Pediatric emergency medicine trisk 3050 3050

Poison
Acetaminophen

Antidote

N -acetylcysteine; intravenous (IV)—150 mg/kg over 1
hr, then 12.5 mg/kg/hr for 4 hrs, then 6.25 mg/kg/hr;
enteral—140 mg/kg, then 70 mg/kg every 4 hrs
Anticholinergics
Physostigmine (adult, 0.5–2 mg; child, 0.02 mg/kg)
slow IV; may repeat in 15 min until desired effect is
achieved; subsequent doses every 2–3 hrs PRN
(Caution: May cause seizures, asystole, cholinergic
crisis; see text )
Anticholinesterases
Atropine, 2–5 mg (adults); 0.05–0.1 mg/kg (children)
intramuscular (IM) or IV, repeated every 2–10 min
until atropinization is evident
Organophosphates
Pralidoxime chloride 1–2 g (adults); 25–50 mg/kg
(children) IV; repeat dose in 1 hr PRN, then every 6–
8 hrs for 24–48 hrs (consider also constant infusion;
see text)
Carbamates
Atropine, as above; pralidoxime for severe cases (see
text)
Benzodiazepines
Flumazenil, 0.01 mg/kg IV (use with caution; see text)
β-Adrenergic blockers Glucagon, 0.1 mg/kg IV, followed by 0.05 mg/kg/hr
Calcium channel
Calcium chloride 10%, 10 mL (adult); 0.2 mL/kg

blockers
(pediatric) IV
Or
Calcium gluconate 10%, 30 mL (adult); 0.6 mL/kg
(pediatric) IV
High-dose insulin 1 unit/kg bolus followed by 0.5
units/kg/hr, with glucose infusion titrated to prevent
hypoglycemia
Carbon monoxide
Oxygen 100% inhalation, consider hyperbaric for
severe cases
Cyanide—
Adult: Amyl nitrite inhalation (inhale for 15–30 s every
nitrites/thiosulfate
60 s) pending administration of 300-mg sodium
nitrite (10 mL of a 3% solution) IV slowly (over 2–4
min); follow immediately with 12.5-g sodium