapy. J Toxicol Clin Exp
1989;9:3-9.
13. Riordan SM, Williams R. Fulminant hepatic failure. Clin Liver Dis 2000;
4: 25-45.
34. Hall AH, Rumack BH, Schaffer MI, et al. Clinical toxicology of cyanide:
North American experiences. In: Ballantyne B, Marrs TC (editors).
Clinical and Experimental Toxicology of Cyanides. Bristol, Wright,
1987:313-333.
14. K e a y s R , H a r r i s o n P, We n d o n J , e t a l . I n t r a v e n o u s
acetylcysteine in paracetamol-induced fulminant hepatic
failure: A prospec tive controlled tr ial. BMJ 1991;303:
1026-9.
15. Lynch RM, Robertson R. Anaphylactoid reactions to intravenous
N-acetylcysteine: A prospective case controlled study. Accid Emerg
Nurs 2004;12:10-15.
16. Berghem L, Bergman U, Schildt B, et al. Plasma atropine concentrations
determined by radioimmunoassay after single-dose I.V. and I.M.
administration. Br J Anaesth 1980;52:597-601.
17. Caulfield MP, Birdsall NJ. International Union of Pharmacology. XVII
classification of muscarinic acetylcholine receptors. Pharmacol Rev
1998;50:279-90.
18. Eddleston M, Buckley NA, Checketts H, et al. Speed of initial
atropinisation in significant organophosphorus pesticide poisoning:
A systematic comparison of recommended regimens. J Toxicol Clin
Toxicol 2004;42:865-75.
19. Namba T, Nolte CT, Jackrel J, et al. Poisoning due to organophosphate
insecticides. Acute and chronic manifestations. Am J Med
1971;50:475-92.
20. Eddleston M, Dawson A, Karalliedde L, et al. Early management after
self-poisoning with an organophosphorus or carbamate pesticide: A
treatment protocol for junior doctors. Crit Care 2004;8:R391-397.
21. Whitten C, Gibson G, Good M, et al. Studies in acute iron poisoning:
Desferrioxamine in the treatment of acute iron poisoning: Clinical
observations, experimental studies and theoretical considerations.
Pediatrics 1965;36:322-35.
22. Hershko C, Link G, Cabantchik I. Pathophysiology of iron overload.
Ann N Y Acad Sci 1998;850:191-201.
23. Nakamura H, Rose PG, Blumer JL, et al. Acute encephalopathy due
to aluminum toxicity successfully treated by combined intravenous
deferoxamine and hemodialysis. J Clin Pharmacol 2000;40:296300.
24. Howland MA. Risks of parenteral deferoxamine. J Toxicol Clin Toxicol
1996;34:491-7.
25. Tenenbein M. Benefits of parenteral deferoxamine for acute iron
poisoning. J Toxicol Clin Toxicol 1996;34:485-9.
26. Cheney K, Gumbiner C, Benson B, et al. Survival after a severe iron
poisoning treated with intermittent infusions of deferoxamine. J
Toxicol Clin Toxicol 1995;33:61-66.
27. Ioannides AS, Panisello JM. Acute respiratory distress syndrome
in children with acute iron poisoning: The role of intravenous
desferrioxamine. Eur J Pediatr 2000;159:158-9.
28. Adamson I, Sienko A, Tenenbein M. Pulmonary toxicity of
deferoxamine in iron-poisoned mice. Toxicol Appl Pharmacol
1993;120:13-9.
29. Lin S, Shieh S, Lin Y, et al. Fatal Aeromonas hydrophilia bacteremia in
a hemodialysis patient treated with deferoxamine. Am J Kidney Dis
1996;27:733-5.
30. Way JL. Cyanide intoxication and its mechanism of antagonism. Annu
Rev Pharmacol Toxicol 1984;24:451-81.
31. Marrs TC. The choice of cyanide antidotes. In: Ballantyne B, Marrs TC
(editors). Clinical and Experimental Toxicology of Cyanides. Bristol,
Wright, 1987:383-401.
52. Singh PK, Jones MM, Xu Z, et al. Mobilization of lead by esters of meso2,3-dimercaptosuccinic acid. J Toxicol Environ Health 1989;27:42334.
53. Grandjean P, Jacobsen IA, Jorgensen PJ. Chronic lead poisoning treated
with dimercaptosuccinic acid. Pharmacol Toxicol 1991;68:266-9.
890
www.japi.org
54. Thomas PS, Ashton C. An oral treatment for lead toxicity. Postgrad
Med J 1991; 67: 63-65.
56. Cullen NA, Wolf LR, St. Clair D. Pediatric arsenic ingestion. Am J Emerg
Med 1995;13:432-5.
58. Mazumder DN, Das Gupta J, Santra A, et al. Chronic arsenic toxicity
in West Bengal: The worst calamity in the world. J Indian Med Assoc
1998;96:4-7,18.
78. Medicis JJ, Stork CM, Howland MA, et al. Pharmacokinetics following
a loading plus a continuous infusion of pralidoxime compared with
the traditional short infusion regimen in human volunteers. J Toxicol
Clin Toxicol 1996;34:289-95.
79. Scott RJ. Repeated asystole following PAM in organophosphate selfpoisoning. Anesth Intensive Care 1986;4:458-60.
61. Besunder JB, Anderson RL, Super DM. Short-term efficacy of oral
dimercaptosuccinic acid in children with low to moderate lead
intoxication. Pediatrics 1995;96:683-7.
84. Pillay VV. Alcohols. In: Comprehensive Medical Toxicology. 2nd edn,
2008. Paras Medical Publisher, Hyderabad, India. 179-215.
65. Willems JL, Langenberg JP, Verstraete AC, et al. Plasma concentrations
of pralidoxime methyl sulfate in organophosphorus poisoned
patients. Arch Toxicol 1992;66:260-6.
85. Barceloux DG, Bond GR, Krenzelok EP. American Academy of Clinical
Toxicology practice guidelines on the treatment of methanol
poisoning. J Toxicol Clin Toxicol 2002;40:415-46.
68. Burgess JL, Bernstein JN, Hurlbut K. Aldicarb poisoning: A case report
with prolonged cholinesterase inhibition and improvement after
pralidoxime therapy. Arch Intern Med 1994;154:221-4.
71. Wo re k F, B a c k e r M , T h i e r m a n n H , e t a l . R e a p p r a i s a l
of indications and limitations of oxime therapy
in organophosphate poisoning. Hum Exp Toxicol 1997;16:
466-72.
92. Whitwam JG, Taylor AR, White JM. Potential hazard of methylene blue.
Anesthesiology 1979;34:181-2.
73. Clement JG, Bailey DG, Madill HD, et al. The acetylcholinesterase
oxime reactivator HI-6, in man: Pharmacokinetics and tolerability in
combination with atropine. Biopharm Drug Dispos 1995;16:415-25.
74. Kassa J, Cabal J. A comparison of the efficacy of a new asymmetric
bispyridinium oxime BI-6, with currently available oximes and H
JAPI VOL. 56 NOVEMBER 2008
www.japi.org
891
892
www.japi.org