Antidotes and

Medications Used in
Chemical Accidents
Dr Geraldine Leong
Available antidotes and medications

• Cyanide Kit – amyl nitrite/sodium nitrite, sodium

thiosulphate
• Calcium gluconate
• Diazepam Autoinjector
• Atropine + Pralidoxime Autoinjector
Cyanide Kit
• Indication: Cyanide Posioning
• Cyanide (CN) Detoxification Process
Cyanide Kit
• Amyl Nitrite
• Good first aid drug - easily administered – inhaled intermittently
• Max metHb 5%
• Sodium Nitrite
• Given as IV sodium nitrite 3% solution 10 mls over 30 min (300 mg)
• Rpt in half hour at half dose according to clinical response
• Max metHb 30%
• Limitations of Nitrites
• Hypotension
• Hypoxia
• Forms metHb which dec O2 carrying capacity
• Worsens preexisting anaemia, CO poisoning
Cyanide Kit
• Sodium Thiosulphate
• Given as IV sodium thiosulphate 25% solution 50 ml over
10 min (12.5g)
• Rpt half dose at half hour according to clinical response
• No significant adverse effects
• Forms thiocyanate (irreversible)
• less toxic
• excreted renally
Calcium Gluconate
• Indication: Hydroflouric Acid poisoning
• Depending on route of exposure:
• Skin exposure
• Apply calcium gluconate gel and massage
• Inhalational exposure
• Calcium gluconate nebulisation
• Oral exposure
• Calcium chewable tablets
• Give water, milk or antacids
Diazepam Autoinjector
• Indications: Seizures sec to toxicity
• Not specific to any particular toxic agent
• Benzodiazepine – aborts seizure
Atropine + Pralidoxime Autoinjector
• Indication: Chemical agents causing cholingeric toxidrome
eg nerve agents
• Atropine
• MOA: competitive inhibitor of acetylcholine at muscarinic
receptors (not at nicotinic receptors)
• Does not reactivate inactivated acetylcholinesterase
• Pralidoxime
• MOA: reactivates inactivated acetylcholinesterase that has not
yet been irreversibly bound with chemical agent
• Happens at both muscarinic and nicotinic receptors at NMJ
• Once chemical agent binds irreversibly with
acethlcholinesterase  pralidoxime will not work
• Early administration is crucial for max benefit!
Atropine + Pralidoxime Autoinjector
• How to give?
• Fixed dosing Regiment
Mild Symptomps 1 x atropine + pralidoxime
autoinjector
Moderate Symptoms 2 x atropine + pralidoxime
autoinjector
Severe Symptomps 3 x atropine + pralidoxime
autoinjector