Question :
Posted On : 09 Sep 2016
This query is from DNB exam point view.
In OSCE exam antidotes of various poisons are asked .Antidote is a substance which reverses or halts the action of a poison.
Once antidote for Sodium Valproate was asked for which few candidates answered as carnitine.Carnitine is given for the hepatotoxicity induced by valproate and it does not affect the action of valproate According to me there is no antidote for valproate.
Similarly for tricyclic antidelressent poisoning the antidote was answered Sodium Bicarbonate which is not so.Please guide me.

Thanks and regards!

Dr Mangesh
Expert Answer :
There is no real antidote for valproate toxicity or TCA poisoning. L-carnitine is the active form of Carnitine and is an essential cofactor in the beta-oxidation of fatty acids in the liver. Long-term use of Valproic acid is associated with depletion of serum Carnitine levels and thus it is useful. Similarly for TCA toxicity
Answer Discussion :
mohammad shukry
sodium bicarbonate
4 years ago
walter Amenaghawon
The antidote for sodium valproate poisoning is both administration of carnitine and symptomatic management. while symptomatic management is encouraged for tricyclic antidepressants poisoning
4 years ago
There are no proven antidotes for valproic acid intoxication, although L-carnitine may be considered an adjunct to standard management.Multiple dose activated charcoal and hemodialysis may be useful.
which means we are targeting the most serious
side effect which encephalopathy.
similarly, TCA can cause Cardiotoxic effects primarily result from blockade of inactivated fast sodium channels in a use-dependent manner {blockade is higher at faster heart rates}.
so giving NaHco3 will result in 1. Plasma alkalinization and TCA plasma protein binding
2. Intracellular alkalosis and TCA receptor binding
3. Intracellular hypopolarization
4. Sodium load
5. Correction of metabolic acidosis

4 years ago
prince eska
1. I also know of physotigmine used as a reversal agent for tricyclic antidepressants

2. an antidote is normally used in the acute phase of a condition. Carnitine has an indirect and unspecific mechanism of action to inhibit the effects of sodium caloric acid especially in the acute phase of hepatotoxicity

4 years ago
fity okere
Well you can try Single or Multiple dose activated charcoal. As well as bowel irrigation.
4 years ago

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