The Critical Role of Antidotes in the Emergency Management of Poisoning: A Comprehensive Review of Mechanisms, Clinical Applications, and Strategic Stockpiling

Abstract

Poisoning, whether accidental or intentional, remains a significant global cause of morbidity and mortality. The emergency management of poisoning is multifaceted, relying on decontamination, supportive care, and the timely administration of specific antidotes where available. This paper provides a comprehensive review of the role of antidotes in clinical toxicology. We define antidotes as therapeutic agents that counteract the effects of a poison through mechanisms such as receptor blockade, chelation, metabolic enhancement, or antibody-antigen neutralization. While fewer than 5% of poison exposures require an antidote, their appropriate use is life-saving and organ-sparing in critical scenarios. This review details the pharmacology of key antidotes, their evidence-based applications, and the logistical challenges of maintaining antidote availability. We emphasize the integration of antidote therapy within a holistic resuscitation framework and discuss future directions, including the development of novel broad-spectrum agents and the implications of precision medicine in toxicology.