Antidotes

ISBN
1

2555

3,000

270 6 10400

0 2201 1084 0 2201 1085 1

0 2214 4660 0 2612 4509

E-mail : smprt2005@yahoo.com

II

4 (Calcium Disodium EDTA),

(Botulinum antitoxin), (Digitalis Fab Fragment)

(Diphtheria antitoxin) 4

.






( )

III

IV

2553



2554

2555
6 10
Diphtheria antitoxin Botulinum antitoxin

2555

( )

2555
(Calcium Disodium EDTA)
(Botulinum antitoxin)
(Digitalis Fab Fragment)
(Diphtheria antitoxin)

1
7
11
17
23

(LEAD POISONING)
(Botulism)
(DIGOXIN POISONING)

29
31
37

1. Antidotes
Botulinum antitoxin Diphtheria antitoxin
2.
3.
4.
5. 3
6. 3

VI

45

51
53
55
57
59


2555

1.

.. 2550 15 2550


50 52 antidotes

Antidotes

2553

2555
10

VMI


G antidotes

G (high risk area)

G

G /

2.

antidotes 2555

10


2555

1.


2.
3.
4.
5.

6.

7.




8.

9.

10.

Dimercaprol (ampule)


Sodium nitrite (ampule)
Sodium thiosulfate (ampule)
Methylene blue (vial)
Glucagon (vial)

Succimer (capsule)

Botulinum antitoxin (bottle)




Diphtheria antitoxin (ampule)

Digoxin specific antibody
fragment (vial)
Calcium Disoduim edetate
(ampule)

50 mg/mL


3% w/v
25% w/v
1% w/v
1mg/mL

100 mg/cap

C. botulinum antitoxin
Type A 750 I.U.,
Type B 500 I.U.,
Type E 50 I.U.
per mL
1,000 I.U./mL

40 mg/vial

200 mg/mL

arsenic, gold, mercury, lead,
copper
Cyanide poisoning
Cyanide poisoning
Methemoglobinaemia
Beta-blocker and calcium
channel blocker poisoning

lead poisoning in children
botulinum antitoxin

diphtheria
toxin
digoxin, cardiac
glycoside
lead,
zinc, cadmium, manganese

.




. botulism diphtheria

botulinum antitoxin
diphtheria antitoxin 1

2

3.

4.


/

/
/ Geographic Information
System (GIS)


/

antidotes 10

Dimercaprol

Sodium nitrite 3%

Sodium thiosulfate 25%

Methylene blue 1%

Glucagon
Succimer
Botulinum antitoxin
Diphtheria antitoxin

Digoxin specific antibody fragment
Calcium disoduim edetate

. . 1- 2
.
, , . , .,
.
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2) internet
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3)

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1



6 10400
G : 1367
G : 0-2-201-1084-6 1
G Email : poisrequest@hotmail.com
G URL : www.ra.mahidol.ac.th/poisoncenter/ PoisonCenter.mahidol.ac.th

5.2 ( 24 )
1) : 3
2) :02-4197317-8
3) : 02-418-1493
4) URL : http://www.si.mahidol.ac.th/th/division/shtc/

6.

6.1






6.2



1

6.3 .

3
5
3 6

6.4

7.

m
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: 02-141-4297
: 084-387-8045
E-mail address : wannapa.s@nhso.go.th
E-mail address : tanl_rx@yahoo.com


(Calcium Disodium EDTA)

Calcium disodium EDTA (ethylenediamine tetraacetic acid) CaNa2EDTA


O

O
+ Na O
N

O- 2+
+ N
Ca
Na O

-
O
O

O

CaNa2EDTA

extracellular fluid
cerebrospinal fluid

(metabolized)
(glomerular filtration)

1
24

Calcium CaNa2EDTA divalent trivalent
EDTA affinity

(chelate) EDTA complex

complex

CaNa2EDTA

CaNa2EDTA chelating agents




1. lead encephalopathy

2.

(blood lead level) 70

3. / 45

100

CaNa2EDTA cerebrospinal fluid
lead encephalopathy dimercaprol (BAL)

chelating
agents

/

CaNa2EDTA EDTA mobilization test
CaNa2EDTA 24 8
0.6 1 CaNa2EDTA

1.
2.

1.
2.

1.

2.

3.

4.


5.
8


6. disodium EDTA calcium disodium EDTA
severe hypocalcemia

CaNa2EDTA 1 5

1000-1500 50-75
2

normal saline 5% dextrose 250-500

1 10% dextrose solution

2-3 1 1
(continuous venous drip)

(deep intramuscular
injection)
2 5



5 1

2

1000

lead encephalopathy dimercaprol

CaNa2EDTA 4

EDTA mobilization test 1/2

CaNa2EDTA 5 (200 )


1. Cory-Slechta DA, Weiss B, Cox C. Mobilization and redistribution of lead over the course of
calcium disodium ethylenediamine tetraacetate chelation therapy. J Pharmacol Exp Ther 1987
Dec; 243 (3): 804-13.
2. Lahaye D, Everaet E, Roosels D. Value of the diagnostic sodium calcium edetate mobilization
test as a criterion of lead absorption. J Soc Occup Med 1989 Winter; 39(4): 136-40.
3. Radwan H, Braun H, Bar-Sela S, Kott E. Lead encephalopathy treated by versenate (CA-EDTA).
Eur Neurol 1982; 21 (3): 157-60.
4. Treatment guidelines for lead exposure in children. American Academy of Pediatrics Committee
on Drugs. Pediatrics 1995 Jul; 96 (1 Pt 1): 155-60.
5. Williams DR, Halstead BW. Chelating agents in medicine. J Toxicol Clin Toxicol 1982; 19(10):
1081-115.

10


(Botulinum antitoxin)

(Botulism) (botulinum toxin)

Clostridium botulinum

(botulinum antitoxin)

7 Clostridium botulinum
A, B, C, D, E, F G A, B E
F C D G

acetylcholine (ACh)
(parasympathetic)

ACh anticholinergic

(anticholinergic toxidrome)



1. (Foodborne botulism)
Clostridium botulinum

2. (Wound botulism) Clostridium botulinum


3. (Infantile botulism Adult intestinal toxemia
botulism) Clostridium botulinum


4.

11


5. A

(botulinum antitoxin) (serum)
immunoglobulin
Fab


(t ) 5-7



A B (bivalent) A, B E (trivalent)
7 (heptavalent)

1.

2.

(absolute contraindication)

(hypersensitivity)

immune

12


1. Anaphylactic Anaphylactoid

2 3 (urticaria)
(bronchospasm)

2.

2


3. Serum sickness

1 3


immunoglobulin Fc
Fab immune
9 17
anaphylactic 1 9

immune (antivenin)

(lyophilized) (concentrated
solution)

250
2 1

epinephrine antihistamine
desensitization
( desensitization )

immune
250

2 8

13



Botulismus-Antitoxin Behring
1 A 750 (international unit), B 500
E 50 250

1. Prick test

1:1,000
(positive control) histamine (negative control)

15-20

histamine (erythema) 3

2. Intradermal test

1
1:1,000 0.02

1:100 (
1 )


1:100 1:1,000

epinephrine (1:1,000)

immune


14

 Desensitization


desensitization

desensitization
15

desensitization

*


1

2

3

4

5

6

7

8

9

10

11

12

13

normal saline
1:1,000
1:1,000
1:1,000
1:100
1:100
1:100
1:10
1:10
1:10

(.)
0.1
0.3
0.6
0.1
0.3
0.6
0.1
0.3
0.6
0.1
0.2
0.6
1.0

* 15

immune anaphylaxis adrenaline
immune desensitization

immune

1.

Anaphylaxis
anaphylaxis
1.1
1.2
1.3
15

2.



3.

1.4
- Adrenaline
- Corticosteroid
- H2 antagonist
1.5 (vital signs)

2.1
2.2
2.3 pethidine
Serum sickness
3.1
3.2 corticosteroid
3.3 plasmaphoresis

1. Geyer HL. Botulism. In: Nelson LS, Lewin NA, Howland MA, Hoffman RS, Goldfrank LR,
Flomenbaum NE, eds. GoldfranksToxicologic Emergencies. 9th ed. New York: McGraw-Hill;
2011: p 682-94.
2. Goldfrank LS, Geyer HL. Botulinum antitoxin. In: Nelson LA, Lewin NA, Howland MA, Hoffman
RS, Goldfrank LR, Flomenbaum NE, eds. GoldfranksToxicologic Emergencies. 9thed. New York
: McGraw-Hill; 2011: p 695-7.
3. Gomez HF. Botulism. In: Brent J, Wallace KL, Burkhart KK, Phillips SC, Donovan JW, eds.
Critical Care Toxicology: Diagnosis and management of the critically poisoned patient. 1st ed.
Philadelphia: Elsevier Mosby; 2005: p 1351-8.
4. Chalk C, Benstead TJ, Keezer M. Medical treatment for botulism. Cochrane Database Syst Rev.
2011 Mar 16;(3):CD008123.
5. Tacket CO, Shandera WX, Mann JM, Hargrett NT, Blake PA. Equine antitoxin use and other
factors that predict outcome in type A foodborne botulism. Am J Med. 1984 May;76(5):794-8.
6. Jones RG, Corbel MJ, Sesardic D. A review of WHO International Standards for botulinum
antitoxins. Biologicals. 2006 Sep;34(3):223-6.
7. Gottlieb SL, Kretsinger K, Tarkhashvili N, Chakvetadze N, Chokheli M, Chubinidze M, et al.
Long-term outcomes of 217 botulism cases in the Republic of Georgia. Clin Infect Dis. 2007;45

(2):174-80.
8. Arnon SS, Schechter R, Inglesby TV, et al. Botulinum toxin as a biological weapon: medical and
public health management. JAMA 2001;285(8):1059-70
16


(Digitalis Fab Fragment)

Digitalis Fab Fragment (DSFab)

(antibody) (cardiac glycoside)

(digoxin) (digitoxin)

DSFab (digoxindicarboxymethoxylamine hapten)

Fab
(antigen)
DSFab


DigiFab DSFab

DSFab
(volume of distribution) 0.3-0.4



(receptor) digoxin-Fab complex (DFC)
DSFab (DigiFab)
40 0.5 DFC 15-18

DFC reticuloendothelial

DSFab 20
(total serum digoxin)
1-2 (free serum digoxin)

17

 150
0.5 6
88

DSFab

/
(steady state concentration) (
8-10 )

DSFab

(oleander)

1. ventricular tachycardia,
ventricular fibrillation, cardiac arrest symptomatic bradyarrhythmia heart block
atropine

2. 5.5

3. 10

4. 6

DSFab
(

150 )

1. (hypokalemia) ( 4)
( 2.5 )

2. rapid ventricular response atrial fibrillation
( 3)

3. ( 1)

4. FDA pregnancy category C

18



1. DSFab
DSFab 2-3 7-10

2. DSFab digoxin-Fab complex

immunoassay

DSFab 4


1



2


3




4

DSFab - (bioavailability)

80
- DSFab 1
( 1)

0.5


DSFab

5 (


8 )
( 2)
DSFab
DSFab :

10-20

:



3-6



1-2


DSFab 1-3
1

19

 1 0.25 30
0.25 x 30 7.5
1 (vial) DSFab 40 0.5
DSFab

= (7.5 ) / DSFab (0.5 )

= 15

2 60 10
(Vd) 5

DSFab ()


= () / DSFab (0.5 )

= [ () x Vd x ()] / [1000 x 0.5
]

= [10 x 5 x 60 ] / [1000 x 0.5 ]

= 6
DSFab 6

: 1.

2.

8-10

3.
5 1
DSFab

(oleander)
DSFab
DSFab


1 (vial)
4 10

2-8 4
0.22 30

20

DSFab ( DigiFab) (lyophilized form) 40

1. Ujhelyi MR, Robert S. Pharmacokinetic aspects of digoxin-specific Fab therapy in the
management of digitalis toxicity. Clin Pharmacokinet. 1995 Jun;28(6):483-93.
2. Schmidt TA, Kjeldsen K. Enhanced clearance of specifically bound digoxin from human
myocardial and skeletal muscle samples by specific digoxin antibody fragments: subsequent
complete digitalis glycoside receptor (Na,K-ATPase) quantification. J Cardiovasc Pharmacol.
1991 Apr;17(4):670-7.
3. Ward SB, Sjostrom L, Ujhelyi MR. Comparison of the pharmacokinetics and in vivo bioaffinity of
DigiTAb versus Digibind. Ther Drug Monit. 2000 Oct;22(5):599-607.
4. Antman EM, Wenger TL, Butler VP, Jr., Haber E, Smith TW. Treatment of 150 cases of
life-threatening digitalis intoxication with digoxin-specific Fab antibody fragments. Final report of
a multicenter study. Circulation. 1990 Jun;81(6):1744-52.
5. Marchlinski FE, Hook BG, Callans DJ. Which cardiac disturbances should be treated with
digoxin immune Fab (ovine) antibody? Am J Emerg Med. 1991 Mar;9(2 Suppl 1):24-8; discussion

33-4.
6. Howland MA. Digoxin-Specific Antibody Fragments (Fab). In: Nelson L, Lewin N, Howland MA,
Hoffman R, Goldfrank L, Flomenbaum N, editors. Goldfranks Toxicologic Emergencies.

New York: McGraw-Hill Professional Publishing; 2010.

7. Kearney TE. Digoxin-Specific Antibodies. In: Olson K, editor. Poisoning and Drug Overdose.
New York: McGraw-Hill Professional; 2011.

21


(Diphtheria antitoxin)

(Diphtheria) Corynebacterium diphtherriae
(toxogenic strain)
(exotoxin)


(Bull neck)




(diphtheria antitoxin, DAT)
penicillin erythromycin
streptococci

phenol 0.25%

Serum Institute of India Vins Bioproducts
g

( and globulin)

23




0.1

DAT 1 : 100 normal saline solution (NSS) 20 1

DAT 1 : 10 NSS 15

(anaphylaxis) serum sickness

serum sickness

Serum Institute of India Vins Bioproducts
10,000-30,000
(Intravenous : IV) 40,000-100,000 30 2



DAT NSS 1 : 20

1 / DAT

m 48 20,000-40,000

m 72

80,000

m bull neck 100,000-120,000

m 10,000-20,000 20,000-40,000

IV
DAT NSS 250-500 ml 2-4
m Pharyngeal or laryngeal disease of 2 days duration : 20,000-40000 units


m Nasopharyngeal disease : 40,000-60,000 units

m Systemic disease of 3 or more days duration or any patient with diffuse swelling of the
neck : 80,000-100,000 units

m Skin lesions only : 20,000-40,000 units



2 8

24



: 10,000 (10 )

1. .
. :
. 2547.
2. Use of Diphtheria Antitoxin (DAT) for Suspected Diphtheria cases. Available from: URL:http://
ww.cdc.gov./vaccines/vpd-vac/diphtheria/dat/downloads/protocol_032504.pdf/ cited in April
2012
3. Leaflet of Diphtheria antitoxin, Swiss Serum and Vaccine Institute Berne, Switzerland.
4. Leaflet of Diphtheria antitoxin, Serum Institute of India Limited, India.
5. Leaflet of Diphtheria antitoxin, Vins Bioproducts Limited, India.

25

27


(LEAD POISONING)

45
CC :
PI : 2 85

1.
m
m

m
m

2.
m ***
m Lead line ( )
m Neurological deficits peripheral nervous system

3.
m CBC, BUN/Cr, serum uric acid, liver function test
m Serum/urine ALAD, erythrocytic protoporphyrins

4. chelating agents

29



: 20 6

5 50-60

mild pale conjunctiva


CBC : Hb 9.2 gm/dL, Hct 28%, WBC 4,500 /cumm, platelet 250 x 103 /cumm,

normochromic normocytic anemia with basophilic stippling

CaNa2EDTA 1 12 5

1 CBC : Hb 11 /

blood lead level 60 47

30


(Botulism)

- 5
2-3

1. Rotavirus Staphylococus aureus Vibrio
parahemolyticus

2.
Amanita pantherina, Amanita phalloides

1

(intravenous fluid)

(conscious)

(ptosis) (shallow breathing)

1.

2. (Tetrodotoxin) (Saxitoxin)

3. (Botulinum toxin)

31

?


acetylcholine

(cholinergic syndrome) (alteration of consciousness)

1

1
()




1-8
:



(Descending paralysis)


6-8
,

32

()
1/2-12
:

(Ascending paralysis)
-
2-3
,


balbar palsy
anticholinergic
(Botulism)

?

Clostridium botulinum (gram positive bacilli)

(obligated anaerobic)

120 30

(botulinum toxin) Clostridium botulinum 7 A, B,

C, D, E, F G A, B E F
C D G

polypeptide 2 light chain heavy
chain heavy chain light chain
zinc dependent endoprotease polypeptide SNARE proteins (soluble
N-ethylmaleimidesensitive factor attachment protein receptor) exocytosis
acetylcholine acetylcholine
(irreversible inhibition)



(botulism) (botulinum toxin )

5

1.1 Foodborne botulism :





1.2 Intestinal botulism : Clostridium botulinum

(infantile botulism) (adult intestinal toxemia botulism)

1.3 Wound botulism : Clostridium botulinum

33


1.4 Biological weapon :
2


1.5 Iatrogenic botulism : A

1-8 ( 2 )


1 :


2 :
(descending paralysis) anticholinergic syndrome


anticholinergic syndrome


(brain death)

?



1.
m Mouse bioassay
m Immunoassay for toxin
m Polymerase chain reaction (PCR) for toxin
m Culture for Clostridium botulinum

2
m (Pulmonary function tests) negative inspiration

force (NIF)
m (Electromyography)

34

?



m

m

m

m


1.
(endotracheal tube)
negative inspiration force (NIF)


2.
paradoxical movement (diaphragm)

3.

4.

5. 1

6.



5-8

26 .. 2493-2502

(.. 1950-1959)

6 .. 2533-2539

(.. 1990-1996) .. 2549

190 42
6-9

35


1. Geyer HL. Botulism. In: Nelson LS, Lewin NA, Howland MA, Hoffman RS, Goldfrank LR,
Flomenbaum NE, eds. Goldfranks Toxicologic Emergencies. 9th ed. New York: McGraw-Hill;
2011: p 682-94.
3. Gomez HF. Botulism. In: Brent J, Wallace KL, Burkhart KK, Phillips SC, Donovan JW, eds.
Critical Care Toxicology: Diagnosis and management of the critically poisoned patient. 1st ed.
Philadelphia: Elsevier Mosby; 2005: p 1351-8.
4. Swaddiwudhipong W, Wongwatcharapaiboon P. Foodborne botulism outbreaks following
consumption of home-canned bamboo shoots in Northern Thailand. J Med Assoc Thai 2000;83

(9):1021-5.
5. Botulism from home-canned bamboo shoots--Nan Province, Thailand, March 2006. MMWR
Morb Mortal Wkly Rep. 2006 Apr 14;55(14):389-92.
6. Kongsaengdao S, Samintarapanya K, Rusmeechan S, Wongsa A, Pothirat C, Permpikul C, et al.
An outbreak of botulism in Thailand: clinical manifestations and management of severe respiratory
failure. Clin Infect Dis. 2006 Nov 15;43(10):1247-56.
7. Wongtanate M, Sucharitchan N, Tantisiriwit K, Oranrigsupak P, Chuesuwan A, Toykeaw S, et al.
Signs and symptoms predictive of respiratory failure in patients with foodborne botulism in
Thailand. Am J Trop Med Hyg. 2007 Aug;77(2):386-9.
8. Witoonpanich R, Vichayanrat E, Tantisiriwit K, Wongtanate M, Sucharitchan N, Oranrigsupak P,
Chuesuwan A, Nakarawat W, Tima A, Suwatcharangkoon S, Ingsathit A, Rattanasiri S, Wananukul W.
Survival analysis for respiratory failure in patients with food-borne botulism. Clin Toxicol (Phila).
2010;48:177-83.
11. Gottlieb SL, Kretsinger K, Tarkhashvili N, Chakvetadze N, Chokheli M, Chubinidze M, et al.
Long-term outcomes of 217 botulism cases in the Republic of Georgia. Clin Infect Dis. 2007;45

(2):174-80.
12. . :
, . . :
; 2552. 51-9.
13. . (Botulism). : , . .
Common problems in Internal Medicine. : 2551: 79-94.
14. . Botulinum toxin .
. 2549.

36


(DIGOXIN POISONING)

60

atrial fibrillation


glipizide 5 / humulin-N 20 unit/
enalapril 10 / atorvastatin 10 / isosorbide dinitrate 30 / aspirin
81 / furosemide 40 / digoxin 0.25 /
100/60 52 / 20 /

1
serum sodium 136 potassium 2.8
chloride 102 bicarbonate 21 BUN 82
/ creatinine 3.8 / serum digoxin 5.4 / (
digoxin 10 )

1 atrial fibrillation with complete heart block
junctional ectopy, 53/ QRS QTc interval 102 486 millisecond

37

(digoxin)
supraventicular tachycardia
(digitoxin) (yellow oleander, Nerium spp.) (Bufo toads)
sodium-potassium
adenosine triphosphate (Na-K ATPase) pumps
Na-K ATPase Na-K ATPase (membrane potential)
Na-K ATPase
- (sodium
calcium exchanger)

1.

2. AV node

supraventicular tachycardia heart block

3. ventricle
(automaticity) (excitability)
ectopic beats, premature ventricular contraction (PVC), bigeminy, ventricular tachycardia
fibrillation bidirectional ventricular tachycardia

4. (hyperkalemia)

1. (
80 )

2. (confusion and delirium)

38


3.
m Bradyarrhythmias : AV blocks (1st, 2nd, 3rd degree), atrial fibrillation with slow
ventricular response ( < 60/minute)
m Tachyarrrhythmias : ventricular ectopic beats, bigeminy, supraventricular
tachycardia with AV block, ventricular tachycardia
m

4. (hyperkalemia)

m (bioavailability) 60-80

m 1-2
(steady state concentration) 6-8

m (volume of distribution) 5-8

m 10-12

m 30-40

2

1.

1

2.

m
m (hypokalemia)

/ (hypomagnesemia)
furosemide thiazide


m amiodarone verapamil quinidine cyclosporine
macrolide erythromycin clarythromycin


39









bradyarrhythmia
tachyarrhythmia






(9 /)

(steady state concentration) 8-10

1. supraventricular tachyarrhythmia atrioventricular block

2. junctional escape rhythms

3. bigeminy premature ventricular contraction

0.6-2.0 /
10-20 /

immunoassay

glucose, insulin sodium bicarbonate
calcium gluconate glucose, insulin,
sodium bicarbonate ()

40


bradyarrhythmia
atropine external cardiac pacing transvenous
cardiac pacing ventricular tachyarrhythmia
( 36) ( 13) phenytoin
lidocaine tachyarrhythmia
Digitalis Fab Fragment

bradyarrhythmia tachyarrhythmia

atrial fibrillation with heart block junctional ectopy

acute kidney injury

() (
)


( 3.5-4 )
bradyarrhythmia
tachyarrhythmia
atropine external cardiac pacing Digitalis Fab Fragment

1. Lip GY, Metcalfe MJ, Dunn FG. Diagnosis and treatment of digoxin toxicity. Postgrad Med J.
1993 May;69(811):337-9.
2. Kemmerer DA. Devious digoxin: a case review. J Emerg Nurs. 2008 Oct;34(5):487-9.
3. Ma G, Brady WJ, Pollack M, Chan TC. Electrocardiographic manifestations: digitalis toxicity.

J Emerg Med. 2001 Feb;20(2):145-52.

4. Prybys KM. Deadly drug interactions in emergency medicine. Emerg Med Clin North Am. 2004
Nov;22(4):845-63.

41

43

 1
Antidotes
Botulinum antitoxin Diphtheria antitoxin

1.

2553 6 4 10

2554

VMI


m antidotes

m (high risk area)

m

m /


2554 2
Botulinum antitoxin
Diphtheria antitoxin


2

2.

1. Botulinum antitoxin
10 vial


2. Diphtheria antitoxin
2000 vial

1.1
1.2 . .
2.1
2.2 . .
2.3
2.4 4
45

3.

4.


/
/
/ Geographic Information
System (GIS)

5.

Botulinum antitoxin Diptheria antitoxin 2
1 2

1 Botulinum antitoxin
.
. / .

. . / . .
. /

IF YES
. . Botulinum
antitoxin . / .
. / .
. /
. .

46

IF YES

1. .
2. .

 2 Diphtheria antitoxin
.
. / .

. . / . .
. /

IF YES
. Diphtheria antitoxin

. / .
. /
. .

DAT

IF YES

. . (4 .)
GPO

1. .
2. .

GPO DAT
.

: 4 .

. .

5.1 Botulinum antitoxin

2

1.

. (.)
(.)

. (.) (.)

(.)

. Botulinum antitoxin

(.) (.)

. (.) (.)



.


.

47


2. .

. .

. Botulinum antitoxin
(.) (.)

. . .
. .


.

.

.


5.2 Diphtheria antitoxin

2

1.

. . .

. . . . . . .


. . Diphtheria antitoxin
. .

.

.

. . . .

. .

2.

.

. Diphtheria antitoxin
. . . .


. . .

. .


.

48

6.




6.1 ( 24 )

1.
m
m

2. internet
m
m

3.
4.

5.
m ........

1



6 10400
m : : 1367
m : 0-2-201-1084-6 1
m E-mail address : poisrequest@hotmail.com
m URL : www.ra.mahidol.ac.th/poisoncenter/ PoisonCenter.mahidol.ac.th

6.2 ( 24 )

1. : 3

2. :02-4197317-8

3. : 02-418-1493

4. URL : http://www.si.mahidol.ac.th/th/division/shtc/

7.

1.
m .

: 02-1414297, 084-3878045

E-mail address : wannapa.s@nhso.go.th

49

2.
m

: 0-2-201-1084-6 5

: 0-2-201-1084-6 1

E-mail address : charuwan.sri@mahidol.ac.th

3.

3.1 Botulinum antitoxin

1. ( 1)

1.1 .


: 02-5903189, 081-8394154


: 02-9510918

1.2 .


: 02-5903183, 089-6805690


: 02-5908436

2.

2.1 . (..)


: 02-5901776, 087-0568866

2.2 .


: 02-5901779, 089-6379012

3.2 Diphtheria antitoxin

1. ( 2)

1.1 .


: 02-5903196-9, 081-4276276


: 02-9659152

1.2


: 02-5903196-9, 081-6478831


: 02-9659152

2.

2.1 . (..)


: 02-5901776, 087-0568866

2.2 .


: 02-5901779, 089-637901

50

 2

.

51

1
2
3
4
5
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7
8

9
10

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/
Sodium nitrite 3%
3% (10 mL)
Sodium thiosulfate 25%
25% (18 mL)
Succimer
100 mg/cap
Methylene blue 1%
10 mg/mL (5 mL)
Glucagon
1 mg/vial
Dimercaprol (British Anti-Lewisite; BAL)
50 mg/mL (2 mL)
Digoxin-specific Antibody Fragments
40 mg/vial
Sodium Calcium edetate
200 mg/mL (5 mL)
(Calcium disodium edetate) (Ca Na2 EDTA)

Botulinum antitoxin
250 mL/bottle
Diptheria antitoxin
1,000 unit/mL (10 mL)

6
2553 1 2553

2554-2555

. .



.





. .


.






.
.

53



1.



2. .


3.

( 4)

4. . .

5. .

6.


7. . .


8. .

54

m .

: 02-1414297
: 02-1439754
: 084-387-8045
E-mail address : wannapa.s@nhso.go.th

(5 )


e-mail address

1
2
3
4
5
6
7
8
9
10

Methylene blue
Sodium nitrite
Sodium thiosulfate
Dimercaprol
Glucagon
Succimer
Botulinum antitoxin
Diphtheria antitoxin
Digoxin specific antibody fragment
Calcium disodium edetate

vial
amp
amp
amp
vial
cap
bottle
amp
vial
amp

55

 5
3



1.


2.
3.
4.
5.

6.

7.




8.

9.


10.

Dimercaprol (ampule)


Sodium nitrite (ampule)
Sodium thiosulfate (ampule)
Methylene blue (vial)
Glucagon (vial)

Succimer (capsule)

Botulinum antitoxin (bottle)




Diphtheria antitoxin (ampule)

Digoxin specific antibody
fragment (vial)

Calcium Disoduim edetate
(ampule)

50 mg/mL


3% w/v
25% w/v
1% w/v
1 mg/mL

100 mg/cap

C. botulinum antitoxin
Type A 750 I.U.,
Type B 500 I.U.,
Type E 50 I.U.
per mL
1,000 I.U./mL

40 mg/vial


200 mg/mL

arsenic, gold, mercury,
lead, copper
Cyanide poisoning
Cyanide poisoning
Methemoglobinaemia
Beta-blocker and calcium
channel blocker poisoning

lead poisoning in children

botulinum antitoxin

diphtheria toxin
digoxin,
cardiac glycoside


lead, zinc, cadmium,
manganese

57



. EMCO www.emco.nhso.go.th

. Antidote http://drug.nhso.go.th/Antidotes/
website
Login


a. 1367

b. 02-4197317-8

. Download

3 www.emco.nhso.go.th ( 6)

.

.

.
3 ( 6)

.


.

.


.

58

 6
3

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2.
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HN ........................... AN ...........................

............ .........
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3. ( )

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13

5% IVIG 50 ml inj. (2.5 g)

5% IVIG 100 ml inj. (5 g)
Liposomal Amphotericin B 50 mg inj.
Dimercaprol inj, (BAL)
Sodium nitrite inj.
Sodium thiosulfate inj.
Methylene blue inj.
Glucagon inj.
Succimer cap. (DMSA)
Botulinum antitoxin inj.
Diphtheria antitoxin inj.
Digoxin specific antibody fragment inj.
Calcium disodium edetate inj

59

4.
- ...........................................................................................................................
............................................................ ....................................................
.............................................................. ....................................................................
5.

................................................ ..........................

60

1367
24

: 0-2419-7317-8
: 0-2419-7007