Each poison has its own antidote. How to save or at least try (upd: about antidotes for domestic poisoning)

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Dedicated to all fighters of the Russian Chemical Safety Base (radiation, chemical and biological protection) who did not shame the honor of their OZK ...

With interest reading articles by colleagues gjf about the most interesting , most terrible and most fearlessI feel nostalgic for poisons :). Because any right chemist, starting his career, is primarily interested in either poisons, or explosives, or drugs. I haven’t met people who would have been led to chemistry by something else, honestly. True, over the years, if a hobby becomes a profession, all information is somehow rethought and streamlined, completely different priorities arise. So now, reading the articles mentioned, I recalled my paper notebook, which included descriptions of unusual poisons. Everything flows, everything changes, now in my “working” notebook there are more “antidotes”. For thousands of ways have been invented by man to destroy life and so far no one has been invented - to create it. Strength is in balance, so if there are poisons on Habré, there must be antidotes. Well, there woke up in me a permanently dormant sergeant of the Belarusian RCHBZ. The article is short, almost without water, but it may turn out to be vital (= "backfill", methanol FAQ)! For the antidote - we go under the cat.

RU Wikipedia teaches us that:
Antidote or antidote (from other Greek. Ἀντίδοτον, lit. - given against) is a medicine that stops or weakens the effect of poison on the body.

In principle, every adult has heard about antidotes at least once in his life. Someone, for example, from an article about the stomach stone of Bezoar, which has been used for centuries as a remedy for any poison (“remedy”). Someone will remember Rasputin, who ate sweet cakes and thereby saved himself from cyanide poisoning ( but this did not save him from a bullet ), and someone from Nicholas Cage from the movie Scala, angrily driving atropines into the heart of an autoinjector.

It is worth recognizing that today antidotes as such have lost their relevance and are most often associated with courses ( posters on the walls of old research institutes)) civil defense, or with films of the corresponding (terrorist, etc.) subject. This happened because intensive care in emergency medicine has reached unprecedented heights. Any poisoning, as a rule, is evaluated and treated symptomatically, sequentially blocking or removing the damaging factors. However, the use of antidotes gives an advantage in reducing the time of poisoning and reducing complications, increases the possibility of recovery of a poisoned patient and saves his vital resources. When opportunities for full-fledged intensive care are unavailable, some antidotes can become vital medicines, especially in remote areas or developing regions.

Until a certain point, all antidotes were not classified and existed completely apart. But the situation changed in 1993, when, firstly, within the framework of the International Program on Chemical Safety (IPCS) of WHO, a new definition was given to the concept of antidote:
Antidote is a therapeutic substance used to counteract the
side effects of xenobiotics.

and secondly, a list was prepared and made public, Guidelines for Poison Control . I recommend it, just in case, download and keep it in a prominent place, even despite the fact that IPCS experts constantly conduct research and update information (= supplement the list, etc.).

Guidelines for Poison Control Cover

The list consists of the following tables:
tab. 1) 48 antidotes that have a positive effect in the treatment of certain acute poisonings
tab. 2) 12 substances used to prevent the absorption of poisons. They also provide symptomatic treatment for
tablets. 3) 19 therapeutic agents that have a positive effect in acute poisoning
tab. 4) 23 antidote and related therapeutic substances that are outdated and the use of which is now not recommended due to inefficiency.

I will give in the article only the first and last tables, as the most vital. The rest, if desired, the inquisitive reader will be able to see for himself by clicking on the link mentioned above.

I would like to note that the WHO-ov definition of the concept is very broad. It
includes both the actual antidotes and non-specific drugs (for example, glucose, vitamin K, diazepam, isoprenaline, etc.), which are widely used in the treatment of specific poisoning.

In the table of antidotes in the column "code" the letter shows the urgency of use:
A - application is necessary immediately (within the first 30 minutes from the moment of poisoning),
B - application is needed immediately (in the first 2 hours),
C - application is necessary immediately (in the first 6 hours).

The number next to the letter identifies such a parameter as the evidence of the effectiveness of the drug: 1 - the effectiveness of the antidote is well documented, 2 - the antidote is widely used, however, additional studies on the effectiveness and indications for use are required, 3 - the effectiveness is in doubt.

Table of Antidotes from IPCS


Outdated, ineffective and dangerous antidotes

Important note: Specific antidotes should only be used if poisoning is detected with the corresponding specific poison, and it is logical that to effectively eliminate the negative effects of poisoning, antidotes should be used as quickly as possible (as soon as possible).

Addition : in response to "from the whole table - I know only 10-15 pieces ...". A few thoughts. For example, the antidote to thallium is Prussian blue , it is Prussian blue. It’s not difficult for a chemist to obtain Prussian blue, the benefit is “ yellow blood salt"And ferric salts are almost everywhere. Ferrocin tablets (originally positioned as a sorbent of radioactive cesium) can help the average person, which after the Chernobyl disaster could still be found, and then it suddenly became difficult. In extreme cases, you can try to search for the veterinary drug Bifézh, fed to animals in areas contaminated with radionuclides. As an emergency option - there is a watercolor paint , where Berlin blue is used as a blue pigment. Take note that yellow blood salt is a food supplement E536, which is put, for example, in a sprat in a tomato produced in Belarus :). Sodium thiosulfate - a common photoreactive in the past, the so-called fixer (simple) neutral.Edetates - salts of EDTA, metal complexes with Trilon-B (EDTA), which is used to soften water and is sold in every stall. One of the best complexing agents - perfectly chelates many heavy metals. Methionine is a sulfur-containing amino acid found in many foods (see USDA ). Methylene blue is an ordinary household blue, which is not a problem to get. Amyl nitrite is a poppers who can also be found without problems in a large city. Etc. etc., if you look, it’s not so sadly :). In the appendage, briefly on the available antidotes:

Poisoning with methanol / ethylene glycol (antifreeze)

A specific antidote to methanol is ethyl alcohol. Given the slow metabolism of methanol, ethanol is taken within 5 days from the moment of methanol consumption. Dose of ethanol: 1 - 2 g / kg of weight per day. The most optimal concentration of ethanol in the blood is 1 ‰. Ethanol is injected either intravenously (in the absence of consciousness, or vomiting) in the form of a 5% solution (20 ml of a 96% solution in 400 ml of a 5% glucose solution) at a rate of 100-150 mg / kg / hour or orally in the form of 30% solution every 3 hours, while the daily dose is evenly distributed between doses. To accelerate the metabolism of formic acid, folic acid is administered at 50-100 mg 4-6 times a day. In case of ethylene glycol poisoning, the actions are the same. At the first opportunity - immediately to the hospital with a description of the manipulations done.

ADDITION:Following up on a small methanol FAQ to dot over i

Q : Is it possible to distinguish pure methanol from pure ethanol by smell?
A : It is possible, but very difficult. The method does not work in the case of a mixture of methanol + ethanol.

Q : Are there chemical methods to distinguish methanol from ethanol.
A : Pure - yes, for example, an iodoform test: the formation of a yellowish precipitate of iodoform upon the action of iodine and alkali on alcohol (sensitivity> = 0.05%).

C 2 H 5 OH + 6NaOH + 4I 2 => CHI 3 + HCOONa + 5NaI + H 2 O

We add Lugol’s solution to the alcohol under investigation, mix it and add the alkali solution (NaOH) dropwise. In the case of ethanol, the solution first decolours and then becomes cloudy, a yellow suspension of iodoform is formed, and a yellow precipitate forms at high alcohol concentrations. Methanol - does not give such a reaction.

The second option may be a reaction of alcohol oxidation with copper oxide. The copper wire, grated to shine, is calcined in the burner flame until blackening, then it is lowered into the test alcohol. In the case of methanol, the reaction proceeds:

CH 3 OH + CuO => H 2 C = O + Cu + H 2 O (formaldehyde is formed and the wire becomes shiny)

In the case of ethanol, the reaction proceeds:

C 2 H 5 OH + CuO => CH3 -CH = O + Cu + H 2 O (acetic aldehyde is formed and the wire becomes shiny) The

method is complicated by the fact that the tester must know how pure aldehydes smell (vinegar - reminds someone of the smell of ripe apples, someone has a strong smell of fume , formaldehyde - irritates the nasal mucosa, a very pungent odor that can be sensed, for example, with the decomposition of phenol-formaldehyde resin).

The sad thing is that the announced methods are not applicable in the case of a mixture of ethanol-methanol. An old laboratory method of determination is the oxidation reaction of a mixture of alcohols with potassium permanganate in the presence of phosphoric acid and an indication of the formaldehyde formed by chromotropic acid. The reaction

proceeds : 5CH 3 OH + 3H 3 PO 4+ 2KMnO 4 => 5HCOH + 2MnHPO 4 + K 2 HPO 4 + 8H 2 O

Formaldehyde formed from methanol gives violet color with chromotropic acid . Acetaldehyde does not interfere with the reaction.

Old GOST 5964-93 recommends the following methodology:

Methodology GOST 5964-93

There are no other “express” options (if pressed, it is better to carry it on a chromatograph). So if there is no desire to understand, it is better to pour or burn such a mixture. If the volumes of the mixture are serious, the mixture can be separated by distillation (temperatures differ significantly + methanol does not form azeotropes with water). The boiling point of methanol is 64.7 ° C, and ethanol is 78.39 ° C (78.15 ° C for rectified alcohol containing at least 4.43% water).

In addition, having a fairly accurate portable refractometer on hand:

and knowing the exact concentration of alcohol, methanol can be distinguished from ethanol in terms of refractive index, for methanol nD 20 1.3828, for ethanol nD 20 1.3611

Poisoning with paracetamol.

Acetylcysteine ​​(mucist, mucosolvin) is used in the first 16 hours. The initial dose of acetylcysteine ​​is 140 mg / kg orally, then 70 mg / kg every 4 hours for 3 days (another 17 doses). The antidote can also be administered intravenously (especially with severe vomiting), however, the oral route of administration is more effective and is associated with fewer side effects.

Iron Poisoning

Antidote is a desferal chelating agent that is administered intravenously or
intramuscularly. In patients with initial manifestations of toxicity (50-60 μg / l of iron in plasma) - the introduction of 10-15 mg / kg / hour of desferal. High doses - 40-50 mg / kg / hour are used
only for severe poisoning. Administration of deferoxamine continues until the level of iron in blood plasma decreases below 35 μg / L. Do not use in case of pregnant women with acute overdose of iron preparations.

Poisoning with iodine

Sodium thiosulfate 30% solution - up to 300 ml per day, intravenous drip, 10% sodium chloride solution 30 ml intravenously.

Poisoning with potassium permanganate (potassium permanganate)

With severe cyanosis (methemoglobinemia) - methylene blue 50 ml of a 1% solution, ascorbic acid - 30 ml of a 5% solution intravenously.

Copper poisoning

Unitiol - 10 ml of a 5% solution, then 5 ml every 3 hours intramuscularly for 3 to 5 days. Sodium thiosulfate - 100 ml of a 30% solution intravenously.

Lead poisoning

Tetacin-calcium (CaEDTA) at a dose of 50 mg / kg / day) divided into 3-4 doses intramuscularly. Unitiol 5-10 ml of a 5% solution intramuscularly 4 times a day for 5 days. DMSA (succimer) orally at 10 mg / kg every 8 hours for 5 days or after 12 hours for 14 days.

Poisoning by poisonous mushrooms with hepatotropic poisons (amatoxins) - pale grebe,
grebe-like fly agaric, fly agaric smelly

Penicillin 1 million units / kg / day. Silibinin (legalon) - 20 mg / kg / day. When using preparations containing silymarin (silibor, karsil), it should be remembered that 70 mg of silymarin approximately correspond to the effectiveness of 30 mg of silybinin.

Disulfiram poisoning - a drug used in the treatment of alcoholism. Actual for "hemmed"

Intravenous administration of 40% glucose solution - 40 ml with 5% ascorbic acid solution - 10 ml. Sodium bicarbonate - 4% solution of 200 ml - intravenously drip. Vitamin B 1 - 5% solution - 2 ml intramuscularly.

Poisoning with nitrites / nitrates, benzene, aniline, nitrogen oxides and other methemoglobin formers.

1% methylene blue solution of 0.1-0.2 ml / kg (1-2 mg / kg) with a 5% glucose solution of 200-300 ml intravenously, if necessary, again after 15-20 minutes. A solution of ascorbic acid 5% to 60 ml per day intravenously. In the case of benzene - 30% sodium thiosulfate solution - 200 ml intravenously.

PS If something is found - write in the comments, try to understand and reopen Habr antidotologiey .

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