Special features

Poisoning — antidotes and their use

By Alison Dines, BSc, MA, Paul Dargan, MBBS, FRCPE, and Stephen Nash, MB, FFAEM

Treatment of poisoning mainly involves providing supportive care to the patient, although a number of antidotes are available for certain circumstances. This article, the second in a special feature, describes some of these antidotes and the circumstances in which they may be used

This article as a PDF (130K)

Alison Dines is senior specialist in poisons information and Paul Dargan is consultant physician and clinical toxicologist, both at Guy’s and St Thomas’ Poisons Unit, Guy’s and St Thomas’ NHS Foundation Trust.

Stephen Nash is chairman of the clinical effectiveness committee of the British Association of Emergency Medicine

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SUMMARY

Antidotes play a crucial part in the management of certain poisons, but they are only available for a small number of drugs and chemicals. As pointed out in the previous article, antidotes are only one aspect of the management of a poisoned patient.

Until recently, there were no nationally recognised guidelines for emergency departments on stocking antidotes or on how to access them. In June 2006 the British Association of Emergency Medicine (BAEM) produced the first such guidelines, in conjunction with Guy’s & St Thomas’ Poisons Unit. These guidelines help hospitals to ensure that appropriate antidotes are held in appropriate areas of the hospital, in sufficient quantities. In the guidelines agents are grouped into four categories depending on the urgency of clinical need. This may be:

• Immediate
• Within one hour
• Within four hours
• Not critically time dependent

This article will describe the common difficulties encountered in the treatment of poisoning with widely used antidotes, as well as the use of novel or unlicensed drugs.

Full text article PDF (130K)