How will you manage a case of organophosphorus poisoning?
The mainstays of medical therapy in organophosphate (OP) poisoning include atropine, pralidoxime (2-PAM), and benzodiazepines (eg, diazepam). Initial management must focus on adequate use of atropine. Optimizing oxygenation prior to the use of atropine is recommended to minimize the potential for dysrhythmias.
When do you give atropine in organophosphate poisoning?
17,19,49,50 In hospitals that have no access to oxygen, atropine should be given early to patients with pesticide poisoning to reduce secretions and improve respiratory function. 32 The patient should be placed in the left lateral position, with the neck extended.
What is the antidote for cholinergic poisoning?
Atropine acts as a direct antidote physiologically by antagonizing the muscarinic receptor’s actions of excessive acetylcholine such as bronchorrhea, bradycardia, salivation, and bronchoconstriction. Atropine can cross the blood-brain barrier and can help decrease the activity of centrally acting excess acetylcholine.
Why atropine is used in OPC poisoning?
Atropine is given to poisoned patients to block muscarinic overstimulation.
What is administered to counter muscarinic symptoms of Organophosphor compound poisoning?
For people afflicted with cholinergic syndrome, atropine sulfate combined with an oxime is used to combat the effects of the acute OP poisoning. Diazepam is sometimes also administered.
When do you stop atropine infusion in OP poisoning?
Their regimen of 0.02—0.08 mg/kg atropine as an infusion over 1 hour would provide a maximum of 5.6 mg atropine in a 70 kg person. Stopping atropine therapy ’24 hours after atropinization’ may cause problems with the continued release of fat-soluble OPs, such as fenthion, from the fat depot.
How do you taper atropine in OP poisoning?
To avoid preservative toxicity powder atropine be reconstituted in normal saline and be used. Duration of maintenance atropine therapy: – This depends on the severity and response to therapy. Usually it is maintained for 24- 48 hrs or longer in severe cases, and gradually withdrawn over 3-5 days.
What is the antidote for acetylcholinesterase inhibitors?
Stockpiles of antidotes and ventilators are an important aspect of planning for disasters involving cholinesterase inhibitors (e.g., terrorist attacks with nerve agents). One of these antidotes, atropine, can be rapidly and economically constituted from bulk powder.
Why do you give atropine before pralidoxime?
Atropine, which is choice of drug to antagonise the muscarinic effects of organophosphates, is administered even before pralidoxime during the treatment of organophosphate poisoning.
Can atropine or 2 Pam be used prophylactically?
It should be noted that atropine or 2-PAM are only effective OP antidotes when they are used together prophylactically or therapeutically. They protect pro- phylactically much better than therapeutically.
How do you administer atropine IV?
Atropine can be administered by intravenous (IV), subcutaneous, intramuscular, or endotracheal (ET) methods; IV is preferred. For ET administration, dilute 1 mg to 2 mg in 10 mL of sterile water or normal saline before administration. For pediatric ET, double the usual IV dose and dilute in 3 to 5 mL.
Which interventions are effective and safe in the treatment of organophosphorus toxicity?
In this systematic review we present information relating to the effectiveness and safety of the following interventions: activated charcoal (single or multiple doses), alpha(2) adrenergic receptor agonists, atropine, benzodiazepines, butyrylcholinesterase replacement therapy, cathartics, extracorpo … Organophosphorus poisoning (acute)
What is the mortality and morbidity of organophosphorus (OP) toxicity?
Death from unintended Organophosphorus poisoning are a less common than those from intentional poisoning and seems to be more common in regions where highly toxic Organophorous pesticides (WHO Class I toxicity) are available. Suicidal poisoning with OP compounds has increased incidence and carries 4-30% mortality in Indian studies.
How is the diagnosis of organophosphorus poisoning confirmed?
Diagnosis of organophosphorus poisoning should ideally be confirmed with an assay to measure butyrylcholinesterase activity in plasma (or acetylcholinesterase in whole blood).17However, the results of such assays are rarely available in time to affect clinical decisionmaking.
How is organophosphorus poisoning treated in Sri Lankan hospitals?
Management of a patient with severe organophosphorus poisoning in a Sri Lankan district hospital The absence of intensive-care beds and ventilators means that unconscious patients are frequently intubated and ventilated on the open ward. This figure is reproduced with permission from the corresponding author.
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