8/28/2023 0 Comments Atropine antidote for![]() ![]() Atropine must be titrated to alleviate bronchorrhea and bronchospasm this may require large doses of atropine and treatment may continue for several days. The initial dose of IV atropine is 2 to 5 mg in adults and 0.05mk/kg in children every 5 minutes until pulmonary symptoms improve. Atropine can cross the blood-brain barrier and can help decrease the activity of centrally acting excess acetylcholine. 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 is given first, as pralidoxime may transiently worsen symptoms. Once suspected, treatment should consist of IV administration of atropine and pralidoxime. The skin and eyes should be washed to avoid continued absorption of the agent. Healthcare workers should wear protective gear to prevent dermal and inhalation exposure to the agent. During intubation, succinylcholine should not be used because the lack of acetylcholinesterase caused by the poisoning will cause prolonged paralysis. Aggressive decontamination is necessary. All clothing should be removed and discarded. Usual airway and circulatory support are necessary with two exceptions. Two helpful mnemonics to remember the muscarinic effects of excess acetylcholine are SLUDGE or DUMBELSĮvaluation and management of every patient should begin with ABCs (airway, breathing, circulation, disability, and exposure). Death can occur due to effects on the heart, respiration, and brain. Excess acetylcholine in the brain patients may cause headache, insomnia, giddiness, confusion, and drowsiness. More severe exposures may cause central depression resulting in slurred speech, convulsions, coma, and respiratory depression. Increased acetylcholine at nicotinic sites at the neuromuscular junction causes muscle fasciculations and flaccid paralysis due to excess acetylcholine at the neuromuscular junction. Activation of muscarinic receptors in the eye by excess acetylcholine will produce miosis and blurry vision. ![]() Acetylcholine accumulation at muscarinic receptors produces an increase in secretions which can manifest as bronchorrhea, salivation, tearing and sweating, bronchoconstriction, tightness in the chest, wheezing, bradycardia, vomiting, increased gastrointestinal motility, abdominal tightness, diarrhea, and cramps. Physical exam findings depend on which receptors experience accumulation of acetylcholine. Nerve agents have been used in subways by terrorist groups and by dictators to suppress communities within countries as well. Sarin is a well-known chemical warfare agent that continues to be a threat worldwide. Accidental exposure accounted for the other 10% with homicidal use less than 1%. More than 90% of the non-occupational incidents were intentional with a fatality rate exceeding 10%. Poisoning due to occupational exposure only accounted for one-fifth of the incidental contact, with a fatality rate of less than 1%. The American Association of Poison Control Centers reported 86914 human exposures to pesticides in the United States in 1996 alone. ![]() One million of these exposures were found to be unintentional, while the other 2 million exposures were secondary to suicidal attempts. There are about 3000000 exposures to organophosphates or carbamates worldwide each year with approximately 200000 fatalities as a result of exposure. Organophosphates have been used worldwide for over 50 years as insecticides, though usage has decreased in the past 10 to 20 years. These drugs may cause weakness, but a cholinergic crisis is very rare with drugs taken at therapeutic doses. Essentially, any agent that creates an abundance of acetylcholine at the synapse may cause cholinergic toxicity. ![]() These drugs include drugs used to treat myasthenia gravis such as edrophonium and neostigmine, pilocarpine used for glaucoma, and Alzheimer drugs such as rivastigmine and donepezil. It is well known for being involved in terrorist attacks in Japan in 19.Ĭholinergic drugs may cause a cholinergic crisis during clinical use or after an overdose. Sarin gas was made originally in Germany in 1938 as a pesticide. Sarin gas is a nerve gas typically seen in chemical warfare. Exposure to these insecticides may be through inhalation of vapors, ingestion, or direct contact of the chemical with the skin or mucous membrane. The most common cause of cholinergic toxicity worldwide is exposure to organophosphate and carbamate insecticides. Cholinergic toxicity may result from insecticides, nerve agents, medications, and mushrooms. ![]()
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