TABLE 132.7 PHARMACEUTICAL STOCKING ESTIMATES FOR ONE EMERGENCY DEPARTMENT IN A HYPOTHETICAL CHEMICAL AGENT ATTACK a Agent/antidote Pediatric dose Adult dose Total requirement (for 500 patients) Nerve agents Atropine 0.02–0.05 mg/kg 2–5 mg (minimum dose, 0.1 mg) Pralidoxime 25–50 mg/kg 1–2 g ampule 30 sec out of every minute 0.33 mL/kg (for Hgb 12 g/dL) 1.65 mL/kg amp 10 mL 1,500 ampules 4,575 mL 50 mL 25,000 mL = 500 vials (50 mL each) 2,138 g Cyanide Amyl nitrite Na nitrite (3%) Na thiosulfate (25%) Hydroxocobalamin 70 mg/kg 5g 6,875 mg = 17,188 amps (1 mL of 0.4 mg/mL); 859 vials (20 mL of 0.4 mg/mL) 1,875 g = 1,875 vials (1 g each) Note: Cyanide treatment would require either 375 nitrite/thiosulfate-based or 428 hydroxocobalamin-based cyanide antidote kits a Assumptions: 500 patients to one emergency department (as per one hospital’s experience in the Tokyo sarin attack); one-half of the patients are children with average weight of 10 kg; if nerve-agent attack, severe exposure necessitating maximal doses of atropine and pralidoxime; five atropine doses over 12 hrs; three pralidoxime doses over 12 hrs; if cyanide attack, severe exposure necessitating initial full dose of Na nitrite/Na thiosulfate, or hydroxocobalamin, followed by 50% of initial dose × Na, sodium; Hgb, hemoglobin CONCLUSION