What is the role of pralidoxime (2-PAM) 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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The controversy continued when other authors observed more respiratory complications and higher mortality rates with use of high-dose 2-PAM. Low-dose (1-2 g slow IV) 2-PAM is the current recommendation. Studies are under way to assess the role of low-dose 2-PAM. Improved survival has been shown in patients with moderately severe OP poisoning who received early, continuous 2-PAM infusion compared with those who received intermittent boluses. [17]

A meta-analysis and review of the literature performed by Peter et al emphasized optimal supportive care along with discriminating use of 2-PAM, especially early in the course of treatment of moderately to severely OP poisoned patients, are the hallmarks of treatment. [18] More prospective data are required.

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