Poison

Antidote and dose (STG 2026)

Organophosphates (malathion, dichlorvos, dimethoate and others)

A: Atropine 2–5 mg IV (adults) or 0.05 mg/kg IV (children), doubling every 3–5 minutes until atropinised (dry secretions, heart rate above 80, systolic BP above 80 mmHg) AND S: pralidoxime 1–2 g IV over 15–30 minutes, repeat after 1 hour then 12-hourly as needed, OR 30 mg/kg IV over 20 minutes then 4–8 mg/kg/hour

Carbamates (propoxur, aldicarb, carbaryl, carbofuran, methomyl)

A: Atropine 2–5 mg IV (adults) or 0.05 mg/kg IV (children), titrated to atropinisation; pralidoxime is usually not needed for carbamates

Organochlorines (endosulfan, lindane, heptachlor, chlordane)

Supportive care

Anticoagulant rodenticides (bromadiolone)

B: Phytomenadione (vitamin K1) 2.5–10 mg PO/SC in adults, up to 25–50 mg if needed, repeated every 12–48 hours; S: cholestyramine 4 g PO every 12–24 hours (maintenance 8–16 g/day, maximum 24 g/day)

Arsenic

D: Dimercaprol 3 mg/kg IM every 4 hours for 48 hours, then 3 mg/kg every 12 hours for 10 days AND D: penicillamine 30–40 mg/kg/day PO for 1–6 months (2 hours before or 3 hours after food)

Methanol

Ethanol: loading 600 mg/kg IV or 600–700 mg/kg PO/NG (diluted); maintenance 0.15 ml/kg/hour (IV: 1.4 ml/kg/hour of 10% ethanol)

Ethylene glycol (antifreeze)

Ethanol as for methanol AND S: folinic acid 60 mg IM once, then 15 mg PO every 8 hours for 48–72 hours AND C: thiamine 100 mg IV once, then 50–100 mg/day IM/IV

Cyanide

C: Hydroxocobalamin 70 mg/kg IV (usually 5 g) over 15 minutes; repeat 5 g if needed

Methaemoglobinaemia (nitrites, nitrates, dapsone, aniline, naphthalene)

C: Methylene blue 1 mg/kg IV over 5–30 minutes; repeat after 1 hour if methaemoglobin is above 30% or symptoms persist

Paracetamol

C: N-acetylcysteine (IV 21-hour regimen; oral 140 mg/kg loading, then 70 mg/kg every 4 hours for 3 days)

Iron

D: Deferoxamine 50 mg/kg IM every 4–12 hours (moderate) or 15 mg/kg/hour IV infusion (severe)

Benzodiazepines

D: Flumazenil 0.2 mg IV over 15 seconds, then 0.1 mg every 60 seconds until awake (usual total 0.3–0.6 mg)

Opioids

B: Naloxone 0.4–2 mg IV, repeated every 2–3 minutes as needed

Isoniazid

B: Pyridoxine 10–25 mg PO every 8 hours for 48 hours

Digoxin

S: Digoxin immune Fab (1 vial binds 0.5 mg digoxin)

Datura (anticholinergic plant)

S: Physostigmine 0.5–2 mg IV slowly (maximum 1 mg/min), repeat after 20 minutes if needed; maintenance 1–4 mg every 30–60 minutes as needed

Snake bite

A: Polyvalent snake venom antiserum IV: mild 5 vials, moderate 5–10 vials, severe 10–20 vials

Dog bite (rabies exposure)

B: Human rabies immunoglobulin, half infiltrated into the wound and half IM/SC

Botulism

S: Botulinum antitoxin IV, starting at 0.5 ml/min for 30 minutes, then slowly with monitoring for hypersensitivity