Organophosphate or Carbamate Poisoning

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  • Very toxic chemicals found in insecticides and pesticides, e.g. Some rat poisons
  • Poisoning may be by ingestion, inhalation, or absorption through the skin
  • Presents with diarrhoea, urination, small pupils, bradycardia, vomiting, lacrimation, secretions, anxiety and restlessness, increased secretions and bradycardia

GENERAL MANAGEMENT: ADULT 

  • Remove any contaminated clothing
  • Establish and maintain airway
  • Artificial respiration with oxygen may be required at any stage during the first 24 hours after poisoning
  • Empty the stomach if poison swallowed
  • If there is skin contact with the poison, wash them thoroughly
  • Wear rubber gloves to prevent contamination
  • Do not rub the skin
  • Shave hair if heavily contaminated
  • Give Atropine 1.2 mg IV or IM (children: 0.05 mg/kg)
  • Then give 0.6 mg (children: 0.05mg/kg) every 10 minutes as required to achieve and maintain atropinisation (hot dry skin, dry mouth, widely dilated pupils, fast pulse)

In severe organophosphate poisoning:

  • Give an initial Atropine dose of 4-6mg (children: 2 mg)
  • Repeat 2mg every 10 minutes as required to achieve and maintain full atropinisation
  • Total needed in first 24 hours is usually < 50 mg
  • High dose Atropine may be required for several days

In severe organophosphate poisoning only and in cases not responding to atropine:

  • Give Pralidoxime Mesylate 1-2g concurrently with Atropine

Children: 20-40 mg/kg

  • Administer by slow IV (over 15-30 minutes) as a 5% solution in water for injections
  • If IV not possible: give IM or S/C and repeat once or twice at 4–6-hour intervals if needed
  • If possible: monitor treatment by determination of blood-cholinesterase concentrations

Note: Do not give Pralidoxime (or other oximes) in carbamate poisoning

Children

  • Irrigate the eyes or skin to remove the chemical if required
  • If available and <4 hours since ingestion, administer activated charcoal
  • Do not induce vomiting
  • If respiratory compromise give oxygen and treat with atropine: 20 micrograms/kg IM or IV. Repeat every 15 minutes until chest is dry.
  • May need escalation to peadiatric intensive care for respiratory support and ongoing treatment