An antidote is an antidote. What is an antidote? Poisons and Antidotes Table of Medicine Antidotes

An antidote is a special medicine that allows you to neutralize poison in the human body. Therapy is effective if the antidote is used at the first signs of the pathological process.

It is equally important to diagnose poisoning in time, since the use of an antidote often provokes the appearance of acute psychosis. In the event of the development of a toxic effect of the drug on the patient’s body, it is necessary to carry out resuscitation measures.

The antidote is administered with caution to patients suffering from heart failure, since there is a high risk of developing vascular complications. In many patients, symptoms of acute poisoning quickly disappear with adequate antidote therapy.

Distribution of substances by groups

For acute intoxication, the following antidotes are used:

sorbents;
medications that neutralize toxins;
compounds similar to poisons (amyl nitrite, methyl alcohol);
competitors of toxic substances of exogenous nature;
drugs that disrupt the metabolism of poison;
immunological preparations (serums).

The classification of antidotes facilitates their use in cases of severe poisoning and allows the additional use of the entire arsenal of drugs for symptomatic therapy.

The antidote prevents the development of complications from poisoning with drugs, household chemicals, pesticides, plant and animal poisons. The most common intoxications are hypnotics and tranquilizers, analgesics, and disinfectants. An antidote allows you to completely neutralize a toxic substance or prevent its further absorption.

Antidotes are used to treat intoxication in strictly defined doses, introduced into the patient’s body through intramuscular and intravenous injections or an inhaled aerosol.

Powerful sorbents

Antidotes exhibit chemical antagonism towards poisons. The following substances are used to provide emergency assistance:

zinc oxide;
white clay (kaolin);
starch paste;
Activated carbon.

To treat intoxication after taking pilocarpine hydrochloride (aceclidine), use a 0.1% solution of potassium permanganate. Then adsorption is carried out with activated carbon. The unabsorbed part of the poison is removed from the body with the help of kaolin in case of poisoning with heavy metal salts or medications.

The drugs Enterodes or Enterosorb are used for food poisoning and taken several times a day in the dose prescribed by the doctor. If acute intoxication with a narcotic substance has developed, the patient is prescribed activated carbon and the adsorbent Polyphepan.

Polysorb quickly removes toxins from the body. Smecta is a naturally occurring aluminosilicate that prevents the loss of water and electrolytes during acute poisoning. Carbolene adsorbs alkaloids, gases, and heavy metal salts. In case of acute intoxication with ethyl alcohol, the drug Carbactin has the greatest antitoxic effect. It is used as a first aid remedy for chronic alcoholism.

Therapy of acute and chronic poisoning

In case of prolonged intoxication of the body, which appears due to poisoning, the drug Unitol is used, which has an antiarrhythmic effect. It is effective during the period of resorptive action of the poison after an overdose of cardiac glycosides. The antidote is used to treat acute carbon monoxide poisoning. In the body of a patient suffering from alcoholism, Unitol forms a non-toxic substance with ethyl alcohol. The drug is prescribed to treat arsenic poisoning.

The drug is not used in geriatric patients suffering from allergies, stage II-III hypertension, and pregnant women. Antidotes are powerful weapons in the fight against poisons, but in some cases Unitol causes the following adverse reactions:

nausea;
vomiting;
headache;
rapid heartbeat.

In patients suffering from chronic alcoholism, the drug improves the functioning of the central nervous system and prevents the development of visual and auditory hallucinations. It should be remembered that Unitol is not used for the treatment of acute ethyl alcohol poisoning. In any case, it is used only as prescribed by a doctor.

Antidote for cyanide poisoning

Antidotes have proven themselves to be indispensable therapeutic agents that prevent fatal poisoning and death. Amyl nitrite is a drug that relaxes the smooth muscles of coronary and cerebral vessels. In acute cyanide poisoning, it reduces the oxygen demand of the heart muscle, but affects the frequency of myocardial contractions and causes an accelerated heartbeat. The antidote is successfully used in medical practice and is highly effective against poisoning with hydrocyanic acid salts.

The drug prevents the development of sexual disorders in a patient after prostate surgery. Caution must be exercised when using antivenom. The drug should not be prescribed to patients suffering from anemia or thyrotoxicosis. The use of an antidote in a patient who has suffered an acute myocardial infarction or traumatic brain injury may cause the development of adverse reactions.

In no case should you use Amyl nitrite for inhalation in a pregnant woman, and you should also take into account the likelihood of a decrease in blood pressure up to collapse while taking the antidote with ethanol.

How to neutralize the effects of poisons and drugs

Toxic substances affect the brain and cause the development of severe mental disorders. Convulsive poisons include:

cicutotoxin;
tetraethyl lead;
curare;
coniine;
atropine;
strychnine.

An overdose of the drug LSD leads to the development of toxic shock. The antidote is the drug Aminazine, which eliminates hallucinations. In some cases, for liquidation acute symptoms poisoning use the tranquilizer Diazepam and the anticonvulsant drug Phenobarbital.

The antidote to the opioid drug Morphine and the narcotic analgesics Omnopon, Promedol, Fentanyl is their antagonist Naloxone, which is administered intramuscularly or intravenously as needed. In case of poisoning with tranquilizers, Flumazenil solution is used for treatment, eliminating the consequences of intoxication - shortness of breath, memory loss. The drug is prescribed with caution to elderly and senile people and is administered intravenously only under the supervision of a physician.

In some cases, severe adverse reactions occur after the use of antidotes:

arrhythmia;
increased blood pressure;
pulmonary edema;
respiratory depression.

Serums in the fight for life

After a cobra bite, the patient develops paralysis of the respiratory muscles. The patient is administered a specific antidote - anti-snake serum. In some cases, the antidote is combined with other solutions for infusion.

An antidote against scorpion venom is used in a hospital setting, and for a karakurt bite, an active chemical reagent is used that destroys the toxin, which is harmless to the victim’s body.

The drug Anascorp contains sucrose, sodium chloride, glycine, pepsin, cresol and is used for course therapy. Anti-caracourt serum is the most effective remedy from a spider bite. However, in a weakened patient, the administration of an antidote causes an allergic reaction, including anaphylactic shock.

There is no specific antidote for the ray injection of the coral polyp of P. toxica and the skin mucus of the dart frog. Many people died from the bite of an Australian snake before the advent of an antidote - antitoxic taipan serum.

Detoxification for atropine intoxication

The drug Nivalin contains the alkaloid galantamine, which affects the membrane of the damaged cell. The medicine is administered intravenously in the first hours after poisoning with anticholinergics. The patient's condition improves after a few hours.

The patient's heart function stabilizes and decreases arterial pressure and body temperature. Antidotes for acute poisoning with anticholinergics are used after gastric lavage through a tube.

To neutralize the toxin, the drug Proserin is used. Atropine is an antidote to physostigmine, an alkaloid from the seeds of a poisonous plant native to western Africa. A 0.1% solution is used as an antidote for poisoning with Clonidine, Aconitine, and cardiac glycosides. If muscle twitching or excessive excitability occurs in a patient after accidentally using a means to kill harmful insects, atropine is used as an antidote.

A diagnosis of poisoning is not uncommon. The antidote neutralizes toxins and restores health.

Poisoning with certain chemicals, a particular case of which are medications, requires etiotropic rather than symptomatic therapy. It involves the use of antidotes - substances that help eliminate specific toxic substances and dangerous medicines from the human body.

Antidote therapy for poisoning is used to change the kinetic characteristics of toxic substances, eliminate them, reduce the pathogenic effect, which improves life and functional prognosis.

Specific antidote therapy can only be used in cases where it is known which poison or drug provoked the damage to the body. Antidotes can bind a toxic substance, compete with it for binding to receptors, and act through a number of other mechanisms to speed up the patient's recovery.

Note! The use of antidotes is advisable for early stage acute intoxication in case of precise clarification of the nature of the toxic substance.

There are several mechanisms of action of antidotes, namely:

Inactivation of physical and chemical properties toxic substance in the digestive system. Contact chemical antidotes have this effect.
Specific reactions of an antidote and a toxic substance in the humoral environment. Chemical antidotes with a parenteral mechanism of action have this effect.
Modification of the biotransformation pathways of a toxic substance. These antidotes are called antimetabolites.
Modification of biochemical processes involving toxic substances. Such antidotes are biochemical antidotes.
Pharmacological antagonism, which manifests itself in the methods of influencing a particular biochemical system. In this case, we talk about pharmacological antidotes.
Reducing the severity of the toxic properties of animal toxins. Antidotes are immunological antidotes.

Important! There is an opinion that there must be an antidote for any toxic substance, however, this is not supported by either theoretical data or practical research.

The presented mechanisms explain the variety of ways to achieve the desired effect of antidote therapy. But for a complete understanding of antidotes, some of their existing classifications should be examined in detail.

Types of antidotes

The classification of antidotes, which was proposed in 1972 by S.N., is considered optimal. Golikov.

According to her, antidotes are:

local action (neutralization by resorption during physical or chemical interaction);
general resorptive action (antagonism of the action of the toxicant and the antidote, or the antidote and metabolites of the toxic substance that circulate in the lymph and blood);
competitive action (displacement of toxicants and binding them into safe substances, while the antidote has a similar structure and properties to enzyme systems, receptors and other elements with which the toxic substance interacts);
immunological (involvement of immunological mechanisms for neutralization - the use of serums and vaccines);
physiological (substances that normalize the state of organs and systems altered by the action of a toxicant).

For comparison, we should consider another classification, which was proposed by E.A. Luzhnikov.

She distinguishes the following groups of antidotes:

Chemical or toxicotropic.
Biochemical or toxic-kinetic.
Pharmacological or symptomatic.
Antitoxic immunodrugs.

Goals of antidote therapy

Detoxifiers are used to prevent the negative effects of poisons on the human body, as well as to inhibit adverse symptoms already provoked by toxic substances.

The main point when choosing an antidote is the correct scheme for prescribing the antidote. Different types of intoxication require the development of specific and effective strategies for specific antidote treatment in emergency and inpatient conditions.

The antidote can:

bind toxicant;
displace poison from the poison-substrate complex;
replace bioactive substances destroyed by the action of the toxicant;
counteract the poison.

Specific antidote therapy using specific examples

To clarify and formulate an idea of antidotes, below is a brief table of antidotes for poisoning:

Poisonous substances (toxicants)	Antidotes (antidotes, detoxifiers)
Ethylene glycol, methanol (see)	Ethanol (orally - 30% solution, parenterally - 5% solution)
Anticholinergics - atropine, cyanides	Aminostigmine
Cardiac glycosides, pilocarpine, clonidine, fly agaric poison (see)	Anthropine, and another antidote for poisoning with cardiac glycosides - potassium chloride
Toadstool poison, paracetamol	Acetylcysteine
Acids	Sodium bicarbonate
Iron	Desferal
Carbon disulfide, carbon monoxide	Oxygen in the form of hyperbaric oxygenation
Heavy metals - lead, copper, bismuth	Penicillamine
Metals - zinc, copper, lead	Edetic acid
Potassium permanganate, aniline	Ascorbic acid, intravenous administration
Anticoagulants with indirect action	Vikasol
Barium salts	Magnesium sulfate
Benzodiazepines	Flumazenil
Hydrocyanic acid, aniline	Methylene blue

Antidote therapy for metal poisoning

To choose an antidote for, you need to know that the most effective antidotes in such cases are complexones. They are also called chelate compounds.

The structure of complexones contains functional groups that can donate electrons to form bonds with cations. In this case, the formation of coordination-covalent bonds occurs. Heavy metals are excreted from the body in the form of complexones.

Note! Chelated compounds are characterized by low selectivity of action, so they can also bind ions needed by the body (zinc, calcium).

The group of complexones includes the following detoxicants:

Deferoxamine (or Desferal).

Binds iron ions. Also used to increase the rate of aluminum removal during renal failure. The products of biotransformation of this substance are excreted in the urine and color it dark red. Adverse reactions to the use of deferoxamine include allergic reactions, visual impairment, deafness, and collapse. Possible renal and liver failure, intestinal infarction and coagulopathy.
Thetacine calcium.

It is an effective complexon for lead, cobalt, cadmium, cesium, yttrium, uranium and some other heavy and rare earth metals. It is effective in binding extracellular ions because it does not pass through membranes well. The drug is used for intravenous and intramuscular administration. The antidote is ineffective against barium, strontium, and mercury ions. In case of overdose, thetacin calcium damages the kidney structure.
Administered intramuscularly in the form of a 10% oil solution. Accelerates the removal of mercury, lead, arsenic, and gold ions. Helps restore the structure and functionality of protein compounds damaged by interaction with a toxicant.
Penicillamine (cuprenil).

It is a water-soluble product of penicillin metabolism. Effective against poisoning with copper compounds. It is used in the course of therapy for Wilson-Konovalov disease. Used as an auxiliary antidote for poisoning with compounds of gold, lead, and arsenic. May cause allergic reactions, dyspepsia, anemia.

Antidote therapy for poisoning with certain drugs

- a common occurrence that requires immediate assistance to the victim.

The following examples of specific antidote treatment for such conditions should be given:

Intoxication with drugs that depress the central nervous system, requires the use of central nervous system stimulants and analeptics: ephedrine, caffeine, cordiamine, cititon, bemegride.
Intoxication with drugs that excite the central nervous system involves the appointment of such antagonists: ether for anesthesia, barbiturates, sibazon.
Intoxication with cholinomimetics and anticholinesterase drugs - administration of anticholinergics (atropine, scopolamine hydrobromide).
The antidote for atropine poisoning is prozerin and other anticholinesterase agents.
Morphine intoxication - administration of naloxone.
The antidote for clonidine poisoning is atropine.
The antidote for poisoning with antidepressants is sodium bicarbonate.

Antidote therapy for intoxication with organophosphorus compounds (OPCs)

Organophosphorus compounds are often used as pesticides; they are also used as medicines in neuropathology, ophthalmology, surgery, and the list of areas of use of OPCs is not limited to this. Intoxication with organophosphorus substances causes irritation of the skin and mucous membranes.

As part of first aid, gastric lavage is first performed. after which detoxifiers are introduced. A common antidote for organophosphate poisoning is calcium gluconate. Calcium lactate is also used as an antidote for FOS poisoning.

Photos and videos in this article are necessary to form a complete understanding of the need and possibilities of using antidotes. You need to understand that in case of any intoxication you should immediately call a doctor.

The speed of assistance is a determining factor in the effectiveness of antidote treatment, and the cost of delay can be human life. Only a specialist can determine which instructions for action are applicable in a particular clinical case.

Toxic substances that can poison you lie in wait at every step - they are found in plants, animals, medicines and various substances that surround people in everyday life. Most poisons are lethal. To neutralize their effects, antidotes for poisoning are used, a table with the classification of which is presented in this article.

General information about antidotes for poisoning

Like any strong medicine, antidotes given for poisoning have their own pharmacological properties, which evaluate the different specifics of the drugs. These include in particular:

time of receipt;
efficiency;
dose of application;
side effects.

Depending on the period and severity of the disease, the value of antidote therapy may vary. Thus, Treatment of poisoning with antidotes is effective only at an early stage, called toxicogenic.

The duration of the stage varies and depends on the substance that caused the poisoning. The longest duration of this phase is 8-12 days and refers to the effect of heavy metals on the body. The least common risk is poisoning from cyanide, chlorinated hydrocarbons, and other highly toxic and rapidly metabolized compounds.

Antidote therapy should not be used if there are doubts about the reliability of the diagnosis and the type of poisoning, since due to the certain specificity of this type of treatment, it is possible to cause double harm to the body, because often the antidote is no less toxic than the object of intoxication itself.

If the first stage of the disease is missed and severe disturbances in the circulatory system develop, then, in addition to antidote therapy, the effectiveness of which will now be reduced, urgent resuscitation measures are necessary.

Antidotes are indispensable in conditions of irreversibility of delayed or acute poisoning, but in the second phase of the disease, called somatogenic, they cease to have a therapeutic effect.

All antidotes can be divided into three groups according to their mechanism of action:

etiotropic – weaken or eliminate all manifestations of intoxication;
pathogenetic - weaken or eliminate those manifestations of poisoning that correspond to a specific pathogenetic phenomenon;
symptomatic - weaken or eliminate some manifestations of poisoning, such as pain, convulsions, psychomotor agitation.

Thus, effective antidotes, which are most helpful in case of poisoning, have a high level of toxicity. And vice versa - the safer the antidote, the less effective it is.

Classification of antidotes

Types of antidotes were developed by S. N. Golikov– it is his version of the classification that is often used by modern medicine:

local action of antidotes, in which the active substance is absorbed by the body tissue and the poison is neutralized;
the general resorptive effect is based on the effect of a chemical conflict between the antidote and the poison;
competitive action of antidotes, in which the poison is displaced and bound by harmless compounds based on the chemical identity between the antidote and enzymes, as well as other elements of the body;
the physiological effect is based on the opposition between the behavior of poison and antidote in the body, which makes it possible to remove disturbances and return to a normal state;
The immunological effect consists of vaccination and the use of specific serum that is effective for a specific poisoning.

Antidotes are also classified and divided according to their nature. Antidotes are distinguished separately:

from animal/bacterial poisoning;
from mushroom toxins;
from plant and alkaloid;
in case of drug poisoning.

Depending on the type of poison, poisoning can be food or non-food. Any poisoning that leads to a deterioration in the patient’s condition must be neutralized with antidotes. They prevent the spread and poisoning of poisons in organs, systems, biological processes, and also inhibit functional disorders caused by intoxication.

Food poisoning

A condition with acute digestive upset that occurs after eating poor-quality foods or drinking is called food poisoning. It occurs when eating spoiled food that is contaminated with harmful organisms or contains dangerous chemical compounds. The main symptoms are nausea, vomiting, diarrhea.

There are infectious and toxic poisonings: the sources of the former are all kinds of bacteria, microbes, viruses and protozoan single-celled organisms that enter the body with food. Toxic poisoning refers to the poisons of heavy metals, inedible plants and other products with a critical content of toxins that have entered the body.

Manifestations of the disease develop within 2-6 hours after infection and are characterized by a sharp development of symptoms. Among infectious poisonings, the greatest danger for infection is represented by meat and dairy products, which, if they are contaminated and have undergone insufficient heat treatment, can cause serious harm, since they represent an ideal environment for the proliferation of bacteria and other organisms.

Methods for identifying hazardous products

An externally fresh and tasty product can also be dangerous, since the microorganisms that initially entered it multiply gradually, but their very presence threatens to spoil the functionality of the gastrointestinal tract. That's why The first and most important rule of food consumption is safety control. Food products can only be purchased in specially designated places; they must be sold by people who have medical books. Food must be kept in premises that have passed a sanitary inspection, are registered in the system and have the right to operate accordingly. Of course, various eateries with shawarma, street pies and other dubious food outlets are not included in this list.

Infectious poisonings are extremely dangerous for others and can lead to infection.. Freshly prepared foods have minimal chance of being contaminated, but leftover food becomes potentially dangerous after just a few hours.

In addition to the expiration date, which should always be checked, even if the purchase is made in a large retail chain, signs that may indicate that the food has been stored for longer than expected include the following:

damaged packaging, traces of defects on the package that led to a violation of its integrity;
atypical, too Strong smell or, conversely, its absence;
stratification of consistency, its heterogeneity;
any bubbles when stirring, if it is not mineral water;
the color and smell are not what they should be - especially if it is meat, eggs, milk;
the presence of sediment, opacity, any suspicious changes in the usual appearance of the product.

The presence of these characteristics should stop you from purchasing a similar product and choose the one that does not raise doubts.

Symptoms

A toxin or microbe that enters the body can act in different ways, but there are characteristic general symptoms that occur most often. This temperature, general weakness, disruption of the gastrointestinal tract. Doctors also often note a patient’s loss of appetite, nausea, pain and bloating in the abdomen. The patient is weakened, looks pale, may break out in a cold sweat and have low blood pressure.

With toxic poisoning, the symptoms and disorders are more serious: the patient shows signs of dehydration, vision is impaired - he sees objects in two, and temporary blindness may occur. Possible salivation, hallucinations, paralysis, loss of consciousness, convulsions, coma.

Risk groups include young children, pregnant women and the elderly. For them, the symptoms may be more severe, and the disease has a poor prognosis.

Primary symptoms of poisoning with some toxins can appear within an hour and increase over several days. It is important to identify the disease as early as possible and begin treatment.

Treatment

It is necessary to immediately call an ambulance and begin providing first aid to the victim: gastric lavage with soda or potassium permanganate, use of enterosorbents, intake of large amounts of fluid. In this condition, you must wait for an ambulance and not undertake other treatment. Antibiotics, bifidobacteria, any antiemetic or alcohol-containing drugs, as well as any medications that are given without a confirmed diagnosis and if poisoning is suspected, can have a detrimental effect on a person and significantly complicate treatment.

All further measures should be carried out in a hospital under the supervision of specialists. With timely treatment, the prognosis is often favorable.

Antidotes used for acute poisoning

At the first signs of acute poisoning, it is first necessary to diagnose the nature of intoxication. To do this, you will need medical history data, various physical evidence - the remains of containers with traces of the use of a toxic liquid, etc. It is also worth paying attention to the presence of a specific odor, which can determine the nature of the substance that caused the poisoning. All data on clinical manifestation symptoms of a poisoned person.

The toxicogenic phase of poisoning is the very first stage of intoxication, in which the poison has not yet had time to affect the entire body, and its maximum concentration in the blood has not yet been reached. But already at this stage the body is damaged by toxins with characteristic manifestations of toxic shock.

It is important to start treatment as quickly as possible. As a rule, the doctor will apply assistance in the first toxicogenic phase on the spot, before the patient is hospitalized. Since it is at this stage of providing or not providing assistance that the entire further prognosis is decided.

First of all, gastric lavage is used, enterosorbents and laxatives are administered, then antidotes are administered.

For certain types of poisoning, the stomach should only be rinsed through a tube, so such questions should be discussed with your doctor.

Symptomatic treatment consists of maintaining and monitoring a person’s life support functions. If patency is impaired respiratory tract, it should be released in the necessary way. Analgesics are used for pain relief, but only before the gastric lavage process, glucose and ascorbic acid are administered.

Table of the most common poisonings with antidotes

In case of acute poisoning, urgent hospitalization is required to the intensive care and resuscitation department. The doctor continues rinsing gastrointestinal tract, artificial ventilation of the lungs, treatment with diuretics, antidotes and antagonists are carried out.

But the most effective results are achieved with the help of artificial detoxification, consisting of hemosorption, hemodialysis, plasmapheresis, and peritoneal dialysis. With these steps, poisons and toxins are eliminated more intensively.

General table of antidotes for poisoning by toxins and poisons

It is necessary to take antidotes, not only to prevent the body from being damaged by toxic substances, but also to stop certain symptoms that develop against the background of poisoning. It is necessary to develop and apply the correct scheme, which will be effective in each individual case, to prevent intoxication. Some types of poisoning have a delayed onset and their manifestations can be sudden and immediately develop into a clinical picture.

Group of toxins	Antidotes
Cyanides, hydrocyanic acid	Amyl nitrite, propyl nitrite, anthicyanin, dicobolt salt EDTA, methylene blue, sodium nitrite, sodium thiosulfate
Iron salts	Desferrioxamine (desferal)
Narcotic analgesics	Naloxone
Copper sulfate	Unithiol
Iodine	Sodium thiosulfate
Opiates, morphine, codeine, promedol	Nalmefene, naloxone, levarphanol, nalorphine
Arsenic	Unithiol, sodium thiosulfate, cuprenil, disodium salt
Silver nitrate	Sodium chloride
Mercury vapor	Unithiol, cuprenil, sodium thiosulfate, pentacin
Ethanol	Caffeine, atropine
Potassium cyanide	Amyl nitrite, chromospan, sodium thiosulfate, methylene blue
Hydrogen sulfide	Methylene blue, amyl nitrite

The method of administration, dosage forms and dosage of antidotes for poisoning should be agreed with the attending physician; it is also necessary to confirm the diagnosis using tests in order to properly conduct therapy.

Any antidote is the same chemical substance, careless handling of which can also harm the body. The effect of the antidote is achieved through a chemical reaction that occurs when it interacts with the source of poisoning.

Table of antidotes for poisoning with substances of different nature

From animal/bacterial intoxication

In case of drug poisoning

Plant and alkaloid antidotes

Antidotes for mushroom toxins

Details of therapy for some poisonings

Let us consider antidote therapy for the most common and dangerous poisonings in detail:

Chlorine. Its vapors can reflexively stop breathing, cause chemical burns and pulmonary edema. In severe poisoning, death occurs within a few minutes. If the toxin damage is of moderate or mild severity, effective therapy is prescribed. First of all, the victim is taken out into fresh air., in severe cases, they do bloodletting, wash the eyes with novocaine, give antibiotics of the penicillin group, and cardiovascular drugs. Treat with morphine, atropine, ephedrine, calcium chloride, diphenhydramine, hydrocortisone.
Salts of heavy metals. Plenty of fluids, diuretics, and enterosorbents are required. When washing the stomach, use a tube and introduce unithiol through it. Use a laxative.
Organophosphorus compounds. These are household and medical pesticides that are used everywhere as a class of OPs. When poisoned by these toxins, the skin and mucous membranes are primarily affected. Calcium gluconate and lactate serve as antidote. A mixture of egg white and milk is suitable. It is necessary to rinse the stomach with saline or soda solution.

Conclusion

To date, urgent measures have been developed for timely response in case of poisoning. varying degrees to effectively eliminate all consequences. In addition to the use of an antidote, measures aimed at preventing and treating intoxication are classified as follows:

Emergency measures, which include washing the gastrointestinal tract, mucous membranes, skin.
Accelerated measures that use various kinds of diuretics that absorb toxins, sorbents and other processes aimed at removing toxins from the body.
Restorative measures aimed at treating the vital functions of body systems and individual organs.
The process of oxygenation necessary for a poisoned organism.

If you follow the rules of hygiene, pay attention to the food and water you consume, and be vigilant about chemicals and household utensils, poisoning prevention is most effective. But if poisoning does occur, it is necessary to take immediate action, the first of which is calling an ambulance. It should be remembered that the effectiveness of treatment increases significantly with a timely and competent approach.

Vladyka A.S., Vegerzhinsky A.G., Sitnik A.G., Rodoslav L.S., Feldman A.V.
Odessa

“Everyone who drinks this remedy gets well... except those for whom it does not help, and they die. Therefore it is clear that it is ineffective only in incurable cases.”

Modern pharmacology is dynamic and reflects the progress of biomedical and pharmaceutical sciences. Every year, dozens of new original medicines and hundreds of drugs with new trade names in a variety of dosage forms enter the pharmaceutical market. As the number of drugs increases, patient care becomes more complex. It must be remembered that drugs, along with their therapeutic effect, can cause a number of side effects, ranging from trivial (mild nausea and vomiting) to fatal (aplastic anemia, anaphylactic shock and others that can lead to the death of the patient). Mortality of patients undergoing hospital treatment as a result of side effect or drug overdose less than 1% (WHO chronicle). However, medications are becoming easily accessible to the average consumer who does not have a medical education, as a result of which about 5% of cases of emergency hospitalization for poisoning are associated with the development of side effects of drugs.

In case of poisoning with certain drugs and various chemicals, symptomatic therapy is carried out, while it is most advisable to use antidotes for adequate elimination of poison from the body. Antidotes are designed to change the kinetic properties of toxic substances, their absorption or removal from the body, reducing the toxic effect on receptors and, as a result, improving the functional and life prognosis of poisoning. Specific antidotes exist for only a few groups of medicinal substances; there are also two more groups of antidotes: antidotes that are pharmacological antagonists and antidotes that accelerate the biotransformation of poison into non-toxic metabolites. According to the classification proposed by E.A. Luzhnikov. There are 4 main groups of antidotes:

The development of methods of resuscitation and symptomatic therapy has made significant changes in the treatment of acute poisoning and increased the role of antidotes in clinical toxicology.

The table below contains a list of antidotes and their synonyms necessary for the most common poisonings. We hope that it will become a convenient reference tool for practicing doctors and medical students.

The drug that caused

poisoning (synonym)

(synonym)

Notes

Barbiturates:

Hexenal

Thiopental-

sodium

Phenobarbital

(Luminal)

Cyclobarbital

(Fanodorm)

Cyclobarbitan+

Diazepam

(Reladorm)

Bemegrid

(Ahypnon, Etimid, Eukraton, Glutamisol,

Malysol, Megimide,

Mikedimide, Megibal, Zentraleptin)

Naloxone

Flumazenil

10 ml 0.5% solution intravenously slowly, 3-4 injections until reflexes are restored.

Has a stimulating effect on the central nervous system,

effective against respiratory and circulatory depression of various origins.

Effective only in cases of poisoning in the lungs

degrees. In case of severe poisoning, it does not exclude the need for cardiopulmonary resuscitation, against which it is contraindicated,

as well as other central nervous system stimulants (caffeine, corazol, cordiamine, etc.).

Benzodiazepines

Alprazolam

(Alzolam,

Kassadan)

Diazepam

(Seduxen,

Sibazon,

Relanium)

Mezapam

Rudotel)

Phenazepam

Nitrazepam

(Eunoctinus,

Radedorm)

Oxazepam

(Nozepam,

Tazepam)

-Chlordiazepoxide

(Chlozepid,

Elenium) and others.

Flumazenil

(Anexat)

It is a competitive antagonist of benzodiazepines and has a short duration of action. The drug is administered intravenously 0,2 mg over 30 s to a total dose of 3-5 mg.

Contraindicated in patients with epilepsy, in severe mixed poisoning with benzodiazepines and proconvulsants (aminophylline, amitriptyline).

Narcotic

analgesics:

Buprenorphine

(Norfin)

Butorphanol

(Moradol)

Hydrocodone

Diamorphine

(Heroin)

Codeine

Methadone

Morphine

Nalbuphine

Omnopon

Pentazocine

Piritramide

Tramadol

(Tramal)

Trimeperidine

(Promedol)

Fentanyl

Estocin

Ethylmorphine

(Dionin), etc.

Naloxone

Nalmefene

Naltrexone

Naltrexone, hydrochloride, Trexan)

Levorphanol

Nalorphine

(Antorphine,

Anarcon, Lethidron, Nalorphine hydrochloride,

Administered intravenously 0,4-2 mg (can be intramuscularly, endotracheally), if necessary, this dose is re-administered every 2-3 minutes until a clinical effect is achieved.

It is also effective in alcoholic coma and various types of shock, which is associated with

I think, with activation during shock and some

forms of endogenous opioid system stress,

as well as the ability of naloxone to reduce hypotension.

Prescribe 0.25 mcg/kg intravenously every 2-5 minutes (not exceeding 1 mcg/kg). Also used for postoperative respiratory depression.

Compared to naloxone, it is more active; effective when taken orally

the effect when taken orally occurs through

1-2 hours and lasts 24-48 hours.

They are weak agonist-antagonists,

they themselves can activate opiate

receptors (e.g. sigma receptors, with

the excitement of which causes hallucinations),

that's why they are used rarely.

Inject 1-2 ml of 0.5% solution, if there is no

effect of the injection is repeated at intervals of 10-

15 minutes, maximum dose - 0.04 mg (8 ml 0.5%

r-ra.

Ethylene glycol

30% solution 50-100 ml orally, 5% solution 100-400 ml intravenously

M-anticholinergics

Atropine

Besalol

Metacin iodide

Platifillina

hydrotartrate

-Scopalomine hydrocarbons, etc.

Physostigmine salicylate

Galantamine

(Nivalin

Aminostigmine

0.5-2 mg intravenously within 5 minutes under ECG control.

Facilitates stimulation in

Neuromuscular synapses and restores

neuromuscular conduction blocked

curare-like drugs

anti-depolarizing action (tubocurarine,

diplacin, etc.), the effect of depolarizing

substances (ditilina) enhances.

Administer 2 mg intravenously.

Warfarin

Protamine sulfate

Vitamin K 1

1 mg protamine sulfate neutralizes 1 mg

heparin. Administered intravenously drip or

injected (slowly) at a dose of 50 mg, if necessary, after 15 minutes the administration can be repeated, maximum dose is 150 mg.

Effective for some types of hemorrhages,

associated with heparin-like blood clotting disorders. In rare cases

idiopathic and congenital hyperheparinemia,

when administering protamine sulfate, it may

a “paradoxical” effect is observed - enhancement

bleeding. 10 mg intravenously(i.m., s.c.),

within 20 minutes.

5-10 mg intravenously

Paracetamol

Acetylcysteine

(Fluimucil)

Methionine

(Acimetion, Athinon,

Banthionine, Meonine, Metione, Thiomedon)

Prevents the transformation of the hepatotoxic metabolite - benzoquinoneimine, 140 mg/kg orally.

Orally.

It is one of the essential amino acids

necessary to maintain growth and nitrogen

balance in the body. Has lipotropic

effect (removal of excess fat from the liver),

participates in the synthesis of adrenaline, creatine, etc.

biologically important compounds.

Through methylation and transsulfuration,

methionine neutralizes toxic products.

Cardiac glycosides

Digitalis

Digibind

A vial of Digibind contains 38 mg of purified digoxin-specific Fab- fragments that bind approximately 0.5 mg of digoxin.

The required amount of the drug is calculated using the formula: digitoxin concentration in serum (ng/ml) X body weight (kg): 1000

The drug is administered intravenously drip.

Anti-tuberculosis drugs:

Hydrazine

Isoniazid

Ftivazid

Vitamin B 6

Intravenously drip, no more than 5 g in 30-60 minutes.

Iron supplements

-Iron fumarate (Heferol, Ferronate)

-Zhektofer (Ektofer)

Ferrous sulfate

(Ferro-gradumet, Tardiferon)

Iron dextran

(Ferrolek-plus)

Iron saccharate

(Ferrum Lek)

Deferoxamine (Desferal, Deferoxamine methansulfonate, Desferan, Desferex, Desferin, Desferrioxamin, DFOM)

10-15 mg/kg/h. Do not administer more than 6 g per day!

When introduced into the body, it promotes the removal of iron from iron-containing proteins (ferritin and hemosiderin), but not from hemoglobin and iron.

Heavy metal salts

Bismuth

Arsenic

Mercury

Lead

Chromium

-copper and its compounds

-Mixture of uranium fission products

Plutonium

(Dimaval, Unitiol)

Complexing agents

connections

(desferal, artamine, bianodine, etc.)

Sodium thiosulfate

Sodium-calcium edetate

(Chelaton, EDTA, Mosatil, Tetracemin,

Thetacine-calcium)

Cuprenil

(penicillamine)

Disodium salt of ethylenediaminetetraacetic acid

(Trilon B, EDTU, Calsol, Dinatriumedetal,

Endrate, Irgalon, Kalex, Prochelate, Questrex,

Tetracemindinatriumi,

Titriplex, Trilon B,

Tyclarosol, Versene)

Pentacine

(Calcii trinatrii pentetas, Calcium trisodium pentetate, Penthamil, calcium trisodium pentetate, pentamil)

Less active in case of lead poisoning.

5% - 10 ml, then 5 ml is administered every 3 hours

within 2-3 days.

10% solution 10-20 ml intravenously

30%-100.0 intravenously

It is administered intravenously by drop method in an isotonic sodium chloride solution or in a 5% glucose solution. The single dose is 2.0, the daily dose is 4.0. When administered 2 times a day, the interval between infusions should be at least three hours.

Can be administered in parallel with unithiol.

Sometimes used to treat some forms of ectopic arrhythmias, especially those occurring in

connection with an overdose of cardiac glycosides. With rapid administration of the drug

physiological mechanisms cannot keep up

eliminate low serum calcium levels

and acute tetany may develop.

Does not have a noticeable effect on the removal of uranium, polonium, radium and radioactive strontium and lead. The drug does not affect potassium levels in the blood.

A single dose is 0.25 g of the drug (5 ml of 5% solution). In acute cases, the single dose can be increased to 1.5 g. Administer intravenously, slowly, monitoring the state of the cardiovascular system..

Potassium permanganate

Vitamin C

Methylene blue

5%-10.0 intravenously

1%-100.0 intravenously

Dichloroethane

N-acetylcysteine

Accelerates the dechlorination of dichloroethane, neutralizes its toxic metabolites. Inside

140 mg/kg.

Organic acids

Magnesium sulfate

Hydroxide

aluminum

Almagel

Almagel-A

20-25 g per 200 ml of water inside.

4% 20-25 ml, 4-6 times a day

2-4 teaspoons 4-6 times a day.

250 ml

Do not give bicarbonate, it is dangerous due to

with the formation of CO 2 !

Thetacine-calcium

Sodium thiosulfate

10%-10,0 in 300 ml of 5% glucose solution, intravenously

30%-100.0 intravenously

Carbon monoxide

(carbon monoxide)

Hyperbaric oxygenation

Ascorbic acid

Eufillin

1-1.5 atm, 40 min.

5% solution, 20-30 ml intravenously

5%-500.0 intravenously

2.4%-10.0, intravenously

Akrikhinin

Tetraethylammonium

(Wotropin)

Administered intravenously 40% glucose 10 ml

Organophosphorus compounds

Dipiroxime

(Trimedoxini bromide, Trimedoxini bromide,

Pralidoxime

Isonitrazine

Cholinesterase reactivator. Apply

in combination with anticholinergic drugs (atropine, aprofen, etc.) for FOS poisoning.

1 ml of 15% solution is administered subcutaneously or intravenously. If necessary, re-introduce with an interval between administrations of 1-2 hours for a total of 6-8 ml.

It should not be used until primary resuscitation measures have been completed and atropine has been administered to suppress excess bronchial secretion. Administer a solution diluted to 5% intravenously over 5 minutes. If muscle weakness persists, a repeat dose can be administered after 60 minutes.

Intramuscularly, 3 ml of a 40% solution must be combined with atropine. In case of severe poisoning, re-introduce every 30-40 minutes for a total of up to 10 ml.

Sodium nitrite

Amyl nitrite

Sodium thiosulfate

(Sodium hyposulfite, Natrium hyposulfurosum,

Natrium thiosulfuricum)

Chromospan

Hydroxycobalamin

Ethylenediamine-

tetraacetate

6 mg/kg for 3-5 minutes. intravenously

0.3 ml inhalation twice with an interval of 3 minutes

Causes the formation of methemoglobin.

250 mg/kg intravenously.

Activates the conversion of cyanides to thiocyanates.

They have antitoxic, anti-inflammatory and desensitizing effects.

They form non-toxic cyanohydrins with cyanides.

40% solution intravenously

Causes immediate cyanide detoxification.

Forms direct chelates with cyanide

(directly chelates cyanide).

Hydrocyanic acid

Amyl nitrite

Propylnitrite

Forms methemoglobin in the blood, which binds

CN ion and thus prevents defeat

tissue respiratory enzymes.

Used by inhalation.

Poisonous mushrooms

type of poisoning:

Gyromitrine

Muscarinic

- anticholinergic

- hallucinogenic

Pyridoxine

Physostigmine

Diazepam

25 mg/kg i.v. Therapy aimed at overcoming liver failure

0,01 mg/kg i.v. If necessary, re-administration.

0.5-1 mg IV

5-10 mg IV

Snake bites

Karakurt spider

"black Widow"

Antivenin

(Latrodectus mactans)

10 thousand units i.v.

20-40 ml IV minimal degree of poisoning

50-90 ml IV moderate degree of poisoning

100-150 ml IV severe poisoning

2,5 ml i.v. (i.m.), after testing for hypersensitivity

Considering that antidotes of different groups used to treat the same poisoning have different mechanisms of action and the majority of antidotes, with the exception of toxicotropic and antitoxic immunodrugs, do not have a direct effect on the poison, complex antidote therapy in the form of sequential use of drugs is recommended. The use of antidotes does not exclude the need for therapy aimed at accelerating the removal of poison from the body.

To carry out effective detoxification of the body, it is necessary to carry out timely syndromic resuscitation correction of violations of the vital functions of the body (toxic shock, acute respiratory failure, etc.).

It is necessary to remember about possible adverse reactions and complications from the antidote itself, the likelihood of which increases with the thoughtless use of these medications. If an antidote is incorrectly administered in a large dose, its toxic effect on the body may occur.

Antidote therapy remains effective only in the toxigenic (early) phase of acute poisoning, the duration of which depends on the toxic-kinetic characteristics of a given toxic substance; the quality of treatment carried out at this stage has a decisive influence on the prognosis and outcome of the disease.

The effectiveness of antidote therapy is significantly reduced in the terminal stage of acute poisoning with the development of severe disorders of the circulatory system and gas exchange, which requires simultaneous resuscitation measures aimed at detoxifying the body and restoring homeostasis of the body as a whole.

Bibliography

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Don H. Decision making in intensive care. - M.: Medicine, 1995. - pp. 24-25

Ershov A. F. Clinic, diagnosis, pathogenesis and issues of treatment of acute poisoning with barbituric acid derivatives. (Clinical experimental study). Author's abstract. dis. ... dr. med. Sciences - M., 1984.

Zaichik A.Sh., Churilov A.P. Fundamentals of pathochemistry. - St. Petersburg, 2000. - 687 p.

Komarov B.D., Luzhnikov E.A., Shimashko I.I. Surgical methods for the treatment of acute poisoning, M.: Medicine, 1981. - pp. 21-24

Compendium. Medicines 1999/2000 - Kyiv, 1999. - 1200 p.

Koposov E.S. // in the book. Tsybulyaka G.N. (ed.): Reanimatology - M. Medicine. 1976. - ss. 217 - 242.

Ludevich R., Klos K. Acute poisoning. - M.: Medicine, 1983. - 560 p.

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Luzhnikov E. A. Modern principles of detoxification therapy for acute poisoning. // Anest. and resuscitation. - 1988. - No. 6. - ss. 4-6.

Luzhnikov E.A. Clinical toxicology. - M., 1994. - pp. 113-118

Luzhnikov E.A., Goldfarb Yu.S., Musselius S.G. Detoxification therapy. - St. Petersburg, 2000.-192 p.

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Resuscitation // Tsibulnyak G.N., M.: Medicine, 1976., - pp. 217-242

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Accent placement: ANTIDO`TY OV

ANTIDOTS (Greek: antidoton given against, antidote) - medicines that prevent or eliminate the toxic effects of agents. Modern agents can cause mass lesions with rapid intoxication, so the use of antidotes is crucial in the system of care for the affected. Depending on the conditions, they can be used with prophylactic or curative measures. goals.

According to the mode of action, antidotes of OM can be divided into two groups: local antidotes, which neutralize OM by absorption into the blood and entry into organs and tissues, and resorptive antidotes, which neutralize OM in the blood and organs or act on the functions of organs in the opposite way to the corresponding OM.

The effectiveness of local antidotes is determined by physical-chemical. (adsorption) or chemical (neutralization, oxidation, etc.) processes. Local antidotes for chemical agents include solutions of alkalis, chlorine-containing compounds (chloramine, hexachlormelamine), special degassing solutions used to treat open areas of the body, and activated carbon used to bind chemical agents that have entered the stomach.

The effectiveness of resorptive antidotes is determined by various processes.

1. Chem. interaction of antidotes and agents. This is the basis for the use of sodium thiosulfate in case of hydrocyanic poisoning.

2. Competitive relationships between antidotes and active groups of proteins with agents, as a result of which the active groups of proteins are released from agents. This principle is the basis for the use of unithiol in case of poisoning with arsenic-containing agents and cholinesterase reactivators in case of poisoning with organophosphate agents (OP).

3. The ability of antidotes to exhibit physiologically an effect opposite to the action of agents.

The use of atropine and other anticholinergic drugs for poisoning with anticholinesterase and organophosphorus agents is based on this property.

In accordance with the specificity of action, antidotes are classified into groups or in relation to certain types of agents: antidotes of organophosphorus agents, hydrocyanic agents, arsenic-containing agents, carbon monoxide, etc.

Antidotes for FOV include anticholinergic drugs and cholinesterase reactivators. Once in the body, OPAs block cholinesterase and disrupt the mediator function of acetylcholine, which leads to excitation and overexcitation of cholinergic systems and the emergence of a typical picture of poisoning. In these cases, the use of substances that block muscarinic and nicotine-sensitive cholinergic receptors is justified. Atropine is of great practical importance as an antidote to FOV. In addition to it, it is recommended to use other anticholinergics as antidotes for FOV: taren, cyclosil, amizil, amednn, aprofen. Cholinesterase reactors are drugs from the oxime group. It has been established that under the influence of oximes, cholinesterase activity is restored and acetylcholine metabolism is normalized. In this case, their ability to eliminate the neuromuscular block of the respiratory muscles becomes of great importance. Other properties of oximes (neutralization of OPA, anticholinergic effect, dephosphorylation of cholinergic receptors) are also important in the antidote effect of drugs. Cholinesterase reactivators include 2-PAM chloride, dipyroxime (TMB-4), toxagonin (lüH-6), isonntrosine. The most complete antidote effect is achieved when using anticholinergics in combination with cholinesterase reactivators.

FOV antidotes are the main means of first aid for those affected, especially effective in the initial period of intoxication. In further treatment, along with antidotes, symptomatic therapy is used.

Antidotes for hydrocyanic acid include methemoglobin formers, sulfur-containing compounds and substances, which include carbohydrates.

The toxic effect of hydrocyanic acid is based on its ability to easily interact with the oxide form of iron of cytochrome a3 (cytochrome oxidase), which leads to blockage of tissue respiration and the development of hypoxia. The antidote effect of methemoglobin formers is based on the affinity of hydrocyanic acid for hemin pigments containing ferric iron, including methemoglobin. Hydrocyanic acid binds to methemoglobin, forming cyanomethemoglobin, which in turn leads to a retention of hydrocyanic acid in the blood and prevents blockade of cytochrome oxidase. When administering antidotes by inhalation, amyl nitrite is recommended as a methemoglobin former; for intravenous administration, a solution of sodium nitrite is recommended. Under the influence of nitrites, the rapid formation of cyanmethemoglobin occurs, but later, as cyanmethemoglobin dissociates, prussic acid is released again. In this case, it is necessary to use antidotes with a different mechanism of action. The most effective in this regard are sulfur-containing antidotes, for example. sodium thiosulfate.

The antidote effect of sulfur-containing compounds is based on their ability to neutralize hydrocyanic acid by converting it into rhodanium compounds. Neutralization occurs with the participation of the rhodanese enzyme within several hours.

Since sulfur-containing drugs are slow-acting antidotes, they are used in combination with other antidotes.

Methylene blue is also used as an antidote. Being a hydrogen acceptor, methylene blue partially restores the function of dehydrases, i.e., it activates the oxidation process. It is assumed that the antidote effect is due to Ch. arr. with this property of the drug.

The antidote effect of carbohydrates (aldehydes and ketones) is based on the formation of non-toxic chemicals. compounds - cyanohydrins. The most widely used antidote of this type is a 25% glucose solution. The neutralizing effect of glucose occurs relatively slowly, so for treatment it should be used in combination with other antidotes. Glucose is also included in the antidote chromosmon (1% solution of methylene blue and 25% glucose solution).

Antidotes for arsenic-containing agents (lewisite) include dithiol compounds - unithiol, BAL, dicaptol, dimecaptol, dithioglycerol. These antidotes, in addition to chemical agents, neutralize compounds of mercury, chromium and other heavy metals (except lead) in the body. The toxic effect of arsenic-containing compounds is due to the blockade of thiol groups of protein components of certain enzyme systems. The mechanism of action of antidotes is explained by their ability to compete with protein molecules for the connection with arsenic-containing agents and heavy metals due to structural proximity to the SH groups of certain enzymes. Chemical occurs. the reaction of neutralizing agents and the formation of soluble compounds that are quickly removed from the body. The most effective use of unithiol is in the initial period of intoxication, but also after 4-5 hours. after poisoning, a positive result is achieved.

The specific antidote to carbon monoxide is oxygen. Under the influence of oxygen, the dissociation of carboxyhemoglobin, formed as a result of the combination of carbon monoxide with divalent iron of hemoglobin, is accelerated, and the removal of carbon monoxide from the body is accelerated. As the partial pressure of oxygen increases, its effectiveness increases.

Characteristics of the main antidotes and medicines used for the prevention and treatment of poisoning with organophosphorus compounds, cyanides, carbon monoxide and other poisons - see the table (Articles 27-29).

Group, name and release forms of the drug	pharmachologic effect	Doses and methods of administration depending on the degree of poisoning
In case of poisoning with organophosphorus compounds
A. Antidotes with anticholinergic action
Atropine sulfate 0.1% solution in ampoules of 1 ml and in syringe tubes	Blocks m-cholinoreactive systems of the body, reducing their sensitivity to acetylcholine; has little effect on n-cholinoreactive systems	For mild poisoning, administer intramuscularly 2 ml. Atropinization is carried out repeatedly in 1-2 ml at intervals of 30 minutes. In case of moderate poisoning, first administer 2-4 ml, then 2 ml every 10 minutes before symptoms of transatropinization appear. The state of atrophy is maintained for several days by administering 1-2 ml drug. In case of severe poisoning, the drug is first administered intravenously (4-6 ml), then intramuscularly 2 ml every 3-8 minutes until muscarinic-like symptoms are completely eliminated. The state of atropinnation is maintained with repeated injections every 30-60 minutes. Total daily dose 25-50 ml. Over the next 2-3 days, administer 1-2 ml in 3-6 hours. Atropine can also be used in combination with cholinesterase reactivators (dipiroxime, toxagonin, 2-PAM chloride, etc.)
Taren tablets 0.2 G, solution in ampoules of 1 ml	Has peripheral and central m- and n-cholinolytic effects	To prevent poisoning, prescribe 1 tablet per dose; can be reapplied after 15-30 minutes. For mild poisoning, prescribe 1-2 tablets per dose or administer intramuscularly 0.5-1 ml
Cyclosil 0.2% solution in ampoules of 1 ml	The mechanism of action is similar to atropine; has more pronounced anticholinergic activity	For mild poisoning, administer 1 ml 0.2% solution, for severe poisoning - 4-5 ml 0.2% solution intramuscularly. If the cramps do not stop, after 15-30 minutes. the drug is administered repeatedly (3 ml). The total dose is no more than 15 ml(5-6 injections or drips)
B. Cholinesterase reagents
2-PAM chloride (2-pyridinaldoxime-methyl-chloride) powder, 30% solution in ampoules of 1 ml	Dephosphorylates and reactivates inhibited FOS cholinesterase. Restores neuromuscular transmission, especially in the muscles of the respiratory organs. Helps reduce the release of acetylcholine. Neutralizes poison through direct interaction. Poorly penetrates the blood-brain barrier	Used in combination with anticholinergics, administered intravenously (in a 40% glucose solution or 20-30 ml physiological solution) at a rate of no more than 0.5 G per minute or drip. intramuscularly, intralingually. subcutaneously and internally. Single dose 1 G, daily allowance - 3 G
2-PAM-iodide powder, 1% and 2% solution (prepare before use)	See 2-PAM chloride	Used in combination with anticholinergics. Administered only intravenously (slowly or drip), once 50 times ml 2% solution or 100 ml 1% solution
2-PAS (pyridine-2-aldoxime-methanesulfonate; P2S) powder in ampoules (aqueous solutions are prepared immediately before use), gelatin capsules containing 1 G drug	See 2-PAM chloride. The drug is the least stable of all oximes of the pyridine series. IN aqueous solutions cyanides are formed during storage and heating	In case of poisoning varying degrees used in combination with anticholinergic drugs. Isotonic sodium chloride solution is administered intravenously (0.2 G drug for 5 ml solution) at speed 1 ml in a minute. In case of severe poisoning, the indicated dose is re-administered after 15-20 minutes. (up to 3-4 injections in 1 hour). After the first injection, they usually switch to drip infusions (daily dose 2-3 G). In case of mild poisoning, the drug can be administered orally, 3 capsules per dose.
Dipiroxime 1-1′-trimethylene-bis-(4-pyridinal-doxime)-dibromide; TMB-4, 15% solution in ampoules of 1 ml	See 2-PAM chloride. It has pronounced reactivating activity compared to 2-PAM chloride, but is somewhat more toxic. Has a moderate anticholinergic effect. more pronounced compared to other oximes	Used in combination with anticholinergic drugs. If signs of poisoning appear (excitement, miosis, sweating, salivation, bronchorrhea), inject subcutaneously 1 ml 15% dipyroxime solution and 2-3 ml 0.1% atropine sulfate solution. If the symptoms of poisoning do not disappear, the drugs are re-administered in the same dose. In case of severe poisoning, administer intravenously 3 ml 0.1% atropine sulfate solution and intramuscular (or intravenous) 1 ml dipyroxime. The administration of atropine is repeated every 5-6 minutes. until bronchorrhea resolves and signs of atropinization appear. If necessary, dipyroxime is re-administered after 1-2 hours; average dose 3-4 ml 15% solution (0.45-0.6 G). In especially severe cases, accompanied by respiratory arrest, administer up to 7-10 ml dipyroxime
Toxogonin Bis-4-oxymnopyridinium (1)-methyl ether dichloride powder in ampoules G(dissolve before use in 1 ml water for injection)	See 2-PAM chloride	Used independently and in combination with anticholinergics. Injected intravenously 0.25 G; in severe cases, the administration is repeated after 1-2 hours. Daily dose up to 1 G
Isonitrosine (1-dimethyllamino-2-isonitrosobutanone-3-hydrochloride) powder, 40% solution in ampoules of 3 ml	Penetrates well through the blood-brain barrier	Used in combination with other reactivators and anticholinergics. Administered intramuscularly in 3 doses ml 40% solution every 30-40 minutes. until muscle fibrillation stops and consciousness clears. Total dose 3-4 G (8-10 ml 40% solution)
For cyanide poisoning(hydrocyanic acid and its compounds)
Amyl nitrite ampoules containing 0.5 ml drug	Interacting with oxyhemoglobin, it forms methemoglobin, which easily combines with hydrocyanic acid, resulting in a slowly dissociating complex - cyanmethemoglobin. This prevents inactivation of cytochrome oxidase by cyanide. The drug causes a rapid but short-term dilation of blood vessels, especially coronary and cerebral vessels	Used when providing first aid. The contents of the ampoule are given to poisoned people to inhale. In case of severe poisoning, the drug can be reused
Sodium nitrite powder for preparing solutions	See amyl nitrite. Acts more reliably and longer than amyl nitrite	In case of hydrocyanic acid poisoning, 10-20 ml 1-2% solution. Highest single dose 0.3 G, daily allowance 1 G
Methylene blue powder and 1% solution in 25% glucose solution and ampoules of 20 and 50 ml(chromosmon)	It has redox properties and can play the role of a hydrogen acceptor formed during the oxidation of the tissue substrate. In this case, the blockade of tissue respiration is partially eliminated, the function of dehydrases is restored, after which further elimination of hydrogen from the substrate (oxidation) is possible. In large doses, the drug is a methemoglobin former (see. Amyl nitrite) - prevents disruption of the function of tissue respiration, preventing the inactivation of cytochrome oxidase in tissues by cyanide	In case of poisoning with cyanide, carbon monoxide, hydrogen sulfide, it is administered intravenously. Therapeutic dose 50-100 ml
Glucose powder, tablets 0.5 and 1 G, 5%, 10%, 25% and 40% solutions in ampoules of 10, 20, 25 and 50 ml; 25% glucose solution with 1% methylene blue solution in ampoules of 20 and 50 ml(chromosmon)	Reacts with cyanides to form non-toxic cyanohydrin; converts methemoglobin to hemoglobin	In case of poisoning with hydrocyanic acid and its salts, carbon monoxide, aniline, arsenic hydrogen, phosgene, drugs and other substances, 25-50 are administered intravenously ml 25% glucose or chromosmon solution. If necessary, hypertonic glucose solutions are administered dropwise up to 300 ml per day
Sodium thiosulfate powder, 30% solution in ampoules no. 5, 10 and 50 ml	Reacts with cyanides in the presence of the rhodanose enzyme, forming non-toxic rhodanate compounds. When interacting with compounds of arsenic, mercury, and lead, non-toxic sulfites are formed	In case of cyanide poisoning, 50 doses are administered intravenously. ml 30% solution. The drug is most effective against the background of methemoglobin-forming agents. In case of poisoning with compounds of arsenic, mercury, lead, 5-10 doses are prescribed intravenously ml 30% solution or 2-3 orally G, dissolved in water or isotonic sodium chloride solution
For carbon monoxide poisoning
Oxygen is pure, a mixture of 40-60% with air, a mixture of 95% oxygen with 5% carbon dioxide (carbogen)	Accelerates the process of carboxyhemoglobin dissociation	Specific remedy against carbon monoxide intoxication. Prescribe continuous inhalations of 40-60% oxygen for 30 minutes. - 2 hours. The combination of oxygen with carbogen is most effective: first inhale carbogen (10-20 minutes), then pure oxygen (30-40 minutes) and again carbogen. For mild poisoning, the duration of carbogen-oxygen therapy is 2 hours, for severe and moderate poisoning - at least 4 hours. An effective method of oxybarotherapy is inhalation of oxygen under pressure up to 2-3 atm for 15-45 minutes, then gradually reducing the pressure to atmospheric pressure (within 45 minutes - 3 hours)
Antidotes used for poisoning of various etiologies
Unithiol tablets of 0.25 and 0.5 G, 5% solution in ampoules of 5 ml, powder in bottles of 0.5 G	Complexing compound. The mechanism of antidote action is based on the ability of its active sulfhydryl groups to react with thiol poisons found in the blood and tissues, forming non-toxic complexes	Used for the treatment of acute and chronic poisoning with thiol poisons - compounds of arsenic, mercury, chromium, bismuth, etc. For acute and chronic poisoning, administer intramuscularly or subcutaneously 5-10 ml 5% solution. In case of poisoning with arsenic compounds, injections are given initially every 6-8 hours, on the second day - 2-3 injections, then 1-2 injections per day. In case of poisoning with mercury compounds - according to the same scheme for 6-7 days. Sometimes prescribed orally (in tablets) at 0.5 G 2 times a day for 3-4 days (2-3 courses)
Thetacine-calcium 10% solution in ampoules of 20 ml, tablets 0.5 G	Forms stable, low-dissociation complexes with many di- and trivalent metals	Used for poisoning with salts of heavy metals and rare earth elements. For chronic intoxication - 0.5 orally G 4 times or 0.25 G 8 times a day, 3-4 times a week; course of treatment is 20-30 days (no more than 20-30 G drug) repetition of the course - no earlier than a year later. In case of acute poisoning, it is administered intravenously in an isotonic solution of sodium chloride or in a 5% glucose solution. Single dose 2 G (20 ml 10% solution), daily - 4 G. The interval between administrations is at least 3 hours. Administer daily for 3-4 days, followed by a break of 3-4 days. Course of treatment - 1 month
Pentacine tablets 0.5 G, 5% solution in ampoules of 5 ml	Complexing compound. Does not change blood concentrations of potassium and calcium	For acute and chronic poisoning with plutonium, radioactive yttrium, cerium, zinc, lead, etc. Administer intravenously at 5 doses ml 5% solution. If necessary, the dose can be increased to 30 ml 5% solution (1.5 g). Enter slowly. Repeated injections - after 1-2 days. The course of treatment is 10-20 injections. Orally prescribed 4 tablets per dose 2 times a day or once 3-4 times G