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Recommended antidotes in pediatric poisonings

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 hydroxocobalamin 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 of 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.
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