Abstract
Poisonings occur for a variety of reasons. For instance, cyanide poisoning can occur from smoke inhalation in fires. Excessive use of over-the-counter medications such as acetaminophen (Tylenol and Panadol) can cause overdose. Several antidotes are available for acute use in emergency rooms. This article focuses on natural antidotes, including vitamins, nutritional supplements, and herbs.

Natural Antidotes in Emergency Care

The following is a list of natural antidotes for poisonings that are commonly stocked in emergency care units.^1-3

• Hydroxycobalamin for cyanide poisoning.
• N-acetylcysteine (NAC) for acetaminophen poisoning.
• Methionine and N-acetylcysteine (NAC) for paracetamol poisoning.
• Folic acid and pyridoxine for methanol and ethylene glycol poisoning.
• Silibinin and pyridoxine for amatoxin, gyromitrin (both are toxins found in mushrooms) and isoniazid toxicity.
• Repeat-dose activated charcoal for enhancement of elimination.
• Magnesium sulphate for cardiac arrhythmias.
• Sodium bicarbonate for metabolic acidosis and cardiac disturbances in cyclic antidepressant overdose.
• Potassium iodide for thyroid radioiodine protection.

Natural Antidotes Based on Clinical Studies

The following natural antidotes are based on human studies.

Antioxidants for acute amitriptyline abuse for pain. Amitriptyline is a tricyclic antidepressant used to treat depression. Tricyclic antidepressants (TCAs) are the main cause of damaging antidepressant overdose because, unlike other antidepressants, they have a narrow therapeutic range and become potent cardiovascular and central nervous system toxins in moderate doses.

Antioxidants like alpha lipoic acid and vitamin C can decrease oxidative stress induced by acute amitriptyline poisoning when compared with routine standard treatment.^4,5

Vitamin E for acute aluminum phosphide poisoning. Aluminum phosphide (AlP) is a cheap, solid fumigant and a highly toxic pesticide which is commonly used for grain preservation.

Vitamin E may be a novel therapy in the treatment of acute aluminum phosphide poisoning.⁶

Rhubarb for acute paraquat poisoning. Rhubarb as the main drug can effectively eliminate paraquat, reduce absorption, prevent the development of multiple organ dysfunction syndrome (MODS), shorten the hospital stay days, and improve the prognosis of acute paraquat poisoning (APP).⁷

Nigella sativa seed for chemical war victims. A study examined the prophylactic effect of boiled extract from N. sativa on chemical war victims of the Iraq–Iran war of 1980–1988 exposed to sulfur mustard (SM).

N. sativa significantly improved all respiratory symptoms, chest wheezing, and PFT. The use of inhaler and oral beta-agonists and oral corticosteroid in the study group decreased at the end of the study.

N. sativa may have a prophylactic effect on chemical war victims.⁸

Rosa roxburghii Tratt juice for Arsenic Poisoning. Rosa roxburghii Tratt (RRT) is a traditional Chinese edible fruit that may be a potential therapeutic agent in arsenicosis.⁹

Conclusion

Many natural antidotes are stocked in emergency rooms. Several natural therapies have been shown to be beneficial in clinical studies. They may be helpful in caring for the chronic issues in these patients.

References

1.   Dart, RC, et al. (2018), ‘Expert Consensus Guidelines for Stocking of Antidotes in  Hospitals That Provide Emergency Care.’, Ann Emerg Med, 71 (3), 314-325.e1. PubMed: 28669553
2.   Dart, RC, et al. (2009), ‘Expert consensus guidelines for stocking of antidotes in hospitals that provide emergency care.’, Ann Emerg Med, 54 (3), 386-394.e1. PubMed: 19406507
3. Pronczuk de Garbino, J, et al. (1997), ‘Evaluation of antidotes: activities of the International Programme on Chemical Safety.’, J Toxicol Clin Toxicol, 35 (4), 333-43. PubMed: 9204092
4. Ali, SHK, et al. (2022), ‘Antioxidants Supplementation in Acute Amitriptyline Abuse for Pain.’, Appl Biochem Biotechnol, 194 (1), 556-69. PubMed: 34699040
5. Kadar Ali, SH and WA Raja (2019), ‘The effect of antioxidants in acute amitriptyline poisoning.’, Toxicol Rep, 6 380-88. PubMed: 31080745
6. Halvaei, Z, et al. (2017), ‘Vitamin E as a novel therapy in the treatment of acute aluminum phosphide poisoning.’, Turk J Med Sci, 47 (3), 795-800. PubMed: 28618724
7. Wang, W, et al. (2015), ‘[Effect of rhubarb as the main composition of sequential treatment in patients with acute paraquat poisoning: a prospective clinical research].’, Zhonghua Wei Zhong Bing Ji Jiu Yi Xue, 27 (4), 254-58. PubMed: 25891453
8. Boskabady, MH and J Farhadi (2008), ‘The possible prophylactic effect of Nigella sativa seed aqueous extract on respiratory symptoms and pulmonary function tests on chemical war victims: a randomized, double-blind, placebo-controlled trial.’, J Altern Complement Med, 14 (9), 1137-44. PubMed: 18991514
9. Dong, L, et al. (2022), ‘Potential value and mechanism of Rosa roxburghii tratt juice on pro-inflammatory responses in peripheral blood of patients with arsenic poisoning.’, Hum Exp Toxicol, 41 9603271221121313. PubMed: 35968550

Published September 23, 2023