title: Pretreating rats with parenteral ophthalmic antimuscarinic agents decreases mortality from lethal organophosphate poisoning.
abstract: BACKGROUND
  In the event of a large scale organophosphate (OP) or nerve agent exposure that depletes a hospital's atropine stores, alternative antidotes should be considered.
  
  
  OBJECTIVE
  To test the effects of parenteral administration of ophthalmic antimuscarinic agents on survivability in a rat model of acute, lethal OP poisoning.
  
  
  METHODS
  After determining appropriate dosing for comparison, rodents were randomized to receive one of four intraperitoneal antidotes (n = 10 per group): 1) normal saline (0.3 mL), 2) atropine sulfate (10 mg/kg), 3) ophthalmic atropine sulfate (1%; 10 mg/kg), or 4) ophthalmic homatropine (5%; 20 mg/kg). Five minutes after pretreatment, dichlorvos (10 mg/kg) was administered subcutaneously. Mortality rates and time to death were compared by using Fisher's exact test and the Kaplan-Meier method with log rank test, respectively. If the animal was alive at 120 minutes, survival was assumed.
  
  
  RESULTS
  Survival in rats pretreated with standard atropine was 100%. Survival in rats pretreated with ophthalmic homatropine and atropine sulfate were 100% (p < 0.001; 95% CI = 0.98 to 1.02) and 90% (p < 0.01; 95% CI = 0.71 to 1.09), respectively, compared with controls (20% survival; 95% CI = 0.04 to 0.45). Time of death ranged between 7 and 19 minutes. Comparison of survival times revealed a statistically significant improvement in experimental groups compared with controls (p < 0.0001).
  
  
  CONCLUSIONS
  Parenteral pretreatment with ophthalmic preparations of homatropine or atropine sulfate was equal to standard atropine in preventing lethality in this rat model of acute, lethal OP poisoning.
authors.affiliation: Department of Emergency Medicine, Cook County-Stroger Hospital, Rush Medical College, Chicago, IL, USA. sbryant@ccbh.org
authors.forename: Sean M
authors.initials: SM
authors.lastname: Bryant
authors.forename: James W
authors.initials: JW
authors.lastname: Rhee
authors.forename: Trevonne M
authors.initials: TM
authors.lastname: Thompson
authors.forename: Steven E
authors.initials: SE
authors.lastname: Aks
mesh_terms: D000818:Animals; D000931:Antidotes / Q000008:administration & dosage / Q000494:pharmacology*; D001285:Atropine / Q000008:administration & dosage / Q000494:pharmacology*; D004006:Dichlorvos / Q000506:poisoning*; D004333:Drug Administration Routes; D007306:Insecticides / Q000506:poisoning*; D008297:Male; D018727:Muscarinic Antagonists / Q000008:administration & dosage / Q000494:pharmacology*; D010276:Parasympatholytics / Q000008:administration & dosage / Q000494:pharmacology*; D011897:Random Allocation; D051381:Rats; D017207:Rats, Sprague-Dawley; D015996:Survival Rate; D014326:Tropanes / Q000008:administration & dosage / Q000494:pharmacology*
chemical_list: D000931:Antidotes; D007306:Insecticides; D018727:Muscarinic Antagonists; D010276:Parasympatholytics; D014326:Tropanes; D001285:Atropine; D004006:Dichlorvos; C100236:homatropine