Treatment guidelines recommend frequent atropine boluses or infusion therapy until pulmonary secretions are minimized, with endotracheal intubation as needed.8,17 The most common cause of treatment failure is inadequate atropinization
. Inadequate atropinization
may con-tribute to high rates of both aspiration pneumonia and death.2,4,16 Pralidoxime is a biochemical antidote for OPP; its beneficial effects include reactivation of cholinesterase by cleavage of phosphorylated active sites, direct reaction and detoxification of unbounded OPCs, and an endogenous anticholinergic effect.3-5 This therapy for OPP also applies to the emergency treatment for sarin, a typical drug of chemical weapons of mass destruction.7,14
Intravenous atropine 2-4 mg bolus and repeated every 5-15 minutes initially until atropinization
. The atropinization
was maintained for 24-48 hrs with intermittent doses, every 15-30 minutes or depending on the need, and then tapered over days depending upon patients' response.
Intravenous atropine 2-4mg bolus and repeated every 5-15minutes initially until atropinization
. The end point of treatment was taken as the drying up of secretions.
Speed of initial atropinization
in significant organophosphorus pesticide poisoning--a systematic comparison of recommended regimens, J Toxicol Clin Toxicol 2004;42:865-75.
Thereafter, a bolus dose of atropine was administered after correcting cyanosis till signs of Atropinization (dryness of mucosa with or without pupillary dilation >7 mm and heart rate >140/min) appeared.
Another important parameter, which strongly influenced ventilator assistance, was the initial bolus atropine requirement to produce signs of Atropinization. Patients requiring more than 60 mg of atropine were more prone (all 13 patients -100 %) for ventilator support as against none among 21 patients with Atropine requirement of less than 35 mg.