title: Recovery from ultra-high dose organophosphate poisoning after "in-the-field" antidote treatment: potential lessons for civil defense.
abstract: Organophosphate poisoning is associated with a high mortality rate due to respiratory failure, dysrhythmias, and multi-organ failure. We report two cases of survival after "in-the field" antidote treatment of very severe organophosphate poisonings. Two patients orally ingested large amounts of the organophosphorous agent oxydemeton-methyl in suicide attempts, resulting in the hypercholinergic syndrome in both. Resuscitation included early administration of antidote by emergency medical personnel as well as high-dose atropine. Plasma levels of pseudo cholinesterase were initially very low in both patients. Long-term mechanical ventilation was necessary, and both patients developed aspiration pneumonia. At discharge, no major neurological deficits were present. Prompt antidote treatment and aggressive supportive emergency and intensive care unit therapy contribute to improved survival after acute organophosphate poisoning. We believe that in cases of mass poisonings--for example, terrorist activity--therapy must be available on the scene as soon as possible. This also may require decentralized antidote storage.
authors.affiliation: Department of Internal Medicine II, University of Bonn, Bonn, Germany.
authors.forename: Jan Wilko
authors.initials: JW
authors.lastname: Schrickel
authors.forename: Thorsten
authors.initials: T
authors.lastname: Lewalter
authors.forename: Berndt
authors.initials: B
authors.lastname: Lüderitz
authors.forename: Georg
authors.initials: G
authors.lastname: Nickenig
authors.forename: Hans-Ulrich
authors.initials: HU
authors.lastname: Klehr
authors.forename: Christian
authors.initials: C
authors.lastname: Rabe
mesh_terms: D000328:Adult; D001285:Atropine / Q000627:therapeutic use; D002801:Cholinesterase Reactivators / Q000627:therapeutic use*; D004632:Emergency Medical Services; D005751:Gastric Lavage; D006464:Hemoperfusion; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000627:therapeutic use; D009768:Obidoxime Chloride / Q000627:therapeutic use*; D062025:Organophosphate Poisoning; D011115:Polyneuropathies / Q000139:chemically induced / Q000517:prevention & control*
chemical_list: D002801:Cholinesterase Reactivators; D018727:Muscarinic Antagonists; D009768:Obidoxime Chloride; D001285:Atropine