A patient is brought in from a skilled nursing facility. Four hours ago, she was given somebody else's pills but the nurse has run away! No one knows what she was given, except that it's probably a common nursing home medication. She was brought in because of a witnessed seizure about three hours ago. She has recovered from the seizure but has altered mental status with delirium. Her vitals show a heart rate of 40 and a blood pressure of 90/50. There are no focal neurologic deficits. Her labs show a glucose of 40 and potassium of 5.5; otherwise electrolytes, BUN, and creatinine are normal. Acetaminophen and salicylate levels are undetectable. Chest X-ray is clear. EKG is shown above.
You secure airway, breathing, and circulation. You give dextrose. You start atropine but the heart rate and blood pressure are minimally responsive.
Challenge: What's the antidote to this ingestion?
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