Browse the corpus

©2013 UpToDate ® Print Email Recommended antidotes in pediatric poisonings Antidote Poisoning indication Pediatric dose N-acetylcysteine Acetaminophen Oral Loading dose: 140 mg/kg orally; oral maintenance doses: 70 mg/kg every four hours for 17 doses Intravenous (IV) administration: 150mg/kg over 1 hour (loading dose); 50 mg/kg IV over 4 hours; 100 mg/kg IV over 16 hours Atropine Carbamate insecticide 0.02 mg/kg IV bolus (0.1 mg minimum dose; maximum single dose 0.5 mg for children and 1.0 mg for adolescents) repeat doses titrated to effect Organophosphate insecticide Crotalid antivenin Crotalid snakes 4 to 6 vials (more if severe) Calcium gluconate and calcium chloride (10 percent) Calcium channel blocker Gluconate: 100 to 200 mg/kg IV Chloride: 20 to 30 mg/kg IV repeat doses and IV infusions are common Hydrogen fluoride (HF) Cyanide antidote kit (may contain sodium nitrite 3 percent ,sodium thiosulfate, and/or hydroxocobalamin) Cyanide Sodium thiosulfate: 400 mg/kg IV (maximum 12.5 grams) Hydroxocobalamin: 70 mg/kg IV (maximum 5 grams) Sodium nitrite: 6 mg/kg by slow IV infusion (maximum 300 mg, only give if not contraindicated and hydroxocobolamin is not available), refer to UpToDate topics on cyanide poisoning Deferoxamine Iron 5 to 15 mg/kg per hour IV infusion, titrated to effect Digoxin immune Fab Digoxin Empiric dosing: 10 to 20 vials IV bolus fo life-threatening toxicity; see package insert for other dosing regimens Digitoxin Natural product (eg, plants, toads) Dimercaprol (BAL, British antilewisite) Acute arsenic 2.5 to 4 mg/kg IM Inorganic mercury Lead (with encephalopathy) Data from: Dart, RC, Goldfrank, LR, Chyka, PA, Lotzer, D. Combined evidence-based literature analysis and consensus guidelines for stocking of emergency antidotes in the United States. Ann Emerg Med 2000; 36:126 and Clinical policy for the initial approach to patients presenting with acute toxic ingestion or dermal or inhalation exposure. Ann Emerg Med 1999; 33:735.

©2013 UpToDate ® Print Email Recommended antidotes in pediatric poisonings Antidote Poisoning indication Pediatric dose N-acetylcysteine Acetaminophen Oral Loading dose: 140 mg/kg orally; oral maintenance doses: 70 mg/kg every four hours for 17 doses Intravenous (IV) administration: 150mg/kg over 1 hour (loading dose); 50 mg/kg IV over 4 hours; 100 mg/kg IV over 16 hours Atropine Carbamate insecticide 0.02 mg/kg IV bolus (0.1 mg minimum dose; maximum single dose 0.5 mg for children and 1.0 mg for adolescents) repeat doses titrated to effect Organophosphate insecticide Crotalid antivenin Crotalid snakes 4 to 6 vials (more if severe) Calcium gluconate and calcium chloride (10 percent) Calcium channel blocker Gluconate: 100 to 200 mg/kg IV Chloride: 20 to 30 mg/kg IV repeat doses and IV infusions are common Hydrogen fluoride (HF) Cyanide antidote kit (may contain sodium nitrite 3 percent ,sodium thiosulfate, and/or hydroxocobalamin) Cyanide Sodium thiosulfate: 400 mg/kg IV (maximum 12.5 grams) Hydroxocobalamin: 70 mg/kg IV (maximum 5 grams) Sodium nitrite: 6 mg/kg by slow IV infusion (maximum 300 mg, only give if not contraindicated and hydroxocobolamin is not available), refer to UpToDate topics on cyanide poisoning Deferoxamine Iron 5 to 15 mg/kg per hour IV infusion, titrated to effect Digoxin immune Fab Digoxin Empiric dosing: 10 to 20 vials IV bolus fo life-threatening toxicity; see package insert for other dosing regimens Digitoxin Natural product (eg, plants, toads) Dimercaprol (BAL, British antilewisite) Acute arsenic 2.5 to 4 mg/kg IM Inorganic mercury Lead (with encephalopathy) Data from: Dart, RC, Goldfrank, LR, Chyka, PA, Lotzer, D. Combined evidence-based literature analysis and consensus guidelines for stocking of emergency antidotes in the United States. Ann Emerg Med 2000; 36:126 and Clinical policy for the initial approach to patients presenting with acute toxic ingestion or dermal or inhalation exposure. Ann Emerg Med 1999; 33:735. Recommended antidotes in pediatric poisonings (continued) Antidote Poisoning indication Pediatric dose Ethanol (10 percent) Methanol Loading dose 10 mg/kg IV or PO, followed by maintenance dose 1 to 2 mL/kg per hour IV or PO Ethylene glycol Fomepizole (4-methylpyrazole) Methanol 15 mg IV bolus, then 10 mg/kg IV every 12 hours for four doses; after these, increase dose back to 15 mg/kg Ethylene glycol Glucagon Beta-adrenergic antagonist 0.15 mg/kg IV bolus followed by 0.1 mg/kg per hour IV infusion titrated to effect Calcium channel blocker Methylene blue

Loading dose 10 mg/kg IV or PO, followed by maintenance dose 1 to 2 mL/kg per hour IV or PO Ethylene glycol Fomepizole (4-methylpyrazole) Methanol 15 mg IV bolus, then 10 mg/kg IV every 12 hours for four doses; after these, increase dose back to 15 mg/kg Ethylene glycol Glucagon Beta-adrenergic antagonist 0.15 mg/kg IV bolus followed by 0.1 mg/kg per hour IV infusion titrated to effect Calcium channel blocker Methylene blue Methemoglobinemia 1 to 2 mg/kg slow IV infusion, repeat doses are common Naloxone Acute opioid poisoning 0.4 to 2 mg IV, titrated to effect Pralidoxime chloride (PAM) Organophosphate insecticide 20 to 40 mg/kg slow IV infusion, followed by 5 to 10 mg/kg per hour continuous infusion or 20 mg/kg every four hours Pyridoxine Isoniazid (INH) 1 gm per gram ingested or empiric dosing 75 mg/kg IV bolus up to 5 g Sodium bicarbonate Tricyclic antidepressant 1 to 2 mEq/kg IV bolus, titrate repeat boluses to QRS duration do not exceed arterial pH 7.55) Cocaine Salicylates 150 mEq + 40 mEq KCl in 1L of D5W infused to maintain urine output at 1 to 2 mL/kg per hour and a urine pH approximately 7.5 Adapted from Dart, RC, Goldfrank, LR, Chyka, PA, Lotzer, D. Combined evidence-based literature analysis and consensus guidelines for stocking of emergency antidotes in the United States. Ann Emerg Med 2000; 36:126 and Clinical policy for the initial approach to patients presenting with acute toxic ingestion or dermal or inhalation exposure. Ann Emerg Med 1999; 33:735.