In all situations advice from On-Call Pharmacy is available,
Please call via switchboard and ask for on-call pharmacy for RHC
Dosing to be guided by Toxbase with strong consideration of discussion with NPIS [0344 892 0111]and mandatory involvement of ED Consultant
Medusa (Injectable medicines guide website) is here or search “Paediatric Intravenous Medicines Monographs” on Staffnet and click through to full medusa website.
If child less than 6 months also consult WoS Neonatal Monographs and discussion On-Call Pharmacy mandatory
Toxbase log in is on the computers in resus and majors, log in will be required to access links
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Antidote |
Administration |
References |
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Acetylcysteine |
As per RHC SNAP guideline |
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Activated Charcoal |
Usually 1g/ Kg, toleration is a significant issue as is rises of aspiration, MUST be discussed with ED Consultant prior to being given |
Toxbase entry: |
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Andexanet Alfa |
D/W On-Call Haematology before administering add 20ml water for injection to vial swirl (do not shake). Final concentration 200mg/20ml. Must be given through an inline 0.2micron filter.
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Atropine |
No dilution needed, give neat |
BNF Atropine sulfate | Drugs | BNFC | NICE and Toxbase Atropine - antidote |
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Calcium Chloride |
Danger of injury if extravasates, ensure as wide-bore cannula as possible and central line ideally Stocked in Resus 10mmol in 10ml (14.7%) & 10% 10ml pre-filled syringe Can be given neat Toxbase advises bolus over 3-5 minutes |
Calcium chloride/calcium gluconate - antidote
Medusa IV guide entry |
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Calcium Folinate/ Folinic Acid
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Dosing depending on surface area, see BNFc appendix and toxbase link for dosing.
Bolus over 2 minutes or Infusion over 30mins with a max rate of infusion 150mg/minute. Can be given neat for injection, infusion dilute to a convenient volume with either Sodium Chloride 0.9% or Glucose 5%. |
Body surface area in children (image) | Medicines guidance | BNFC | NICE
Folinic acid - calcium folinate or disodium folinate - antidote
Medusa IV Guide entry
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Calcium Gluconate
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Dilute with sodium chloride 0.9% or glucose 5%. IV injection and IV infusion: Dilute each 1mL of calcium gluconate 100mg per 1mL (0.22mmol of calcium in 1mL) with 4mL diluent (final concentration obtained is 0.045mmol in 1mL). Concentrations greater than 0.045mmol in 1mL should be given via a central venous access device. IV injection over 5-10 minutes with cardiac monitoring |
NHS GG&C Paediatric Monograph |
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Calcium Gluconate Gel |
Apply topically or subcutaneously |
Toxbase entry: |
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Cyproheptadine |
Give orally down NG Tube, tablets can be crushed and mixed with 15-30ml of water for administration, always flush NG tube post dose with 10ml of water |
Newt Guideline: NEWT Guidelines - Admin of Tablets |
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Dantrolene |
Reconstitute each 120mg vial with 20ml water for injection. Shake until no particles – do not use if the solution contains particles. Give over at least one minute. This has a high pH – give centrally If possible if not should be given via a large peripheral vein and monitor site closely. Dosing via Toxbase table Dantrolene - antidote |
Medusa IV Guide |
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Desferrioxamine |
Dilution: For intravenous or subcutaneous infusion, reconstitute powder with Water for Injection to a concentration of 100 mg/mL; dilute with Glucose 5% or Sodium Chloride 0.9%. Rate: give 15 mg/kg body weight/hour intravenously until 80mg/kg has been given and then reassess, if not resolved can continue for a further 4 hours |
BNF directions for administration Desferrioxamine mesilate | Drugs | BNFC | NICE And Toxbase entry for rate |
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Digoxin specific antibody (Digibind or Digifab) |
Each vial should be reconstituted with 4 mL of sterile water by gentle mixing (Toxbase) Give as slow IV bolus over 3-5 minutes
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Flumazenil |
No dilution needed See Toxbase entry for dosing, speed and advised timing of dosing |
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Fomepizole |
See toxbase entry and will require discussion with NPIS |
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Glucagon |
Can use neat. See toxbase, only use 5% glucose for dilution if required for infusion |
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Glyceryl Trinitrate |
For continuous intravenous infusion, dilute to max. concentration of 400 micrograms/mL (but concentration of 1 mg/mL has been used via a central venous catheter) with Glucose 5% or Sodium Chloride 0.9%. |
Glyceryl trinitrate | Drugs | BNFC | NICE
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Hydroxocobalamin |
Reconstitute with 0.9% Sodium Chloride and give over 15 minutes Dose of 70mg/kg, 5g max dose DO NOT give Cyanokit in the same IV line (cannula) as other drugs |
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Idarucizumab |
D/W Haematology Consultant |
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Insulin (actrapid) |
When using for high-dose insulin eugylcaemia therapy, use Actrapid neat at 1 unit/ kg See toxbase for infusion details. D/W NPIS On-call prior to using Limited information regarding use in children but all current information suggest using similar doses to adults. |
High Dose Insulin Euglycaemic Therapy - Adults only
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Intralipid 20% |
See toxbase for dosing tables |
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Levocarnitine (L-Carnitine) |
Dosing table on Toxbase |
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Lorazepam |
From BNFc dilute with an equal volume of Sodium Chloride 0.9% (for neonates, dilute injection solution to a concentration of 100 micrograms/mL). Give into a large vein over 3–5 minutes; max. rate 50 micrograms/kg over 3 minutes. |
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Magnesium |
Dilute to 10% (100 mg magnesium sulfate heptahydrate (0.4 mmol Mg2+) in 1 mL) with Glucose 5% or 10%, Sodium Chloride 0.45% or 0.9% or Glucose and Sodium Chloride combinations For Torsades de Pointes give as IV bolus over 3-5 minutes If less emergency indication use protocol for IV Magnesium for acute wheeze Acute wheeze: escalation to intravenous therapy for Acute Wheeze Integrated Care Pathway (ICP) for patients over 2 years old (1128) | Right Decisions |
Magnesium sulfate | Drugs | BNFC | NICE
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Mesna |
Dose as per individual treatment protocol, D/W On-Call Haematology/ Oncology Consultant as required |
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Methylthioninium Chloride (Methylene Blue) |
dosing on toxbase |
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Midazolam |
Give dose over 3 minutes, do not need to dilute |
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Naloxone |
IV bolus Can be given neat or diluted to convienient volume with 0.9% NaCL or 5% GLucose, suggest 4-10ml and titrate dose as required IV Infusion: see monograph |
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Octreotide |
Dosing from toxbase, (1-1.5mg/kg), dilution from bnf For intravenous injection or intravenous infusion, manufacturer advises dilute requisite dose to a ratio of at least 1:1 and up to a maximum of 1:9 by volume with Sodium Chloride 0.9% ?need to specify ration |
Octreotide | Drugs | BNFC | NICE
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Phytomenadione (Vitamin K1) |
Slow IV injection, don’t need to dilute |
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Procyclidine |
Fine to go neat should be given over at least 3 minutes |
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Protamine Sulphate |
See instructions on Toxbase depending if reversing LMWH or Unfractionated heparin |
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Pyridoxine |
See toxbase |
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Sodium Bicarbonate 8.4% |
See monograph |
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Sodium Bicarbonate 1.26% |
As 8.4% |
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Sodium Thiosulphate |
See toxbase entry |
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European Viper Antivenom |
Toxbase has doses on both formulations and oncall pharmacy will supply the vials-Please ensure oncall pharmacy are aware this is EUROPEAN viper antivenom as this needs to be typed in the Pharmacy system properly in order to find a supply. |
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GGC Paediatric Guidelines