Civilian adult self injections of atropine-trimedoxime (TMB4) auto-injectors.
BACKGROUND
The clinical effects of self injections of atropine-trimedoxime auto-injectors distributed to the civilian population as a field antidote for nerve agent attack were assessed.


METHODS
Data on self injections by adults (> or = 18 years) were collected from the Israel Poison Information Center and a hospital Emergency Department's records during a 2-year period. The data included demographics, time interval from injection, type of auto-injector, clinical manifestations and atropinization score.


RESULTS
Sixty-five patients, all with unintentional self injections, were reported. Systemic atropine effects were observed in 24 patients, but no severe atropinization. The atropinization score was significantly higher in the 2 mg atropine dose group than in the two lower dose groups, which were in the normal range. No specific adverse effects attributable to trimedoxime were observed. Intravenous fluids and physostigmine were not required.


CONCLUSIONS
Only mild reactions were observed following self-injection of atropine trimedoxime auto-injectors in adults, attesting to their relative safety under these conditions.
Bentur
Yedidia
Y
Israel Poison Information Center, Rambam Medical Center, Faculty of Medicine, Technion, Haifa. d_bentur@rambam.health.gov.il
Layish
Ido
I
Krivoy
Amir
A
Berkovitch
Matitiahu
M
Rotman
Eran
E
Haim
Shmuel Bar
SB
Yehezkelli
Yoav
Y
Kozer
Eran
E
D000059:Accidents / Q000706:statistics & numerical data; D000328:Adult; D000931:Antidotes / Q000008:administration & dosage / Q000506:poisoning*; D001285:Atropine / Q000008:administration & dosage / Q000506:poisoning*; D004338:Drug Combinations; D006801:Humans; D007267:Injections / Q000295:instrumentation; D007557:Israel / Q000453:epidemiology; D011041:Poisoning / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D012651:Self Medication / Q000009:adverse effects*; D014289:Trimedoxime / Q000008:administration & dosage / Q000506:poisoning*
D000931:Antidotes; D004338:Drug Combinations; D014289:Trimedoxime; D001285:Atropine