Organophosphate Poisoning
atropine diagnostic use
1mg IV (if pulse increase or pupils dilate not poisoned)
therapeutic atropine
2-5mg IV slowly in adults 0.5mg/kg IV slow in kids repeat in 10-30 minuts prn to complete atropinization
epidemiology of organophosphate poisoning
20 deaths per year only 1%of cases in Cali reported
malathion fatal dose
60g
Cholinergic mnemonic (DUMBELS)
Diarrhea Urination Miosis Bronchospasm Emesis Lacrimation Salivation
cholinesterase levels
RBC levels- take 120 days to recover pseudocholinesterase levels-nerves 1-2 weeks to recover
PK of organophosphate toxicity
absorption- rapid and from skin, GI, lungs distribution- some fat soluble, delays toxicity
atropine compared to pralidoxime
atropine little CNS effect pralidoxime- Nicotinic>muscarinic?CNS (allows lower dose atropine, synergistic together)
when is atropinization done
clearing of rales and drying of pulmonary secretion
cholinergic symptoms
diarrhea, miosis (constricted pupils), mydriasis (dilation of pupil), muscle tense
decontamination
emesis CI due to seizures gastric lavage or charcoal remove clothes and shower for 30 minutes
odor with organophosphates
garlic odor
CNS symptoms
giddy, anxious, restless, insomnia, nightmare, HA, depression, drowsy, seizure, depressed resp center, coma
what even is organophosphate?
insecticides
clinical presentation
may have muscarinic nicotinic or CNS but not all three
duration of symptoms
mild- resolve in month severe- resolve in several months
diazinon fatal dose
oral 25g
chronic effects
polyneuropathy (8-14 days after) paresthesia, weakness, cramps, improves months-years neurobehavioral persist-drowsy, mental confusion, anxiety, depression
pralidozime
reactivated cholinesterase by dephos and inactivating organophos indications-muscle and diaphragm weakness, coma, seizures use in 48h RBC cholinesterase levels increase after 2 PAM
treatment
stabilization decontamination atropine pralidoxime
stabilization
suctioning, intubation cardio monitor IV line atropinization with decontamination pralidoxime in serious pts
onset of symptoms
within 12 hours but may vay