title: Beneficial late administration of obidoxime in malathion poisoning.
abstract: Early treatment of organophosphate (OP) poisoning with oximes results in reactivation of acetylcholinesterase and patient recovery. Data on efficacy of late administration of oximes, particularly obidoxime, is limited. A 42-y old woman swallowed 60 ml of 50% malathion in a suicide attempt. Characteristic muscarinic, nicotinic and central manifestations of OP poisoning appeared: atropine and 250 mg obidoxime i.v., resulted in marked improvement. Several hours after the last dose, clinical manifestations recurred and ventilation was required. After 10 d cholinesterase was still low and liver enzymes were elevated. Obidoxime was reinstituted after the 9 d interruption and muscle strength improved with the first dose. The patient could be disconnected from the ventilator and within <24 h was extubated. Oxime therapy should be considered even late in the course of untreated or partially treated OP intoxications, especially when the etiologic agent is a lipid-soluble compound (ie malathion) that can cause a protracted course of poisoning. The clinical course of this patient did not support a cause-and-effect relationship between obidoxime and the abnormal liver function.
authors.affiliation: Israel Poison Information Center, Rambam Medical Center, Bruce Rappaport Faculty of Medicine, Technion-lsrael Institute of Technology, Haifa.
authors.forename: Yedidia
authors.initials: Y
authors.lastname: Bentur
authors.forename: Bianca
authors.initials: B
authors.lastname: Raikhlin-Eisenkraft
authors.forename: Pierre
authors.initials: P
authors.lastname: Singer
mesh_terms: D000328:Adult; D001285:Atropine / Q000008:administration & dosage; D002801:Cholinesterase Reactivators / Q000008:administration & dosage*; D003937:Diagnosis, Differential; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007306:Insecticides / Q000506:poisoning*; D008294:Malathion / Q000506:poisoning*; D009768:Obidoxime Chloride / Q000008:administration & dosage*; D011041:Poisoning / Q000175:diagnosis / Q000188:drug therapy; D012121:Respiration, Artificial; D013406:Suicide, Attempted
chemical_list: D002801:Cholinesterase Reactivators; D007306:Insecticides; D009768:Obidoxime Chloride; D001285:Atropine; D008294:Malathion