HWN Suggests

CRACKCast E163 – Pesticides

Reversal of acetylcholine excess = titrate atropine to respiratory secretions. The atropine dose for the treatment of organophosphate poisoning is 1 to 3 mg (0.05 mg/kg in children) intravenously with doubling of each subsequent dose every 5 minutes until there is control of the muscarinic effects, particularly reduction in airway secretions. Average reversal dose is typically 20-30mg Some patients need 200-500 mg of atropine in the first hour. Patients often need an atropine infusion (20% reversal dose/hour.

The second part of the treatment of organophosphate poisoning is the use of an oxime to regenerate acetylcholinesterase function… PAM

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 Lightning Learning: Organophosphate Poisoning

OP irreversibly inactivates acetyl-Cholinesterase (AChE). Patients can die as a result of acute cholinergic syndrome. Features of inhibition of acetylcholinesterase are: S.L.U.D.G.E – Salivation. Lacrimation. Urination. Diarrhoea. GI upset. Emesis.

 Tox in The Land: Organophosphate Toxicity

Atropine Reverses peripheral & central muscarinic toxicity. 2-5 mg IV/IM/IO bolus (0.05 mg/kg IV in kids) with escalation. Titrate until clearing of respiratory secretions and cessation of bronchoconstriction.

Articles of Interest

Nerve Agent Information...

In the body, a nerve agent exerts its effects by inhibiting an enzyme (acetylcholinesterase), resulting in acute illness – specifically, cholinergic crisis. Organophosphorus or carbamate pesticides produce similar effects to nerve agents.

Organophosphate Poisoning

Specific Therapy: atropine: 0.02mg/kg boluses -> recurrent boluses q5min doubling the dose each time, treats bradycardia, hypotension and excess secretion production. pralidoxime chloride 30mg/kg IV -> 8mg/kg/hr: muscle weakness. benzodiazepines: midazolam 0.2mg/kg, seizures or agitation. activated charcoal if presents with 1-2 hours.

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Emergency Medicine Cases

Atropine is the most important antidote to give. It should be dosed at 1-2 mg IV to start, and then given at double the dose every 5 minutes until your patient has a clear chest and is hemodynamically stable. Then start an infusion at 10-20% of the total dose of atropine given per hour.