In low risk patients, the routine use of even low risk antidotes such as activated charcoal is unwarranted. Importantly, most poisoned patients who reach hospital can recover with supportive care alone. For some antidotes, such as atropine and insulin, the doses employed can be orders of magnitude higher than standard dosing. Consequently, decisions about when to use them are often based on a mechanistic understanding of the poisoning and the expected influence of the antidote on the patient's clinical course. There is little randomized trial evidence to support the use of most antidotes. Even then, most are used in a minority of poisonings. These include activated charcoal, acetylcysteine, naloxone, sodium bicarbonate, atropine, flumazenil, therapeutic antibodies and various vitamins. Of the dozens of antidotes currently available, only a few are regularly used. An understanding of mechanisms, potential benefits and risks of antidotes is essential for clinicians who manage poisoned patients.
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