Table 4. Commonly Used Doses of Antidotes for Resuscitation in Critical Poisoning

Atropine

Organophosphates Carbamates

1–2 mg, doubled every 5 min

0.02 mg/kg, doubled every 5 min

10%–20% of the total loading dose per hour up to 2 mg∙h⁻¹ (adults)

Titrate to reversal of bronchorrhea, bronchospasm, and bradycardia.

Calcium chloride

β-blockers

CCBs

2000 mg

28 mEq Ca²⁺

20 mL 100 mg/mL solution

20 mg/kg

0.28 mEq Ca²⁺/kg

0.2 mL/kg 100 mg/mL solution

20–40 mg∙kg⁻¹∙h⁻¹

0.28–0.56 mEq Ca²⁺∙kg⁻¹∙h⁻¹

0.2–0.4 mL∙kg⁻¹∙h⁻¹ 100 mg/mL solution

Titrate to blood pressure.

Do not exceed serum ionized calcium concentration 1.5–2 times the upper limits of normal.

Administer through central line,

especially in children.

Calcium gluconate

β-blockers

CCBs

6000 mg

28 mEq Ca²⁺

60 mL 100 mg/mL solution

60 mg/kg

0.28 mEq/kg Ca²⁺

0.6 mL/kg 100 mg/mL solution

60–120 mg∙kg⁻¹∙h⁻¹

0.28–0.56 mEq

Ca²⁺∙kg⁻¹∙h⁻¹

0.6–1.2 mL∙kg⁻¹∙h⁻¹ 100 mg/mL solution

Titrate to blood pressure.

Do not exceed serum ionized calcium concentration 1.5–2 times the upper limits of normal.

Digoxin immune Fab

Digoxin

Acute overdose: 1 vial for every 0.5 mg digoxin ingested

Chronic poisoning: Use formula: dose in vials=serum digoxin concentration (ng/mL)×weight (kg)/100

Acute overdose, critically ill, ingested dose unknown: 10–20 vials

Same as adult

None

1 vial contains 40 mg Fab. Lower doses may be equally effective. ⁴

Digoxin immune Fab

Yellow oleander

Bufo toad venom and other cardioactive steroids

1200 mg (30 vials)

Unknown

None

Glucagon

β-blockers

CCBs

2–10 mg

0.05–0.15 mg/kg

1–15 mg∙h⁻¹ (adult)

Anticipate vomiting.

Flumazenil

Benzodiazepines

0.2 mg, titrated up to 1 mg

0.01 mg/kg

None

Many contraindications

Hydroxocobalamin

Cyanide

5 g

70 mg/kg

Repeat doses may be necessary.

Transient hypertension

Insulin

β-blockers

CCBs

1 Units/kg

Same as adult

1–10 Units∙kg⁻¹∙h⁻¹

Regular human insulin. Monitor for hypoglycemia, hypokalemia, volume overload.

Intravenous lipid emulsion 

Local anesthetics

less than 70 kg: 1.5 mL/kg

greater than 70 kg: bolus 100 mL over 2–3 min

Same as adult

less than 70 kg 0.25 mL∙kg⁻¹∙min⁻¹ for up to 30 min

greater than 70 kg: 200–250 mL over 15–20 min

All studies use 20% lipid emulsion.

Methylene blue

CCBs

Methemoglobinemia

1–2 mg/kg, repeated every hour if needed

Same as adult

1 mg∙kg⁻¹∙h⁻¹ (for vasodilatory shock)

Maximum 5–7 mg/kg

Naloxone

Opioids

0.2–2 mg IV/IO/IM

2–4 mg intranasal

Repeat every 2–3 min as needed

0.1 mg/kg

Two thirds of the waking dose per hour

Titrate to reversal of respiratory depression and restoration of protective airway reflexes.

Pralidoxime

Organophosphates

2 g IV infusion over 15–30 min (do not bolus) or 0.6 g IM up to 3 doses

20–50 mg/kg

1 g∙h⁻¹ (adult)

10–20 mg∙kg⁻¹∙h⁻¹ (pediatric)

Sodium bicarbonate†

Sodium channel blockers Cocaine

Local anesthetics

50–150 mEq

1–3 mEq/kg

Prepare 150 mEq/L solution, infuse at 1–3 mL∙kg⁻¹∙h⁻¹

Watch for hypernatremia, alkalemia, hypokalemia, hypochloremia.

Sodium nitrite

Cyanide

300 mg

6 mg/kg

None

Watch for hypotension.

Sodium thiosulfate

Cyanide

12.5 g

250 mg/kg

None