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Dose
. By intravenous injection over 5–20 minutes (as sod-
ium nitrite injection 30 mg/mL),
300 mg;
CHILD
4–
10 mg/kg (max.
300 mg)
1
Sodium Nitrite A
Injection
, sodium nitrite 3% (30 mg/mL) in water for
injections
Available from ‘special-order’
manufacturers or specialist
importing companies, see p.
988
SODIUM THIOSULPHATE
Indications
in conjunction with sodium nitrite for
cyanide poisoning
Dose
. By intravenous injection over 10 minutes (as sodium
thiosulphate injection 500 mg/mL),
12.5 g;
dose may
be repeated in severe cyanide poisoning if dicobalt
edetate not available;
CHILD
400 mg/kg (max.
12.5 g);
dose may be repeated in severe cyanide poisoning if
dicobalt edetate not available
1
Sodium Thiosulphate A
Injection
,
sodium thiosulphate 50% (500 mg/mL) in
water for injections
Available from ‘special-order’
manufacturers or specialist
importing companies, see p.
988
Ethylene glycol and methanol
Fomepizole (available from ‘special-order’
manufac-
turers or specialist importing companies,
see p.
988) is
the treatment of choice for ethylene glycol
and metha-
nol (methyl alcohol) poisoning. If necessary, ethanol (by
mouth or by intravenous infusion) can be used, but with
caution. Advice on the treatment of ethylene glycol and
methanol
poisoning
should
be
obtained
from the
National
Poisons Information Service.
It
is important
to start
antidote treatment
promptly in cases of
sus-
pected poisoning with these agents.
Heavy metals
Heavy metal
antidotes include succimer (DMSA) [unli-
censed],
unithiol
(DMPS) [unlicensed],
sodium calcium
edetate,
and dimercaprol.
Dimercaprol
in the manage-
ment of heavy metal poisoning has been superseded by
other chelating agents. In all cases of heavy metal pois-
oning,
the advice of
the National
Poisons Information
Service should be sought.
SODIUM CALCIUM EDETATE
(Sodium Calciumedetate)
Indications
lead poisoning
Renal impairment
use with caution in mild impair-
ment;
avoid in moderate to severe impairment—
contact the National Poisons Information Service for
advice
Side-effects
nausea,
diarrhoea,
abdominal pain,
pain
at site of injection,
thrombophlebitis if given too
rapidly,
renal damage particularly in overdosage;
hypotension,
lacrimation, myalgia,
nasal congestion,
sneezing,
malaise,
thirst,
fever,
chills,
headache,
and
zinc depletion also reported
Dose
. By intravenous infusion,
ADULT
and
CHILD
40 mg/kg
twice daily for up to 5 days; if necessary,
a second
course can be given at least 7 days after the first
course, a third course can be given at least 7 days after
the second course
Ledclair
c
(Durbin) A
Injection
,
sodium calcium edetate 200 mg/mL,
net
price 5-mL amp = £7.29
Noxious gases
Carbon monoxide
Carbon monoxide poisoning is
usually due to inhalation of
smoke,
car
exhaust,
or
fumes caused by blocked flues or incomplete combus-
tion of fuel gases in confined spaces.
Immediate treatment of carbon monoxide poisoning is
essential.
The person should be moved to fresh air,
the
airway cleared,
and high-flow oxygen 100% adminis-
tered through a tight-fitting mask with an inflated face
seal.
Artificial
respiration should be given as necessary
and continued until
adequate spontaneous breathing
starts,
or
stopped only after
persistent
and efficient
treatment
of
cardiac
arrest
has
failed.
The patient
should be admitted to hospital
because complications
may arise after
a delay of
hours
or
days.
Cerebral
oedema may occur in severe poisoning and is treated
with an intravenous infusion of mannitol (section 2.2.5).
Referral
for
hyperbaric oxygen treatment
should be
discussed with the National Poisons Information Service
if the patient is pregnant or in cases of severe poisoning,
such as if the patient is or has been unconscious, or has
psychiatric or neurological
features other than a head-
ache, or has myocardial ischaemia or an arrhythmia, or
has a blood carboxyhaemoglobin concentration of more
than 20%.
Sulphur dioxide,
chlorine,
phosgene,
ammonia
All of these gases can cause upper respiratory tract and
conjunctival irritation.
Pulmonary oedema,
with severe
breathlessness and cyanosis may develop suddenly up
to 36 hours after exposure.
Death may occur.
Patients
are kept
under
observation and those who develop
pulmonary oedema are given oxygen.
Assisted ventila-
tion may be necessary in the most serious cases.
CS Spray
CS spray, which is used for riot control, irritates the eyes
(hence ‘tear gas’) and the respiratory tract;
symptoms
normally settle spontaneously within 15 minutes.
If
symptoms persist,
the patient should be removed to a
well-ventilated area, and the exposed skin washed with
soap and water after removal of contaminated clothing.
Contact
lenses
should be
removed and rigid ones
washed (soft ones should be discarded). Eye symptoms
should be treated by irrigating the eyes with physio-
logical
saline (or
water if
saline is not
available)
and
advice sought
from an ophthalmologist.
Patients with
1.
A restriction does not apply where administration is for
saving life in emergency
40
Emergency treatment of poisoning
BNF 61
Emergency treatment of poisoning