Acute poisoning with cardiac glycosides. Overdose of cardiac glycosides Emergency care for intoxication with cardiac glycosides

Of greatest toxicological interest are those cumulating in the body cardiac glycosides and preparations from various types of foxglove- digitoxin, gitoxin, celanide, lantoside, digalen-neo and others, as well as glycosides from oleander adjacent to them in terms of pharmacological properties. Absorbed at different rates from the stomach and intestines: preparations of foxglove purpurea slowly, woolly (celanid) - quickly.

In the blood, they are adsorbed by plasma proteins, excreted slowly (cumulated) by the kidneys.

Digitalis poisoning and its preparations may occur either as a result of an overdose, or with prolonged use due to the ability of this group of cardiac glycosidoses to accumulate in the body, as well as due to increased sensitivity to them.

A lethal dose of foxglove leaves and squill bulbs 2-4 g digitoxin- 2-4 mg; for other digitalis-like drugs, it is 20-50 times the maintenance dose.

Pathogenesis and symptoms of poisoning. In the pathogenesis of poisoning with cardiac glycosides of the digitalis group, the deterioration of the work of the heart under the direct action of toxic doses of these drugs on it, as well as a direct effect on the central nervous system, in particular, the stimulating effect on the centers vagus nerve. As a result of a sharp deterioration in atrioventricular conduction and increased excitability, significant cardiac arrhythmias can occur: extrasystole, bigeminia, partial or complete atrioventricular blockade with atrial fibrillation, tachysystole and paroxysmal tachycardia of ventricular origin. Impact on the central nervous system, in particular stimulation of the vomiting center, causes anorexia, nausea, and vomiting. Less common are neuropsychiatric disorders associated with hypoxic shifts and the effect of drugs on the activity of the cerebral cortex (motor excitation, delirium, convulsions, loss of consciousness). The inhibition of diuresis noted during the period of poisoning is associated with a central dysfunction of the vagus nerve and with a spasm of the renal vessels.

Symptoms of acute poisoning with cardiac glycosides: anorexia, nausea, persistent vomiting, hiccups, colicky pain in the epigastric region and abdomen, diarrhea with delayed diuresis. The pulse is sharply slow, irregular. Rhythm disorders - from individual extrasystoles, bigeminia to ventricular fibrillation, ventricular paroxysmal tachycardia (with complete atrioventricular blockade). Changes on the ECG are characteristic - prolongation of the PQ interval, displacement of the ST segment under the isoelectric line. Vision may be impaired: xanthopsia, diplopia, photophobia, etc. The pupils are dilated (rarely narrowed), exophthalmos, paresis of the eye muscles are observed.

Are celebrated headache, weakness, drowsiness, in case of severe poisoning - delirium, shortness of breath, cyanosis, coma, convulsions, lowering blood pressure, ventricular fibrillation, cardiac arrest in the diastolic stage.

Symptoms of irritation of the digestive system (colic, vomiting, diarrhea) are also clearly manifested in case of poisoning with oleander and its preparations.

First aid and treatment for poisoning with cardiac glycosides. Gastric lavage through a probe with a suspension of activated charcoal (20-30 g in 1 liter of water) or 0.2-0.5% tannin solution, followed by the introduction of saline laxative and cleansing enema. Emetics in case of poisoning with digitalis preparations and their analogues are contraindicated. The toxic effect of cardiac glycosides on the myocardium (arrhythmias, cardiogenic collapse) is stopped by potassium chloride. With normal kidney function, the latter is prescribed (in the absence of vomiting) by mouth at 0.5 g (dissolved in water) every 15 minutes or in the form of a 0.3% potassium chloride solution (in 5% glucose solution) slowly intravenously - until until an improvement is noticeable on the ECG or the potassium content in the blood does not increase to 5 mmol / l.

With reduced kidney function, it is necessary to preliminarily determine the content of potassium in the blood serum before the introduction of potassium chloride. Maximum dose potassium chloride on the first day after poisoning - 4 g; the next day - 2g. Intravenously, 20 ml of a 10% solution of tetashsh-kalshya is injected intravenously with 300 ml of a 5% glucose solution.

To reduce the toxic effect of cardiac glycosides, unithiol is also used (intramuscularly, 5 ml of a 5% solution 4 times a day) and disodium EDTA (2-4 g in a 5% glucose solution intravenously over 3-4 hours).

Apply anaprilin (10-30 mg 3 times a day), novocaine-amide - orally 0.5-1 g every 2 hours (total up to 4 g) or intramuscularly 5-10 ml of a 10% solution 3-4 times a day day, as well as quinidine sulfate - orally 0.2 g 3-4 times a day, novocaine - intravenously, 2-5 ml of a 0.25% solution 2-3 times a day. Severe bradycardia, nausea, vomiting are stopped by repeated administration of atropine sulfate (0.5-1 ml of a 0.1% solution under the skin).

To combat dehydration, parenteral fluid administration (isotonic sodium chloride solution, 5% glucose solution) is recommended. To eliminate hypoxia, inhalation of oxygen is used. The phenomena of excitation are stopped by barbiturates. In the event of cardiogenic collapse, vasoconstrictors (adrenaline hydrochloride, norepinephrine hydrotartrate) may cause ventricular fibrillation and are therefore contraindicated. In the treatment of acute poisoning with cardiac glycosides, strict bed rest is necessary.

Treatment of acute poisoning, 1982

These substances, used for weakness of the heart, are one of the vital important medicines which are essential for the elderly.

However, only the correct dosage of the drug will provide a good therapeutic effect.

The process of absorption of drugs is quite complicated, even a slight deviation from the prescribed dose can play a cruel joke: instead of the desired improvement in the condition, the patient develops glycoside intoxication.

Features of drugs

Glycosidic substances are able to restore the balance of minerals in the heart muscle for its normal functioning. They do an excellent job with heart failure, weakness of the heart muscle, bradycardia and tachycardia.

However, only the exact dose will help the patient feel much better. An overdose of cardiac glycosides can occur even with a negligible excess of a substance that has the ability to accumulate. That is why the first symptoms of an overdose of cardiac glycosides may occur a day or two after an increase in the applied dose.

The main symptoms of poisoning

Poisoning with cardiac glycosides affects the functioning of such systems of the human body:

• gastrointestinal tract;
• nervous system;
• excretory functions;
• cardiovascular system.

Mild glycoside intoxication may slightly worsen the patient's condition. If it was an extraordinary pill that a person took due to elementary forgetfulness, then intoxication with cardiac glycosides may resemble food poisoning.

Urgent care with glycoside intoxication with cardiac drugs, it is necessary if the following symptoms occur:

• visual impairment (visual color hallucinations appear, the prevailing colors are yellow and green);
• trembling in the hands, weakness;
• a significant decrease in the number of heartbeats per minute (bradycardia);
• blueness of fingertips and nasolabial triangle.

Influence on the gastrointestinal tract

Poisoning with cardiac glycosides in small doses can cause nausea and vomiting. If it was a single overdose, then the symptoms of malaise will subside in a few hours. A day later, a person will feel much better.

If you notice signs of an overdose in yourself or a close relative, you should calm him down, give activated charcoal and provide plenty of fluids.

Heart drugs and the nervous system

In case of poisoning with cardiac glycosides, a serious load on the nervous system occurs. A specific sign is the appearance of color visual hallucinations (primary colors are yellow and green).

Hand tremors and seizures may occur.

When intoxicated with such substances, it worsens general state a person, there is confusion, dizziness and an acute shortage of fresh air.

Glycosidic substances and excretory functions

Excess of these substances in the body affects the liver and kidneys. A distinctive feature of the manifestation of these substances in the body can be considered a lack of appetite and a sharp decrease in urine output, up to its complete absence.

Drug overdose: effects on the heart

The paradoxical effect of substances is that their excess leads to a sharp deterioration in the symptoms against which the remedy was used. The victim has:

• weakness, lethargy;
• weakening heart rate, heart failure occurs;
• heart rhythm failures that are easily diagnosed on an ecg.

Actions in case of poisoning

Everyone who has heart problems, as well as close relatives of these people, needs to know about the first emergency aid for an overdose of the drugs they take. After all, digitalis intoxication, the treatment of which involves constant monitoring by specialists, can nullify a long regressive period of the disease.

Most often, inpatient treatment is necessary, because an ECG with an overdose of cardiac glycosides may be required quite often.

What can be done at home

If cardiac poisoning is suspected, the next dose should be withheld and activated charcoal should be taken according to weight.

When the drug has been used for a long time and there are suspicions that several tablets were drunk at once, you should rinse the stomach by drinking several glasses of water in one gulp and then pressing on the root of the tongue.

It is important to provide good air access and complete rest, unfasten tight clothing and put the victim to bed.

Calling the emergency team

The antidote of cardiac glycosides is administered in a hospital setting. It can be a drug based on antibodies to digoxin, obtained from sheep serum or chicken protein. In medical practice, several substances are used with similar properties, but only a qualified specialist in a hospital can choose the most effective one.

At home, the emergency team will perform an additional gastric lavage using a special tube. Through an additional tube, about a glass of oil can be injected into the stomach to stop the spread of digoxin throughout the body.

Depending on the condition of the victim and the data on the cardiogram, the emergency team analyzes whether this type of assistance was effective and what further measures are necessary. Thus, they come to a decision about the need for hospitalization.

Severe poisoning: hospitalization

In case of intoxication with cardiac glycosides, caused by a dose twice the therapeutic one, treatment is carried out in a hospital. It is important to remember that by taking five times more of the drug than necessary, a person can die.

Therefore, the use of these substances by persons who have memory problems should be carried out under the supervision of relatives. In cases of accidental overdose, urgent medical attention is required.

In a hospital, all available methods are used to alleviate the condition of the victim. After the introduction of the antidote, positive dynamics should be observed already within an hour. It can be clearly traced with the use of special cardiac equipment.

If the body tolerated the introduction of the antidote well, then the consequences and the disease state of the person are corrected.

Since the digitalis preparations used disrupt the balance of essential trace elements in the heart muscle, additional injections of potassium or magnesium electrolytes may be required.

Glucose deficiency may occur, then a saline solution with glucose is administered by drip. This combination is useful in almost any type of poisoning.

Further treatment is carried out under the strict supervision of specialists who, with the help of laboratory observations, must restore the disturbed balance.

Forecast

The positive effect of digitalis substances on the cardiovascular system has long been known. To improve the functioning of the heart, foxglove was used, Latin name which sounds like digitalis.

Description:

A condition that develops as a result of the toxic effects of cardiac glycosides. can occur both against the background of an overdose and at a normal concentration of digitalis preparations in the blood plasma (for example, when most of the cardiac glycosides circulate in a free state, which leads to a more rapid development of toxic effects). The course is usually acute, rarely chronic. Statistical data. The frequency is 5–23% of patients taking digitalis preparations and other cardiac glycosides.

Symptoms:

Symptoms of rhythm disturbance: (especially non-paroxysmal tachycardia from the atrioventricular node), occurring after a period of normalization of heart rate or bradycardia; , ventricular (especially bigeminia); ventricular tachycardia (including multifocal); (seldom). It must be remembered that while maintaining tachycardia in a patient taking cardiac glycosides, their overdose must be excluded.

Symptoms of conduction disorders: AV blockade of various degrees; sinoatrial blockade.

Symptoms of gastrointestinal dysfunction: anorexia, abdominal pain,.

Symptoms of dysfunction of the central nervous system: headache, nightmares, decreased visual acuity, impaired color vision (yellow or green spots before the eyes), blindness.

ECG signs: trough-shaped depression of the ST segment; prolongation of the P–Q interval >0.20 s; decrease in amplitude, inversion of the T wave; shortening of the QT interval; sudden cardiac arrhythmia on the background of taking CG: sinus bradycardia, atrioventricular, atrial or ventricular extrasystoles (often allorhythmia in the form of bigeminy or trigeminy), non-paroxysmal tachycardia from the atrioventricular node, (rarely), AV blockade of the second degree in Samoilov's periodicals – Wenckebach, bundle branch block, atrial tachycardia with AV block, bidirectional ventricular tachycardia (QRS complexes on the ECG are alternately positive and negative).

Laboratory tests: Elevated levels of SG in the blood (for digoxin >2 ng/ml [>5.1 nmol/l], for digitoxin >35 ng/ml), .

Causes of occurrence:

Overdose of cardiac glycosides (including suicidal attempts). Poisoning by plants containing cardiac glycosides.
Risk factors:
- Hypoxia
- Hypokalemia (including when taking diuretics that remove potassium from the body)
-
-
- Myocardial infarction
- Postinfarction
- Transferred in the past
- hepatic or
-
-
- Electrical cardioversion
- Elderly age
- Hypoproteinemia (including due to insufficient intake of protein with food)
- Co-administration of cardiac glycosides and quinidine, verapamil, amiodarone, propafenone.

Treatment:

For treatment appoint:

Lead tactics. Mode - stationary with limited physical activity, the abolition of cardiac glycosides. Maintaining the optimal concentration of electrolytes in blood plasma (potassium - per upper bound norms: 5.5 mmol/l). The use of quinidine, which increases the concentration of digitalis in plasma by releasing it from the bound state and reducing the renal and extrarenal excretion of the drug, as well as b-blockers and b-adrenergic agonists, should be avoided. Temporary transvenous pacemaker if necessary (in cases of severe bradycardia, complete AV blockade with Morgagni-Adams-Stokes attacks).

Drug Therapy:

With bradycardia - atropine.
In case of intoxication against the background of hypokalemia - potassium preparations, for example, potassium chloride orally or intravenously as part of a polarizing mixture (potassium chloride 2 g, insulin 6 IU, 5% glucose solution 350 ml; potassium chloride 4 g, insulin 8 IU, 10% glucose solution 250 ml). When taking the drug orally in patients with dilatation of the left atrium or in the treatment of anticholinergics, the risk of ulceration of the mucous membrane of the esophagus and stomach is increased.
With tachycardia, in addition to potassium preparations, it is possible to prescribe b-blockers.
For ventricular arrhythmias - lidocaine 50-100 mg IV over 3-4 minutes, if necessary, repeat every 5 minutes up to a total dose of 300 mg / h, or infusion at a rate of 20-50 mcg / kg / min. Magnesium preparations are indicated for each patient with suspected digitalis intoxication in the absence and without impaired renal function.
To accelerate the excretion of the glycoside - activated charcoal 25 g every 4 hours for 40 hours.
acidosis correction. The course and prognosis are favorable after 24 hours from the first signs of intoxication.
Observation: frequent ECG, determination of concentrations of potassium and cardiac glycosides in blood plasma, monitoring of kidney function.

Prevention: Careful monitoring of the patient taking SG. Monitoring the concentration of potassium in the blood plasma. Complete nutrition.

For treatment various diseases hearts, cardiac glycosides have been successfully used for many years. These herbal preparations have cardiotonic and antiarrhythmic effects. Preparations of this group allow you to establish an economical and efficient work of the heart muscle with various types heart failure. Cardiac glycosides have a decongestant, vasoconstrictor, diuretic effect. These drugs are prescribed according to strict indications, and are also used to relieve acute conditions. Such a cautious approach to cardiac glycosides is due to the high toxicity of these drugs, which tend to accumulate in the body. If the patient is prescribed cardiac glycosides, then he must constantly be monitored by a doctor to adjust the dosage.

An overdose of cardiac drugs, such as cardiac glycosides, can occur for a variety of reasons. Most often, an overdose of cardiac glycosides occurs in people undergoing treatment with these drugs. It should also be mentioned that an overdose of cardiac drugs with a fatal outcome often occurs in cases where a person has planned to commit suicide with the help of cardiac glycosides. Symptoms of an overdose of cardiac glycosides are manifested in visual impairment, a decrease in heart rate, and disorders of the gastrointestinal tract. In acute poisoning with glycosides, death occurs due to cardiac arrest and asphyxia.

If the victim has such signs of an overdose of cardiac glycosides as headache, dizziness, blue nasolabial triangle, shortness of breath, hypoxia, convulsions, then he needs emergency help. An overdose of cardiac glycosides leads to coma. To avoid this, it is necessary to wash the stomach and conduct a specific treatment with an antidote - sodium citrate or disodium salt with glucose. In case of an overdose of cardiac glycosides, treatment should be carried out in a hospital, since the condition of the victim is assessed as extremely serious.

The patient is in the intensive care unit until his condition is completely stabilized. Treatment of overdose with cardiac glycosides involves the use of a number of drugs and medical measures: the introduction of glucocorticosteroids, antiarrhythmic drugs, glucose with insulin, Atropine, potassium preparations. Only after several days of intensive therapy can we say that the consequences of an overdose of cardiac glycosides are completely eliminated, and the prognosis for recovery is favorable.

Other popular cardiac drugs can also cause overdose. In the first place in terms of the number of poisonings is Corvalol. According to statistics, 99% of older people use Corvalol daily in order to calm down and relieve heart pain. Active substance in this preparation - phenobarbital, which provides an antispasmodic and sedative effect. Therefore, Corvalol is taken not only for cardiovascular diseases, but also with insomnia, hypochondria, irritability. Many doctors believe that Corvalol is not only useless, but simply dangerous, since an overdose of this drug often ends in death. Just half a bottle and death from an overdose of Corvalol is guaranteed. Another danger is the ability of this drug to be addictive, which entails an increase in dosage. Violation of the instructions for use and neglect of the recommendations of the attending physician leads to an overdose of Corvalol of varying severity.

Many older people cannot imagine their life without these heart drops. They take increased doses of the drug several times a day, which inevitably leads to negative consequences from an overdose of Corvalol. It is worth saying that, depending on the amount of the drug taken, there is a mild, moderate and severe degree of poisoning with this medicine. Is it possible to die from an overdose of Corvalol? Yes, if we are talking about acute drug intoxication. Symptoms of an overdose of Corvalol are more than alarming: a person loses consciousness, does not respond to irritating effects, since reflexes are impaired, breathing is weak. This condition is called barbituric coma.

With an overdose of Corvalol in drops, signs of heart failure develop very quickly: a sharp drop in blood pressure, a cyanotic skin tone in the nasolabial triangle, wheezing and weak breathing. Without immediate treatment, an overdose of Corvalol leads to pulmonary edema, from which death occurs. What to do with an overdose of Corvalol to save a person's life? It is necessary to immediately call professional doctors, call an ambulance! Before the doctors arrive, lay the patient down, provide oxygen access, turn his head to one side. Monitor breathing and pulse, if there are no indicators, proceed to artificial respiration and indirect massage hearts.

It is necessary to say a few words about the foreign analogue of Corvalol, namely, about Valocordin. It should be remembered that its vasodilating, antispasmodic and hypnotic effect is provided by phenobarbital, which, in combination with alcohol, can be very dangerous. In most countries of the world, this drug is on the banned list, however, in Russia it can be freely purchased at any pharmacy at a very affordable price. An overdose of any heart medication is extremely dangerous for a person, so you should carefully read the instructions for use. This will help to avoid an overdose of Valocordin. In high doses, Valocordin has a depressing effect on the central nervous system. Symptoms in case of severe overdose of Valocordin are identical with the signs of Corvalol intoxication described above: a drop in blood pressure, heart rhythm disturbance, falling into a deep coma with tissue hypoxia.

Death from an overdose of Valocordin occurs due to acute liver or acute heart failure. At the first sign of poisoning, it is necessary to immediately call the doctors, this is the only chance to save a person's life. The consequences of an overdose of Valocordin can only be eliminated in a hospital where appropriate measures will be taken: artificial ventilation of the lungs, administration of glucose, and other measures aimed at maintaining the vital functions of the body.

A few words about an overdose of the well-known heart pills called Validol. Chemical composition This drug is non-toxic, which means that poisoning can occur when used in excess of doses of the drug. Usually, daily dose should not exceed 300 mg. An overdose of Validol is very dangerous for children, as it causes respiratory arrest. But with age, this reaction disappears. This drug is usually taken for cardioneurosis, pain in the heart. The overdose symptoms that these heart pills cause are manifested when high doses of the drug are used: lacrimation, nausea, vomiting, salivation, dizziness, headache, decreased blood pressure, loss of consciousness.

As mentioned above, death from an overdose of Validol occurs in children due to oppression. respiratory function, so they should not be given these mint tablets. However, there are often cases of overdose with Validol tablets, which children find in home medicine cabinets. In some situations, Validol may cause allergic reaction up to Quincke's edema. How to avoid the severe consequences of an overdose of Validol? It is necessary to wash the stomach of the victim, give him an absorbent, as well as antihistamine. If such actions do not bring the desired result: immediately call an ambulance! The victim needs emergency treatment in a hospital setting.

Cardiac glycoside poisoning can occur with an overdose of these potent drugs. More often, an overdose of cardiac glycosides develops with the simultaneous treatment of heart failure with diuretic drugs.

First emergency aid for cardiac glycoside poisoning, symptoms and treatment.

Signs of poisoning with cardiac glycosides appear when the minimum therapeutic dose is exceeded by only 2 times. Given the individual sensitivity of patients to medicines, the risk of overdose of cardiac glycosides is great. Exceeding the minimum therapeutic dose of cardiac glycosides by 5-10 times is fatal.

The most commonly prescribed glycoside for the treatment of heart disease is digoxin. Its absorption and distribution to tissues in the body is slow, it gradually accumulates in muscle tissue and liver. With violations of the functions of the kidneys and liver, its excretion from the body slows down even more and the likelihood of poisoning increases. Therefore, cardiac glycosides are prescribed only under the supervision of a physician and their doses are adjusted during treatment. Patients with an overdose of cardiac glycosides or poisoning with them need emergency care.

Symptoms of poisoning with cardiac glycosides.

In case of poisoning with cardiac glycosides, vomiting appears, consciousness is disturbed (confusion), then it is lost, there may be convulsions. Visual disorders develop - vagueness of visible objects, impaired color perception, fear of light, loss of visual fields. Toxic damage to the heart is manifested by disturbances in the rhythm of its contractions, a decrease in the frequency, atrioventricular blockade. In acute poisoning, on the contrary, there is an increase in heart rate, a decrease in the level of potassium in the blood.

Emergency care for poisoning with cardiac glycosides.

In case of poisoning with cardiac glycosides, these drugs are canceled. Do not induce vomiting or give emetics, as this may adversely affect cardiac activity. It is necessary to wash the stomach through a tube. Give the victim activated charcoal and a saline laxative (15–30 g sodium sulfate). Activated charcoal is also given in the future, it helps to remove cardiac glycosides, not only in the intestines, but also contained in the blood.

Intramuscularly injected 5% unithiol solution (5 ml 4 times a day) and 30% solution of tocopherol acetate (vitamin E) - 2 ml per day. Of the glucocorticosteroid drugs, hydrocortisone is used (intramuscularly administered at 125 mg 3 times a day). If a frequent pulse is noted against the background of poisoning, then drugs such as a 20–25% solution of magnesium sulfate, a solution of lidocaine (1–3 mg / kg of body weight), phenytoin (according to the scheme) are administered.

When the pulse slows down, 1 ml of a 0.1% solution of atropine sulfate is injected subcutaneously. It is possible in this case to use isoprenaline hydrochloride intravenously (0.05–2 μg / kg of body weight per minute), antidigoxin. The last drug is administered intravenously slowly over 30 minutes, with cardiac arrest - in a stream. To neutralize 0.6 mg of digoxin, 40 mg of antidigoxin is required.

With atrial fibrillation (very frequent ineffective heart contraction), 5 ml of a 10% solution of novocainamide is injected intravenously. Infusion therapy in the mode of forced diuresis and hemodialysis are ineffective in case of poisoning with cardiac glycosides. Hemosorption can give a positive result.

Poisoning by opiates, substances and medicines narcotic action.

Opiates include substances and narcotic drugs derived from opium (morphine, heroin, codeine, promedol, and others). With an overdose of these substances, inhibition of the cerebral cortex, depression of the respiratory and cough centers, and excitation of the vomiting center of the brain occur.

Symptoms of poisoning with opiates, substances and drugs of narcotic action.

First, deep sleep develops, which gradually turns into. There is a lack of consciousness and pain sensitivity. Pronounced blue skin, sweating. Body temperature is reduced. Breathing becomes shallow, then irregular. The pulse slows down. Arterial pressure decreases. Pulmonary edema often develops. The pupils are very narrowed, look like dots, do not react to light.

First emergency aid in case of poisoning with opiates, substances and drugs of narcotic action.

It is necessary to turn the head of the victim to one side to prevent leakage of the contents of the stomach into Airways. Provide access to fresh air. Urgently call an ambulance medical care". Conduct activities as needed. The doctor inserts a breathing tube into the trachea and a probe into the stomach. Then the stomach is thoroughly washed, preferably with a weak (1: 2000) solution of potassium permanganate, and 100–150 ml of a 33% solution of magnesium sulfate is injected into the stomach. After that, diuretics (furosemide) are administered.

All victims are inhaled with humidified oxygen, intravenously injected with a solution of sodium bicarbonate. In case of poisoning with opiates, antagonists - naloxone hydrochloride or nalorphine hydrochloride - are administered intravenously, intramuscularly or subcutaneously. The initial dose for adults is 400 micrograms, for children - 5-10 micrograms / kg of body weight. After 3-5 minutes, if necessary, the drug is administered again.

Based on the book "Quick help in emergency situations."
Kashin S.P.