- Activated Charcoal
- Mechanism of Action: Adsorbent agent. Large surface area of charcoal binds to toxins and prevents systemic absorption.
- Indications: Toxic ingestions/drug overdoses (solids only); should be administered within 1-2 hours of ingestion.
- Contraindications: Risk of aspiration, ingestion of caustic material
- Dosage: 25-100mg PO
- Onset: Begins within 1 minute; achieves equilibrium within 10-25 minutes.
- Duration: Up to 4 hours
- Adverse Reactions: aspiration, bowel obstruction.
- Special Considerations: N/A
- Mechanism of Action: Antidote/Mucolytic; helps replete glutathione reserves in the liver, which helps protect the liver from hepatotoxic NAPQI metabolite. Also functions as a mucolytic to help break down thick pulmonary secretions.
- Indications: Acetaminophen toxicity
- Contraindications: Allergy to drug/class
- Dosage: Three separate infusions:
- First dose: 150mg/kg in 100 mL D5W over 60 minutes
- Second dose: 50mg/kg in 250 mL D5W over 4 hours
- Third dose: 100 mg/kg in 500 mL D5W over 16 hours
- Onset: Generally rapid onset
- Duration: Generally short duration
- Adverse Reactions: Nausea/vomiting, anaphylaxis
- Special Considerations: Almost 100% effective if given within 8 hours of ingestion for maximum benefit. May still be beneficial after >24 hours.
*Deep Dive: N-acetylcysteine (Life in the Fast Lane)
- Mechanism of Action: Opiate antagonist; competitively binds to mu, kappa, and sigma opiate receptor sites in the CNS for reversal of opiate toxicity and improvement of respiratory drive.
- Indications: Opioid toxicity (recreational or iatrogenic)
- Contraindications: Allergy to class/drug
- Dosage: 0.4 – 2.0 mg (IV/IM/SC), repeat q 2-3 minutes prn. Max dose 10 mg
- Onset: 1-2 minutes
- Duration: 20-90 minutes
- Adverse Reactions: Non-cardiogenic pulmonary edema, opioid withdrawal (diaphoresis, tachycardia, agitation)
- Special Considerations: Patients with opiate overdose should be held in the ED until naloxone wears off (usually 1-3 hours). Consider discharging patients with naloxone in-hand.
- Mechanism of Action: Vitamin; combines with ATP in liver, kidneys, and leukocytes to produce thiamine diphosphate, which acts as a coenzyme in carbohydrate metabolism. Used to prevent brain damage (encephalopathy) from thiamine-depleted states.
- Indications: Alcoholism, beriberi anorexia, bulimia, pregnancy, malignancies
- Contraindications: Allergic reactions to vitamin supplements
- Beriberi: 5-30 mg TID x 1 month
- Wernicke’s Encephalopathy: 500mg IV TID x 2 days
- Onset: Rapid
- Duration: Depends on degree of deficency
- Adverse Reactions: Anaphylaxis, pruritus, injection site pain
- Special Considerations: None
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