Template:Cholinergic Toxicity Treatment: Difference between revisions
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===Antidotes=== | ===Antidotes=== | ||
*'''Atropine''' | *'''[[Atropine]]''' | ||
**Competitively blocks muscarinic sites (does nothing for nicotinic-related muscle paralysis) | **Competitively blocks muscarinic sites (does nothing for nicotinic-related muscle paralysis) | ||
**May require massive dosage (hundreds of milligrams) | **May require massive dosage (hundreds of milligrams) | ||
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***Child: 0.05-0.1mg/kg (at least 0.1mg) IV; repeat bolus q2-30m until tracheobronchial secretions controlled | ***Child: 0.05-0.1mg/kg (at least 0.1mg) IV; repeat bolus q2-30m until tracheobronchial secretions controlled | ||
****Once secretions controlled → start IV gtt 0.025 mg/kg/hr | ****Once secretions controlled → start IV gtt 0.025 mg/kg/hr | ||
*'''Pralidoxime''' | *'''[[Pralidoxime]]''' | ||
**For Organophosphate poisoning only. | **For Organophosphate poisoning only. | ||
**Has no use in Nicotinic poisoning | **Has no use in Nicotinic poisoning | ||
Revision as of 01:54, 22 June 2015
Decontamination
- Providers should wear appropriate PPE during decontamination.
- Neoprene or nitrile gloves and gown (latex and vinyl are ineffective)
- Dispose of all clothes in biohazard container
- Wash patient with soap and water
Supportive Care
- IVF, O2, Monitor
- Aggressive airway management is of utmost importance.
- Intubation often needed due to significant respiratory secretions / bronchospasm.
- Use nondepolarizing agent (Rocuronium or Vecuronium).
Antidotes
- Atropine
- Competitively blocks muscarinic sites (does nothing for nicotinic-related muscle paralysis)
- May require massive dosage (hundreds of milligrams)
- Dosing[1]
- Adult: Initial bolus of 2-6mg IV; titrate by doubling dose q5-30m until tracheobronchial secretions controlled
- Once secretions controlled → start IV gtt 0.02-0.08 mg/kg/hr
- Child: 0.05-0.1mg/kg (at least 0.1mg) IV; repeat bolus q2-30m until tracheobronchial secretions controlled
- Once secretions controlled → start IV gtt 0.025 mg/kg/hr
- Adult: Initial bolus of 2-6mg IV; titrate by doubling dose q5-30m until tracheobronchial secretions controlled
- Pralidoxime
- For Organophosphate poisoning only.
- Has no use in Nicotinic poisoning
- Displaces an organophosphate from acetylcholinesterase (if given early)
- Dosing
- Adult: 1-2gm IV over 5-10min; continuous infusion of 500mg/hr if no initial response
- Child: 20-40mg/kg (up to 1gm) IV over 5-10min; 5-10mg/kg/hr if no initial response