title: Rapid atropine synthesis for the treatment of massive nerve agent exposure.
abstract: OBJECTIVE
  We developed and tested a protocol for compounding a large volume of injectable atropine from powder. The resulting protocol could be used by hospitals to rapidly use large amounts of stockpiled atropine.
  
  
  METHODS
  The protocol required 2 g of solid (powdered) atropine and 1 L of normal saline solution. The solution was filtered and mixed. One hundred syringes were filled by using a standard syringe-batching system. Modifications, including hand filling, were studied to reduce the time required to synthesize one hundred 3-mL syringes.
  
  
  RESULTS
  A single pharmacist was able to reconstitute one hundred 6-mg atropine syringes in 29 minutes using the batching system. The quickest method for a single pharmacist filling syringes by hand was 34 minutes. The cost to the hospital for 5 g of powdered atropine was 11 dollars versus 5,000 dollars for prefilled syringes.
  
  
  CONCLUSIONS
  Large quantities of atropine syringes can be compounded from a powdered form in a timely manner. Additionally, there is a significant cost advantage to using powdered atropine as a hospital stockpile.
authors.affiliation: Department of Emergency Medicine, Mission Hospital Regional Medical Center, Mission Viejo, CA, USA. rjkozak@uci.edu
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Kozak
authors.forename: Scott
authors.initials: S
authors.lastname: Siegel
authors.forename: Jim
authors.initials: J
authors.lastname: Kuzma
mesh_terms: D000931:Antidotes / Q000737:chemistry* / Q000191:economics / Q000600:supply & distribution; D001285:Atropine / Q000737:chemistry* / Q000191:economics / Q000600:supply & distribution; D002619:Chemical Warfare Agents / Q000506:poisoning*; D002626:Chemistry, Pharmaceutical; D003365:Costs and Cost Analysis; D006801:Humans; D010607:Pharmacy Service, Hospital; D011208:Powders; D012996:Solutions; D013594:Syringes / Q000191:economics; D013996:Time and Motion Studies
chemical_list: D000931:Antidotes; D002619:Chemical Warfare Agents; D011208:Powders; D012996:Solutions; D001285:Atropine