A study in this issue of CMAJ showing that most Ontario hospitals do not stock “even minimally adequate amounts” of 10 common antidotes comes as no surprise to a Quebec physician who has been warning rural hospitals about the same problem.
Dr. Vydas Gurekas of the Society of Rural Physicians of Canada says the lack of certain antidotes in rural areas that don't have a pharmacy nearby is “unacceptable.” Gurekas, director of the Centre de Santé de Temiscaming, said many emergency departments in both rural and urban areas do not have enough of a specific antidote on hand to treat 2 adult patients at once.
The CMAJ study (page 27) found that only 1 hospital of the 179 surveyed stocked adequate amounts of all 10 selected antidotes. “Poisonings are often sporadic, but if you aren't prepared, the patient can really suffer,” said the study's chief investigator, Dr. David Juurlink. Cyanide exposure can result in death within 45 minutes; the antidote costs $50. Juurlink says the main problem is that hospitals simply don't think about these stocks because they are used so rarely.
The authors conclude that the problem could largely be solved, at no cost, if hospitals stopped stocking excessive amounts of some expensive antidotes. (The most expensive in the study is the digoxin immune Fab antibody fragments, used to treat digoxin-induced arrhythmias — $8241 for a minimum stock.) “But even cheap antidotes aren't stocked,” said Juurlink.