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Antidote therapy - specific detoxification
Medical expert of the article
Last reviewed: 04.07.2025
A detailed study of the processes of toxicokinetics of chemical substances in the body, the paths of their biochemical transformations and the implementation of toxic action has now made it possible to more realistically assess the possibilities of antidote therapy and determine its significance in various periods of acute diseases of chemical etiology.
Antidote therapy retains its effectiveness only in the early, toxicogenic phase of acute poisoning, the duration of which varies and depends on the toxic-kinetic characteristics of the given toxic substance. The longest duration of this phase and, consequently, the duration of antidote therapy are observed in cases of poisoning with heavy metal compounds (8-12 days), the shortest - when the body is exposed to highly toxic and rapidly metabolized compounds, such as cyanides, chlorinated hydrocarbons, etc.
Antidote therapy is highly specific and can therefore only be used if there is a reliable clinical and laboratory diagnosis of this type of acute intoxication. Otherwise, if the antidote is mistakenly administered in a larger dose, its toxic effect on the body may manifest itself.
The effectiveness of antidote therapy is significantly reduced in the terminal stage of acute poisoning with the development of severe disorders of the circulatory system and gas exchange, which requires the simultaneous implementation of the necessary intensive therapy.
Antidote therapy plays a significant role in the prevention of irreversible states in acute poisoning, but does not have a therapeutic effect during their development, especially in the somatogenic phase of these diseases.
Among the numerous medicinal products proposed by different authors at different times as specific antidotes for acute poisoning with various toxic substances, four main groups of drugs can be distinguished that have not lost their significance to this day.
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Chemical (toxicotropic) antidotes
Antidotes that affect the physicochemical state of the toxic substance in the gastrointestinal tract (chemical antidotes of contact action). In general, this method of treating poisoning is currently classified as the above-mentioned group of artificial detoxification methods called enterosorption (gastrointestinal sorption).Activated carbon (in a dose of 50-70 g) and various synthetic sorbents are used as sorbents.
Antidotes that carry out a specific physical and chemical interaction with a toxic substance in the humoral environment of the body (chemical antidotes of parenteral action). These drugs include thiol compounds (unithiol), used to treat acute poisoning with heavy metal compounds and arsenic, and chelating agents (EDTA salts, sodium calcium edetate) to form non-toxic compounds in the body - chelates with salts of certain metals (lead, cobalt, cadmium, etc.).
Biochemical antidotes (toxicokinetic), providing a beneficial change in the metabolism of toxic substances in the body or the direction of biochemical reactions in which they participate, without affecting the physicochemical state of the toxic substance itself. Among them, the greatest clinical application at present is found in cholinesterase reactivators (oximes) - in poisoning with organophosphorus substances, methylene blue - in poisoning with methemoglobin formers, ethanol - in poisoning with methyl alcohol and ethylene glycol, antioxidants - in poisoning with carbon tetrachloride.
Sodium hypochlorite (0.06% solution - 400 ml intravenously) has the most universal effect, since it promotes the oxidation of various toxicants (usually drugs), the natural detoxification of which in the body occurs in the same way.
Pharmacological antidotes provide a therapeutic effect due to pharmacological antagonism, acting on the same functional systems of the body as toxic substances. In clinical toxicology, the most widely used pharmacological antagonism is between atropine and acetylcholine in poisoning with organophosphorus compounds, naloxone in poisoning with opium preparations, between proserin and pachycarpine hydroiodide, potassium chloride and cardiac glycosides. Their use allows to stop many dangerous symptoms of poisoning with the listed drugs, but rarely leads to the elimination of all symptoms of intoxication, since the specified antagonism is usually incomplete. In addition, drugs - pharmacological antagonists, due to their specific action, should be used in sufficiently large doses, exceeding the concentration in the body of a given toxic substance.
Biochemical and pharmacological antidotes do not change the physicochemical state of the toxic substance and do not interact with it in any way. However, the specific nature of their pathogenetic therapeutic effect brings them closer to the group of chemical antidotes, which makes it possible to combine them under one name - specific antidote therapy.
Essential drugs for specific (antidote) treatment of acute poisoning
Activated carbon, 50 g orally |
Non-specific sorbent of medicinal products (alkaloids, sleeping pills) and other toxic substances |
Ethanol (30% solution orally, 5% - intravenously 400 ml) |
Methyl alcohol, ethylene glycol |
Aminostigmine (2 mg intravenously) |
Anticholinergics (atropine, etc.) hydrocyanic acid (cyanides) |
Atropine (0.1% solution) |
Fly agaric, pilocarpine, cardiac glycosides, FOB, clonidine |
Acetylcysteine (10% solution - 140 mg/kg intravenously) |
Paracetamol Death cap |
Sodium bicarbonate (4% solution - 300 ml intravenously) |
Acids |
HBO (1-1.5 ati, 40 min) |
Carbon monoxide, carbon disulfide, methemoglobin formation |
Disferal (5.0-10.0 g orally, 0.5 g 1 g/day intravenously) |
Iron |
Penicillamine (40 mg/kg daily orally) |
Copper, lead, bismuth, arsenic |
Ascorbic acid (5% solution, 10 ml intravenously) |
Aniline, potassium permanganate |
Vikasol (5% solution, 5 ml intravenously) |
Indirect anticoagulants |
Sodium hypochlorite (0.06% solution, 400 ml intravenously) |
Medicines |
Sodium nitrite (1% solution, 10 ml intravenously) |
Hydrocyanic acid |
Proserin (0.05% solution, 1 ml intravenously) |
Pachycarpine hydroiodide, atropine |
Protamine sulfate (1% solution) |
Sodium heparin |
Anti-snake serum (500-1000 IU intramuscularly) |
Snake bites |
Cholinesterase reactivators (dipiroxime 15% solution 1 ml, diethixime 10% solution 5 ml intramuscularly) |
FOB |
Magnesium sulfate (25% solution 10 ml intravenously) |
Barium and its salts |
Sodium thiosulfate (30% solution, 100 ml intravenously) |
Aniline, benzene, iodine, copper, hydrocyanic acid, corrosive sublimate, phenols, mercury |
Unithiol (5% solution, 10 ml intravenously) |
Copper and its salts, arsenic, corrosive sublimate, phenols, chromate |
Flumazenil (0.3 mg, 2 mg/day intravenously) |
Benzodiazepines |
Sodium chloride (2% solution, 10 ml intravenously) |
Silver nitrate |
Calcium chloride (10% solution, 10 ml intravenously) |
Anticoagulants, ethylene glycol, oxalic acid |
Potassium chloride (10% solution, 20 ml intravenously) |
Cardiac glycosides, formalin (gastric lavage) |
Edetic acid (10% solution, 10 ml intravenously) |
Lead, copper, zinc |
Methylene blue (1% solution, 100 ml intravenously) |
Aniline, potassium permanganate, hydrocyanic acid |
Antitoxic immunotherapy has become most widespread for the treatment of poisoning with animal venoms from snake and insect bites in the form of antitoxic serum (anti-snake, anti-black widow, etc.)
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