Manejo de Antídotos

Antídotos 

Hernando Andrés Olaya Acosta
Médico y Cirujano. Especialista en Toxicología y Farmacología Clínica
Toxicólogo Clínico, Clínica del Country – Hospital Infantil Universitario de San José. Bogotá D.C
Profesor Asistente, Pontificia Universidad Javeriana. Bogotá D.C
Miembro de la Asociación de Toxicología Clínica Colombiana –ATCC
Miembro de la Asociación Colombiana de Medicina Interna –ACMI

Miguel Antonio Tolosa Rodríguez
Médico y Cirujano Especialista en Toxicología Clínica
Toxicólogo Clínico, Hospital Infantil Universitario de San José. Bogotá D.C
Profesor Asistente, Fundación Universitaria Ciencia de la Salud – FUCS
Miembro de la Asociación de Toxicología Clínica Colombiana –ATCC
Miembro de la Academia Americana de Toxicología Clínica –AACT

Verónica Manosalva Jiménez
Médica y Cirujana
Residente de Toxicología Clínica de la Fundación Universitaria Ciencia de la Salud –FUCS
Miembro de la Asociación de Toxicología Clínica Colombiana -ATCC

 

Introducción 

Según reporte epidemiológico del Sistema de Vigilancia de Eventos en Salud Pública – Sivigila, en el año 2015 se reportaron al sistema 14.477 casos de intoxicación con intencionalidad suicida, siendo el 53.5% intoxicaciones con medicamentos y 34.4% con plaguicidas población1.

La población más afectada fueron jóvenes entre 15 y 24 años1. En ese mismo año, fueron notificados a Sivigila 33.503 casos de intoxicaciones por sustancias químicas (principalmente con medicamentos), lo que representó un aumento del 5.4% de casos respecto al año anterior (1).

Por otra parte, la Asociación Americana de Centros de Control de Envenenamiento (APCC por sus siglas en inglés) anualmente reporta en promedio 2.400.000 exposiciones a tóxicos en humanos y 1300 muertes relacionadas con intoxicaciones2. Sin embargo, solo algunos pacientes requieren hospitalización y no a todos se les administra antídoto, debido a que estos se utilizan bajo criterios especiales y no siempre se cuenta con ellos. (Lea también: Enfermedades Transmitidas por Alimentos)

La poca disponibilidad de antídotos:

Es un fenómeno mundial que se ha atribuido a costos, dificultades en importación o en fabricación, medicamento disponible en una forma farmacéutica inadecuada para tratamiento de la intoxicación, poco uso de algunos o dificultades regulatorias3, 4. Por ejemplo en Inglaterra solo alrededor del 50% de los hospitales tiene disponible los antídotos recomendados para un servicio de urgencias5.

En este capítulo se incluye tabla con los antídotos más frecuentemente usados en servicios de urgencias a nivel mundial, infortunadamente algunos de los mencionados no se encuentran disponibles o tienen acceso muy limitado en Colombia al igual que en otros países de América Latina. La tabla como guía práctica, incluye indicación, dosis, forma de administración, seguimiento clínico, precauciones y eventos adversos frecuentes de cada uno de ellos.

Adicionalmente se debe tener en cuenta que en algunas situaciones es el escenario clínico quien determina la decisión no solo del uso de un antídoto, sino que también su vía de administración y el cálculo de la dosis. La indicación puede ser variable dependiendo del tóxico y del momento clínico de la administración.

Se recomienda que, ante cualquier sospecha de intoxicación o envenenamiento, siempre se cuente con el apoyo de líneas de toxicología y de centros hospitalarios que cuenten con toxicólogos clínicos.

Definiciones a tener en cuenta:
  • Agonista: molécula o fármaco que se une al receptor y activa señalización intracelular6.
  • Antagonista: molécula o fármaco que se une al receptor, pero no desencadena la generación de una señal6.
  • Antídoto: agente que aumenta la dosis letal media de una toxina o simplemente un agente que invierte o neutraliza un veneno7.
  • Quelante: del latín chela o garra, molécula con la propiedad de unirse con el metal y formar complejos atóxicos que facilitan la excreción del organismo8.

Antídotos seleccionados para manejo de urgencias

Ácido Folinico (Leucovorina)

Anticuerpos FAB antidigital

Atropina

Azul de metileno

BAL (Dimercaprol)

Bicarbonato de sodio

Calcio

Dantroleno

Deferoxamina

Edetato Cálcico Disódico

Emulsiones lipídicas

Etanol

Fomepizol

Flumazenilo

Glucagón

Insulina ( dosis altas de insulina con glicemia normal)

N-acetil cisteina (NAC)

Naloxona

Nitrito de amilo

Nitrito de sodio

Octreotido

Piridoxina

Pralidoxima

Protamina

Succimer

Antiveneno polivalente antibotrópico, anticrotálico y/o antilachesico

Suero antiofídico monovalente antielápido

Tiamina

Tiosulfato de sodio

Vitamina K1 (Fitomenadiona)

 

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