Antidotes are arguably the most intriguing drugs out there: Someone is severely poisoned and all it takes is one dose of one drug that is the perfect opposite of the poison to cure them. The truth is, there are a limited number of antidotes in existence—not every poison has one. A few are pretty fascinating, and here are my 3 favorites:
Hydroxocobalamin is an antidote for cyanide poisoning. Cyanide is a ruthless, quick acting poison. It is produced in the combustion of synthetic materials, and it has a variety of industrial uses. It is found in trace amounts in some fruits, and it has famously been employed as a weapon in homicides and terrorism. Luckily, true cyanide poisoning is pretty rare but when it happens it is a big deal: cyanide prevents the body’s cells from using oxygen and a poisoned patient can go from fine to sick to dead in pretty short order. A quick acting, effective, and safe antidote is ideal.
That is where hydroxocobalamin comes in. When injected into the patient, it combines with cyanide in the body to form cyanocobalamin. Cyanocobalamin is…Vitamin B12. That’s right, this antidote turns cyanide into a vitamin—I told you it was sexy.
Ethanol is the type of alcohol that is in beverages (aka the cause of, and solution to, all of life’s problems). While I can’t promise that ethanol will be the solution to all problems, it actually is an antidote for the very toxic substances methanol and ethylene glycol. Methanol and ethylene glycol are found in automotive products such as windshield washer fluid and antifreeze. After being swallowed, these chemicals are broken down by the liver to very toxic byproducts that can cause symptoms such as blindness, kidney damage, and death.
You may know that ethanol is also processed by the liver. That is what makes it an antidote to methanol and ethylene glycol—the liver keeps itself busy by preferentially processing the ethanol, so methanol and ethylene glycol can’t be turned into their toxic byproducts.
When a doctor or nurse calls us for help with a poisoned patient, it is a little interesting for the official IPC treatment recommendation to be “get the patient drunk”. When used as an antidote, the goal is a blood ethanol level of 0.1-0.15% (for comparison, 0.08% is considered too drunk to drive in Illinois). Luckily, IPC does not have to make that recommendation very often anymore—in the late 1990s, a drug called fomepizole was FDA approved to treat methanol/ethylene glycol poisonings. It works the same way as ethanol: by preventing the liver from converting methanol and ethylene glycol into their toxic byproducts. Still, on occasion, a hospital won’t have fomepizole and we’ll have to go back to the old standby.
Naloxone is the antidote to opioids: heroin, oxycodone, morphine, hydrocodone, fentanyl, methadone and all the rest. This is a sexy antidote because it works so rapidly and completely. Opioids kill by suppressing the body’s drive to breathe. You can have an overdose patient who has just stopped breathing and is minutes from death, but after one dose of naloxone, they are awake and breathing (and also angry, which is not sexy, but that is another story).
The other neat thing about naloxone is that it can be given to the patient a variety of ways. In the hospital, it is often administered IV. Naloxone also comes as a nasal spray so that a family member, friend, or police officer can easily give a squirt into the nose anywhere anytime—no need to find a vein. They key with naloxone is that it has to be given very soon after an overdose: if the patient has significantly slowed or stopped breathing, they can only survive for a few minutes due to lack of oxygen. This is why there is a public health effort to arm first responders and the public with naloxone. The US is in the midst of an opioid epidemic and having the antidote on hand saves lives.
Other poisoning treatments may not be as glamorous as these three, but this is what IPC does best. If you ever suspect that a poisoning has occurred (even if you are not sure), call the poison center at 1-800-222-1222 to get expert advice on what treatment, if any, is needed.
March is Illinois Poison Prevention Month (IPPM). In Illinois, there are more people hospitalized for poisonings than for injuries from firearms and motor vehicle collisions combined! Education is the key. We invite you to join us for IPPM by ordering FREE IPPM promotional and educational materials (children’s paint sheets, jar grippers, safety packets, stickers, and magnets). Supplies are limited so order now!