title: Early death due to severe organophosphate poisoning is a centrally mediated process.
abstract: OBJECTIVE
  To distinguish whether early death from severe organophosphate (OP) poisoning with dichlorvos is mediated through peripheral or central nervous system (CNS) actions.
  
  
  METHODS
  Wistar rats (n = 72) were randomized to pretreatment with either: normal saline (controls), peripheral anticholinergics (glycopyrrolate [low, medium, or high dose] or nebulized ipratropium bromide), or CNS + peripherally acting anticholinergics (diphenhydramine, nebulized atropine, or injected atropine). All treatments were given prior to a subcutaneous injection of 25 mg/kg dichlorvos (n = 8 per group). Survival was assessed at 10 minutes (early death) and 24 hours (delayed death). Kaplan-Meier (95% confidence intervals [95% CIs]) and chi-squared analysis was then performed to determine differences between treatments.
  
  
  RESULTS
  Regardless of treatment, all animals exhibited profound nicotinic effects (fasciculations) without obvious seizures within 2 minutes of poisoning. In rats pretreated with peripherally acting agents, the fasciculations were rapidly followed by reduced motor activity, sedation, and death. Mortality at 10 minutes for saline controls, glycopyrrolate, and ipratropium was 88%, 96%, and 100%, respectively. The single control animal surviving beyond 10 minutes went on to develop peripheral cholinergic manifestations, including hypersalivation, urination, and defecation. Only one of 24 animals treated with injected atropine, nebulized atropine, or diphenhydramine died during the early phase of poisoning; all others survived to 24 hours (p < 0.01).
  
  
  CONCLUSIONS
  Death in acute, severe OP poisoning is prevented by pretreatment with anticholinergic agents that cross the blood-brain barrier, but not by agents with only peripheral actions. Early death due to OP poisoning appears to be a centrally mediated process.
authors.affiliation: Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA.
authors.forename: Steven B
authors.initials: SB
authors.lastname: Bird
authors.forename: Romolo J
authors.initials: RJ
authors.lastname: Gaspari
authors.forename: Eric W
authors.initials: EW
authors.lastname: Dickson
mesh_terms: D000818:Animals; D002493:Central Nervous System Diseases / Q000139:chemically induced / Q000517:prevention & control*; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D004006:Dichlorvos / Q000494:pharmacology / Q000506:poisoning*; D004155:Diphenhydramine / Q000627:therapeutic use*; D004195:Disease Models, Animal; D006024:Glycopyrrolate / Q000627:therapeutic use*; D006634:Histamine H1 Antagonists / Q000627:therapeutic use*; D007306:Insecticides / Q000494:pharmacology / Q000506:poisoning*; D009241:Ipratropium / Q000627:therapeutic use; D008297:Male; D018727:Muscarinic Antagonists / Q000627:therapeutic use*; D011446:Prospective Studies; D011897:Random Allocation; D051381:Rats; D017208:Rats, Wistar
chemical_list: D018680:Cholinergic Antagonists; D006634:Histamine H1 Antagonists; D007306:Insecticides; D018727:Muscarinic Antagonists; D004006:Dichlorvos; D004155:Diphenhydramine; D009241:Ipratropium; D006024:Glycopyrrolate