How do you start a neutralizing drip?

Starting a Neutralizing Drip

For a neutralizing drip, immediately irrigate the affected area with copious amounts of water, as this is the most effective first-line approach for chemical exposures, especially for acids and alkalis. 1

Initial Assessment and Management

When dealing with a chemical exposure requiring neutralization:

1. Safety first: Ensure you are wearing appropriate protective equipment (gloves, eye protection)
2. Remove contaminated clothing: Brush powdered chemicals off skin with a gloved hand 1
3. Irrigation:
   • For skin/eye exposure: Immediately flush with copious amounts of water 1
   • Continue irrigation for at least 15-20 minutes

Specific Neutralizing Drips by Toxin Type

Alkali Ingestion

• Do NOT attempt chemical neutralization with acids 1, 2
• Do NOT induce vomiting as this may cause additional trauma 2
• Water irrigation is the preferred method for external exposures
• For ingestions, early dilution with water or milk may be considered, though evidence is limited 2

Acid Exposure

• Immediately irrigate with copious amounts of water 1
• Do NOT attempt chemical neutralization with alkalis
• Continue irrigation until pH normalizes

Calcium Channel Blocker Toxicity

• For hemodynamically unstable patients:
  • Administer 20 mg/kg (0.2 mL/kg) of 10% calcium chloride IV over 5-10 minutes 1
  • If beneficial, continue with infusion of 20-50 mg/kg per hour
  • Monitor serum ionized calcium to prevent hypercalcemia
  • Preferably administer via central venous catheter to avoid tissue injury 1
  • If no central access, use calcium gluconate through secure peripheral IV 1

Digoxin Toxicity

• Administer antidigoxin Fab antibodies for severe toxicity 1
• Dosing:
  • If ingested dose known: 2 vials of Fab for every mg of digoxin ingested
  • If unknown dose: Calculate vials using formula: serum digoxin concentration (ng/mL) × weight (kg)/100
  • For critical cases: Empirically administer 10-20 vials 1

Nerve Agent Exposure

• Administer pralidoxime chloride (2-PAM) or obidoxime IV 1
• Follow with atropine and benzodiazepines for CNS effects 1
• Decontaminate with copious amounts of water before administering medications 1

Acetaminophen Toxicity

• Administer N-acetylcysteine (NAC) as early as possible 1
• Routes:
  • Oral: 140 mg/kg loading dose, followed by 70 mg/kg q4h for 17 doses
  • IV: 150 mg/kg loading dose over 15 minutes, then 50 mg/kg over 4 hours, followed by 100 mg/kg over 16 hours 1

Important Cautions

• Do NOT administer anything by mouth for poisoning unless advised by poison control or emergency medical personnel 1
• Do NOT administer activated charcoal unless advised by poison control 1
• Do NOT administer syrup of ipecac for toxin ingestions 1
• For calcium administration, monitor for extravasation which can cause tissue necrosis 3
• When administering calcium with cardiac glycosides, monitor ECG closely due to risk of arrhythmias 3

Contact Resources

Always contact the Poison Help hotline (800-222-1222 in US) for guidance on specific neutralizing protocols 1. They can provide tailored advice based on the specific toxin involved.

Remember that the primary goal of neutralization is to minimize tissue damage and prevent systemic absorption of the toxin, with the ultimate aim of reducing morbidity and mortality.