What is the role of atropine in the treatment of organophosphate (OP) toxicity?

Updated: Dec 31, 2020
  • Author: Kenneth D Katz, MD, FAAEM, ABMT; Chief Editor: Sage W Wiener, MD  more...
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Much larger doses of atropine are often needed for OP pesticide poisoning than when atropine is used for other indications. In order to achieve adequate atropinization quickly, a doubling approach typically used, with escalation of doses from 1 mg to 2 mg, 4 mg, 8 mg, 16 mg, and so on. A severe OP pesticide poisoning case has been known to deplete a hospital’s supply of atropine. Data from the sarin attack on the Tokyo subway suggest that patients poisoned by nerve agents require much less atropine than those poisoned by OP pesticides.

de Silva et al studied the treatment of OP poisoning with atropine and 2-PAM and, later the same year, with atropine alone. [16] They found that atropine seemed to be as effective as atropine plus 2-PAM in the treatment of acute OP poisoning.

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