Dorset Formulary

	Dorset
	The Dorset Formulary has been developed in associations with NHS Dorset Clinical Commissioning Group Dorset County Hospital NHS Foundation Trust Dorset Healthcare University NHS Foundation Trust Poole Hospital NHS Foundation Trust Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust

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Formulary Chapter 18: Emergency Treatment of Poisoning - Full Chapter

Notes:

The antidotes listed here are those recommended by the Royal College of Emergency Medicine and UK National Poisons Information Service (NPIS). They are included in the Formulary as RED traffic light medicines.

Please see individual entries for local availability of antidotes.

In cases of poisoning it is strongly recommended that advice is sought from NPIS by telephone on 0344 892 0111 or online using Toxbase. Advice is available 24/7/365.

See the current BNF for notes on the emergency treatment of poisoning or click on the BNF icon adjacent to individual drugs for further details.

Details...

Poisoning

Acetylcysteine IV (Parvolex)

Formulary

See BNF for treatment graph and acetylcysteine treatment protocols for paracetamol overdose.

Activated charcoal

Formulary

For reduction of absorption of poisons in the gastro-intestinal system. Useful for many oral poisons (but see Toxbase or NPIS for advice on use).

Atropine injection

Formulary

For bradycardia and organophosphate or carbamate insecticide poisoning.

Calcium chloride injection

Formulary

For calcium channel blocker overdose and systemic effects of hydrofluoric acid.

Calcium folinate

Formulary

For methotrexate overdose or poisoning and methanol or formic acid poisoning.

Calcium gluconate

Formulary

Injection (by local infiltration) and gel (topically) for hydrofluoric acid burns.

RBCH: Gel kept in ED Resus

Cyproheptadine (Periactin^®)

Formulary

Anticholinergic (antimuscarinic) antihistamine used in serotonin syndrome.

RBCH: kept in EDC and pharmacy

Dantrolene IV

Formulary

For malignant hyperthermia, neuroleptic malignant syndrome (NMS). Other drug related pyrexia seek NPIS advice.

RBCH: Kept in ITU and Theatres

Desferrioxamine

Formulary

For iron poisoning.

RBCH: kept in ED resus and Pharmacy

Dicobalt edetate IV

Formulary

For severe cyanide poisoning.

RBCH: kept in Emergency Drug Cupboard

Digoxin specific antibody fragments (Digifab^®)

Formulary

For digoxin overdose - see Dorset-wide guideline.

All Dorset Hospitals Policy for Use of DigiFab

Ethanol (alcohol) injection

Formulary

Orally or by injection for ethylene glycol (antifreeze) and methanol (methyl alcohol) poisoning as alternative to fomepizole.

European Viper Venom Antivenom

Formulary

For European adder (Vipera berus) envenoming (bites).

DCH: Kept in ED Fridge & Emergency Drugs Fridge.

Flumazenil

Formulary

For reversal of benzodiazepines.

Fomepizole

Formulary

Unlicensed. Treatment of choice for methanol (methyl alcohol) and polyethylene glycol (antifreeze) poisoning. PbR excluded: Commissioned by CCG.

There is an agreement that DCH, RBCH and PHT will keep initial doses of fomepizole to allow time for additional doses to be sourced from other trusts - contact Pharmacy to arrange supplies

DCH: Available in Emergency Drugs Fridge.

RBCH: Kept on ITU

Glucagon injection (GlucaGen^® Hypokit)

Formulary

For treatment of hypoglycaemia due to insulin overdose and supportive off-label (unlicensed) treatment of beta-blocker overdose. Other indications e.g. calcium channel blockers, seek NPIS advice.

Beta-blocker overdose requires large amounts of glucagon - contact Pharmacy to arrange supplies ASAP.

Glucarpidase

Formulary

Orphan drug

High Cost Medicine: Commissioned by NHS England for urgent treatment of methotrexate-induced renal dysfunction in accordance with policy.

Due to the cost of this antidote for methotrexate toxicity, it is not stocked at any hospital in the area. If a supply is needed it can be obtained on a named-patient basis from Clinigen Group 24 hours a day 7 days a week.
Within office hours:
Tel: 01283 494 340
Fax: 01283 494 341
Out of hours:
Email: outofhours@clinigengroup.com
Phone number: 07741 242858

Hydroxocobalamin (Cyanokit®)

Formulary

Can be considered for use in victims of smoke inhalation who show signs of significant cyanide poisoning.

RBCH: 1 kept in ED; obtain further supplies from PHT

Macrogols (Klean-Prep^® or similar)

Formulary

For gut decontamination of agents not bound by activated charcoal (e.g. iron & lithium).

Mesna

Formulary

For cyclophosphamide toxicity.

RBCH: IV kept in Pharmacy Aseptic Unit

Methylthioninium chloride injection (methylene blue)

Formulary

Unlicensed. For treatment of methaemoglobinaemia and as a diagnostic aid for fistula detection.

RBCH: kept in ITU and Theatres

Naloxone injection

Formulary

For emergency treatment of opioid overdose.

RBCH Guidelines for Intravenous Naloxone Use in Suspected Opioid Overdose

Octreotide injection

Formulary

For sulphonylurea overdose.

Penicillamine (Distamine^®)

Formulary

Phentolamine injection

Formulary

For digital ischemia due to accidental injection of epinephrine (adrenaline) and resistant hypertension related to sympathomimetic drugs of abuse, MAOIs and clonidine.

Phytomenadione (Vitamin K1)

Formulary

For reversal of warfarin and other coumarin anticoagulants (vitamin K1 antagonists).

Primary Care Management of high INR July 2017

Pralidoxime chloride (Protopam^®)

Formulary

For use as an adjunct to atropine in the treatment of poisoning by organophosphorus insecticides or nerve agents. ‘NAAS pods’ containing pralidoxime chloride can be obtained through the Ambulance Service from the National Blood Service — see NPIS or TOXBASE for list of designated centres.

RBCH is a designated regional holding site - kept in ED Resus

Procyclidine injection

Formulary

For dystonic reactions.

RBCH: kept in Emergency Drug Cupboard, ED resus and AMU

Protamine Sulphate

Formulary

For emergency reversal of heparin based anticoagulants.

Pyridoxine injection

Formulary

For isoniazid toxicity.

Sodium bicarbonate infusion

Formulary

Use for urinary alkalinisation & tricyclic antidepressant overdose & class 1a and 1c antiarrhythmic drugs.

Sodium nitrite injection

Formulary

For cyanide poisoning.

RBCH: kept in Emergency Drug Cupboard

Sodium thiosulphate

Formulary

For cyanide poisoning.

RBCH: kept in Emergency Drug Cupboard

Tetanus Immunoglobulin (antidote botulism)

Formulary

For treatment of tetanus infection (botulism)

18.11.01

Skin cleansers and antiseptics

18.11.07

Preparations for promotion of wound healing

....

Non Formulary Items

Dimercaprol

Non Formulary

Check Rarely Used Medicines (RUM) list for stockists if required.

DMPS (unithiol)

Non Formulary

Available from Poisons Unit at Guys & ST Thomas' Hospital if supply required.

Sodium calcium edetate

Non Formulary

Southampton is nearest centre to stock this item.

Key

	Notes
	Section Title (top level)
	Section Title (sub level)
	First Choice item
	Non Formulary section
	Restricted Drug
	Unlicensed
	Display tracking information
	Link to adult BNF
	Link to children's BNF
	Link to SPCs

	Cytotoxic Drug
	Controlled Drug
	High Cost Medicine
	Cancer Drugs Fund
	NHS England
	Homecare
	CCG

Traffic Light Status Information

Status	Description
	May be initiated, stabilised and maintained in primary, secondary or tertiary care
	Amber drug - without shared care
	Amber drug - with shared care guideline
	For secondary or tertiary care initiation and long-term maintenance of prescribing
	Not recommended