Antidotal therapy for

TABLE 19.5. Supportive therapy and specific antidotal therapy for acute cyanide poisoning... 

Current antidotal therapy for organophosphate exposure resulting from warfare or terrorism includes parenteral atropine, an oxime (2-PAM or HI-6), and a benzodiazepine as an anticonvulsant. Oximes and their metabolites are readily eliminated by the kidney. 

Casualties with advanced toxicity from a large amount of cyanide may require specific antidotal therapy in addition to the vigorous supportive therapy outlined above. The recommended agents or components of specific antidotal therapies for cyanide... 

A 41-year-old woman became weak and had difficulty breathing after ingesting 30 apricot kernels (estimated total, 15 g) purchased at a health food store. She became comatose and hypothermic but responded promptly to antidotal therapy for cyanide poisoning (Suchard et al. 1998). 

A principle of the therapy for acute poisonings with anticholinesterase compounds (OPC, carbamates) lies in the complex performance of specific antidotic therapy including methods for poison excretion and intensive resuscitation measures. 

Methods for Reducing Toxic Effects. The usefulness of methods and treatments for reducing peak absorption and reducing the body burden of carbon tetrachloride are rather limited due to the chemical s rapid rates of absorption and tissue disposition. On the other hand, investigations of antidotal therapy based on the mechanism of action has been limited to a few studies involving the administration of compounds to reduce free radical injury. Additional studies would be useful to better establish the effectiveness of both acute and prolonged antidotal therapy, since carbon tetrachloride is persistent in the body. 

When a specific antidote or other treatment is under consideration, quantitative laboratory testing may be indicated. For example, determination of the acetaminophen serum level is useful in assessing the need for antidotal therapy with acetylcysteine. Serum levels of salicylate (aspirin), ethylene glycol, methanol, theophylline, carbamazepine, lithium, valproic acid, and other drugs and poisons may indicate the need for hemodialysis (Table 58-3). 

TABLE 6.7. Recommended antidote protocol for emergency nerve agent exposure therapy ... 

Respiratory, skin, and eye protection is required for personnel working with trichothecenes. There are no specific therapies for trichothecene toxicoses. Neither vaccines nor specific antidotes are readily available. Treatment in people and animals is symptomatic and supportive, and the only known prophylactic measure is avoidance of exposure (Fricke and Poppenga, 1989 National Academy of Science, 1983). T-2 toxin is stable in the environment, and resistant to heat and ultraviolet light. 

Monitoring the cholinesterase changes during the intoxication is at present the best indication of the severity of OP poisoning as well as a basis for antidotal therapy. 

Most unintentional holly exposures result in selflimited gastrointestinal symptoms with no specific treatment needed. The main goal of therapy for holly ingestions is fluid replacement and supportive care. There is no specific antidote available. Activated charcoal may be used for substantial recent ingestions. For patients who are symptomatic with significant gastrointestinal effects, intravenous fluid replacement may be used if oral liquids cannot be tolerated. 

Immediate and vigorous fluid and electrolyte replacement must be carried out. Oral activated charcoal may be given if the ingestion occurred within the previous 24 h and severe vomiting has not yet begun. No specific antidotal therapy exists for the treatment of this ingestion, although many substances have been tried. The mainstay of therapy is meticulous supportive care. 

Basic and advanced life-support measures should be utilized as necessary. Gastric decontamination with activated charcoal should be considered for substantial recent ingestions. Treatment recommended after decontamination is symptomatic and supportive. There is no antidotal therapy. Because patients taking an overdose of sertraline may also have access to other medications/chemicals, the patient should be evaluated and treated as appropriate for other substances that may have been ingested. 

The usage of cholinolytics becomes a basis for antidotic therapy of poisonings induced OPC and carbamates. Atropine sulfate has received the most wide spread occurrence among all the cholinolytics suggested for this purpose. Atropine sulfate eliminates muscarine-like effects (bronchospasm in particular), reduces glandular secretion and salivation. 

---