title: Cases of organophosphate poisoning treated with high-dose of atropine in an intensive care unit and the novel treatment approaches.
abstract: Organophosphate poisoning is a life-threatening condition, which is being responsible for the symptoms due to cholinergic effects. Clinical status and blood levels of cholinesterase are used its diagnosis. While atropine and pralidoxime (PAM) appear as essential medications, hemofiltration treatments and lipid solutions have been widely studied in recent years. In this study, the importance of high-dose atropine therapy and early intervention and novel treatment approaches are discussed. Records of a total of 25 patients treated for organophosphate poisoning in the intensive care unit (ICU) between April 2007 and December 2011 were evaluated retrospectively. Of the 25 patients, 14 (56%) were male and 11 (44%) were female with a mean age of 34.8 ± 17.66 years (range: 14-77 years). The patients were most frequently admitted in June (n = 4) and July (n = 4) (16%). Of the 25 patients, 22 patients (88%) were poisoned by oral intake, two (8%) by inhalation, and one (4%) by dermal route. Of them, 20 patients (80%) took organophosphates intentionally for suicidal purposes, while five (20%) cases poisoned due to accidental exposure. The scores of Glasgow Coma Scale of nine patients (36%) were below 8 point upon admission to hospital. The highest dose of atropine given was 100 mg intravenously on admission and 100 mg/h/day during follow-up. The total dose given was 11.6 g/12 days. A total of 11 patients (44%) were on mechanical ventilation for a mean duration of 5.73 ± 4.83 days. The mean duration of ICU stay was 6.52 ± 4.80 days. Of all, 23 patients (92%) were discharged in good clinical condition and one patient (4%) was referred to another hospital. This study suggests that atropine can be administered until secretions disappear and intensive care should be exerted in follow-up of these patients. In addition, in case of necessity for high doses, sufficient amounts of atropine and PAM should be available in hospitals.
authors.affiliation: Department of Emergency Medicine, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey drkarakus@yahoo.com.
authors.forename: Ali
authors.initials: A
authors.lastname: Karakus
authors.affiliation: Department of Internal Medicine, Faculty of Medicine Mustafa Kemal University, Hatay, Turkey.
authors.forename: Muhammet Murat
authors.initials: MM
authors.lastname: Celik
authors.affiliation: Department of Anesthesia, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Karcioglu
authors.affiliation: Department of Anesthesia, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey.
authors.forename: Kasim
authors.initials: K
authors.lastname: Tuzcu
authors.affiliation: Department of Chest Diseases, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey.
authors.forename: Ersin Sukru
authors.initials: ES
authors.lastname: Erden
authors.affiliation: Department of Forensic Medicine, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey.
authors.forename: Cem
authors.initials: C
authors.lastname: Zeren
mesh_terms: D061605:Administration, Intravenous; D000293:Adolescent; D000328:Adult; D000368:Aged; D000931:Antidotes / Q000008:administration & dosage / Q000627:therapeutic use*; D001285:Atropine / Q000008:administration & dosage / Q000627:therapeutic use*; D003422:Critical Care / Q000379:methods*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D062025:Organophosphate Poisoning / Q000188:drug therapy* / Q000628:therapy; D012121:Respiration, Artificial; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000931:Antidotes; D001285:Atropine