Open-Label Randomized Clinical Trial of Atropine Bolus Injection Versus Incremental Boluses Plus Infusion for Organophosphate Poisoning in Bangladesh

Abedin, Mohammed Joynal; Sayeed, Abdullah Abu; Basher, Ariful; Maude, Richard J.; Hoque, Gofranul; Faiz, Mohammad Abul

doi:10.1007/s13181-012-0214-6

Cited by 59 publications

(45 citation statements)

References 23 publications

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“…Although the combination of a cholinesterase reactivator and anticholinergic atropine has a poor effect (Buckley et al, 2011;Elsinghorst et al, 2013), a previous study has shown that use of atropine at an optimum dose can decrease the mortality rate (Biswas et al, 2013). However, atropine has a short half-life, requires administration of large dosages, and patients with severe poisoning require intravenous administration (Abedin et al, 2012); moreover, repeated administration at an interval of 2-10 min is required (Connors et al, 2013) and nursing of patients is tedious; furthermore, an appropriate dosage of atropine is not easy to determine; small dosages are not sufficient to achieve the therapeutic effect and large dosages can easily cause poisoning (Sharma et al, 2013). A previous study shows that penehyclidine hydrochloride (PHC) is a new generation cholinergic antagonist (Han et al, 2005) that can selectively act on M1, M3, N1, and N2 receptors, and can rapidly improve the muscarinic symptoms with a little effect on the heart rate.…”

Section: Introductionmentioning

confidence: 99%

Clinical analysis of penehyclidine hydrochloride combined with hemoperfusion in the treatment of acute severe organophosphorus pesticide poisoning

Liang¹,

Zhang²

2015

Genet. Mol. Res.

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ABSTRACT. This study aimed to observe the clinical curative effect of penehyclidine hydrochloride (PHC) combined with hemoperfusion in treating acute severe organophosphorus pesticide poisoning. We randomly divided 61 patients with severe organophosphorus pesticide poisoning into an experimental group (N = 31) and a control group (N = 30), and we compared the coma-recovery time, mechanical ventilation time, healing time, hospital expenses, and mortality between the two groups. The coma-recovery time, mechanical ventilation time, and healing time were lower in the experimental group than in the control group (P < 0.05), while the hospitalization expenses were higher in the experimental group than in the control group (P < 0.01); moreover, no significant difference was observed in the mortality rate between the two groups. Thus, PHC combined with hemoperfusion exerts a better therapeutic effect in acute severe organophosphorus pesticide poisoning than PHC alone.

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Section: Introductionmentioning

confidence: 99%

Clinical analysis of penehyclidine hydrochloride combined with hemoperfusion in the treatment of acute severe organophosphorus pesticide poisoning

Liang¹,

Zhang²

2015

Genet. Mol. Res.

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“…Studies conducted after the year of 2000 have consistently shown mortality rates below 15%. 37,39 This can be explained by universal provision of continuous high dose atropine, consistent use of pralidoxime and better access to supportive therapy such as ICU care, ventilator support and respiratory therapy etc. In our study, the mortality was 17.34% (56 of the 323 cases) and 124 (38.41%) patients had to be ventilated.…”

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confidence: 99%

The clinico-demographic study of morbidity and mortality in patients with organophosphate compound poisoning at tertiary care hospital in rural India

Mundhe¹,

Birajdar²,

Chavan³

2017

Int J Adv Med

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Background: Organophosphates (OP) are commonly used and potentially fatal insecticides. Given the unrestricted availability and widespread use, OP poisoning is very much common following either accidental or intentional exposures. Many parameters are proposed to predict outcome, yet there is no consensus about these parameters. This study aimed to investigate different factors associate with morbidity and mortality in rural population that can help in identifying patients in need of intensive care and treatment to prevent deaths.Methods: This was a cross-sectional observational study of 323 patients, admitted to the tertiary care rural public hospital with OP poisoning between December 2015 to November 2016.Results: Of the 323 patients studied, 62.85% were male, 227 (70.27%) were suicides, 241 (74.61%) ingested OP compounds, 40 (12.38%) patients developed intermediate syndrome and 56 (17.34%) died. There were statistically significant differences between ventilatory support group and no ventilatory group for suicidal intention, sex, comorbid psychiatric conditions, route of exposure, certain clinical features on admission, GCS score, POP scale, time from exposure to initiation of treatment, plasma pseudocholinesterase levels, oxygen saturation, and random blood sugar levels (p<0.05).Conclusions: OP poisoning is a life-threatening condition which requires immediate management. Early initiation of decontamination, atropine and pralidoxime therapy, with supportive ICU care, can save lives. Different demographic, exposure related parameters; some of the clinical features, treatment variables and certain laboratory findings can provide useful prognostic information and help to predict outcomes. A measures to control unchecked availability of these compounds and early transfer of victims to health care facility is needed to save many lives.

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“…Once atropinization has been obtained, an infusion should be set up and titrated against effect. This doubling-dose approach has been shown in a randomized controlled trial to markedly speed resuscitation (from a mean of 152 to 24 min) and reduce mortality (from 22.5 to 8%) compared with standard atropine dosing (2-5 mg every 10-15 min) (94). No clinical studies have been performed after OP nerve agent poisoning, but this titrated regimen can be followed for patients who survive to hospital presentation (95).…”

Section: Management Of Op Nerve Agent and Insecticide Poisoningmentioning

confidence: 99%

Respiratory Complications of Organophosphorus Nerve Agent and Insecticide Poisoning. Implications for Respiratory and Critical Care

Hulse

Davies

Simpson

et al. 2014

Am J Respir Crit Care Med

144

104

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Organophosphorus (OP) compound poisoning is a major global public health problem. Acute OP insecticide self-poisoning kills over 200,000 people every year, the majority from self-harm in rural Asia. Highly toxic OP nerve agents (e.g., sarin) are a significant current terrorist threat, as shown by attacks in Damascus during 2013. These anticholinesterase compounds are classically considered to cause an acute cholinergic syndrome with decreased consciousness, respiratory failure, and, in the case of insecticides, a delayed intermediate syndrome that requires prolonged ventilation. Acute respiratory failure, by central and peripheral mechanisms, is the primary cause of death in most cases. However, preclinical and clinical research over the last two decades has indicated a more complex picture of respiratory complications after OP insecticide poisoning, including onset of delayed neuromuscular junction dysfunction during the cholinergic syndrome, aspiration causing pneumonia and acute respiratory distress syndrome, and the involvement of solvents in OP toxicity. The treatment of OP poisoning has not changed over the last 50 years. However, a better understanding of the multiple respiratory complications of OP poisoning offers additional therapeutic opportunities.

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Open-Label Randomized Clinical Trial of Atropine Bolus Injection Versus Incremental Boluses Plus Infusion for Organophosphate Poisoning in Bangladesh

Cited by 59 publications

References 23 publications

Clinical analysis of penehyclidine hydrochloride combined with hemoperfusion in the treatment of acute severe organophosphorus pesticide poisoning

Clinical analysis of penehyclidine hydrochloride combined with hemoperfusion in the treatment of acute severe organophosphorus pesticide poisoning

The clinico-demographic study of morbidity and mortality in patients with organophosphate compound poisoning at tertiary care hospital in rural India

Respiratory Complications of Organophosphorus Nerve Agent and Insecticide Poisoning. Implications for Respiratory and Critical Care

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