Poisoning – Organophos-phates and Carbamates

Notes
  • They inhibit cholinesterase enzyme leading to elevated levels of acetylcholine and subsequent muscarinic effects.
  • Carbamates are cleared faster than organophosphates which tend to bind irreversibly to cholinesterase.
Symptoms
  • Bradycardia
  • Bronchorrhea
  • Bronchospasm
  • Rhonchi
  • Wheezing
  • Pin point pupil
  • Diarrhea
  • Emesis
  • Increased urinary frequency
  • Lacrimation (excessive)
  • Miosis
  • Muscle fasciculations
  • Muscle weakness
  • Neuropathy
  • Salivation (excessive)
Diagnosis
  • Clinical
  • Atropine challenge:

*1mg in adults and 0.01-0.02 mg/kg in children reverses or reduces muscarinic effects.

  • Characteristic odour specific for poison.
Management
  • Support treatment especially that of respiratory system.
  • Atropine injection

*Relieve of respiratory symptoms

*2 - 5 mg IV  in adults and 0.05 mg/kg in children then double the dose after every 3-5 mins until there is satisfactory relieve (there is no maximum dose in organophosphate poisoning).

  • Pralidoxime (2-PAM)injection

*Relieve of neuromuscular symptoms

*Administer  IV bolus after atropine: 1-2g in adults and 20-40 mg/kg in children for over 15 to 30 min. This dose may be followed by infusion of 8 mg/kg/hr in adults and 10 to 20 mg/kg/hr in children.

  • Diazepam - For prevention of neurocognitive sequelae and treatment of seizures.

*1.V inj. 10-20mg at 0.5ml / 30secs.

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