Please find the power point on Organophosphate poisoning and its management. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Please find the power point on Organophosphate poisoning and its management. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
· IndicationsSee Pronunciation· Used systemically and locally .docxodiliagilby
· Indications
See Pronunciation
· Used systemically and locally in a wide variety of chronic diseases including:
· Inflammatory,
· Allergic,
· Hematologic,
· Endocrine,
· Neoplastic,
· Dermatologic,
· Autoimmune disorders,
· Management of cerebral edema,
· Diagnostic agent in adrenal disorders.
Unlabeled Use:
· Short-term administration to high-risk mothers before delivery to prevent respiratory distress syndrome in the newborn.
· Adjunctive management of nausea and vomiting from chemotherapy.
· Treatment of airway edema prior to extubation.
· Used in neonates with bronchopulmonary dysplasia to facilitate ventilator weaning.
Action
· In pharmacologic doses, suppresses inflammation and the normal immune response.
· Has numerous intense metabolic effects (see Adverse Reactions and Side Effects).
· Suppresses adrenal function at chronic doses of 0.75 mg/day.
· Has negligible mineralocorticoid activity.
Therapeutic Effects:
· Suppression of inflammation and modification of the normal immune response.
Pharmacokinetics
Absorption: Well absorbed after oral administration. Sodium phosphate salt is rapidly absorbed after IM administration. Absorption from local sites (intra-articular, intralesional) is slow but complete.
Distribution: Widely distributed, crosses the placenta, and appears to enter breast milk.
Metabolism/Excretion: Mostly metabolized by the liver.
Half-life: Low birth weight infants with BPD: 9.3 hr; Children 3 mo–16 yr: 4.3 hr; Adults: 3–4.5 hr (plasma), 36–54 hr (tissue); adrenal suppression lasts 2.75 days.
Contraind./Precautions
Contraindicated in:
· Active untreated infections (may be used in patients being treated for tuberculous meningitis)
· Known alcohol or bisulfite hypersensitivity or intolerance (some products contain these and should be avoided in susceptible patients)
· Epidural use (may result in serious neurological injury or death)
· Lactation: Avoid chronic use.
Use Cautiously in:
· Chronic treatment (will lead to adrenal suppression; use lowest possible dose for shortest period of time)
· Stress (surgery, infections); supplemental doses may be needed
· Potential infections (may mask signs)
· OB: Safety not established
· Pedi: Early postnatal administration of high doses can cause significant and persistent reductions in neuromotor and cognitive functioning; results in growth; use lowest possible dose for shortest period of time.
Adv. Reactions/Side Effects
Adverse reactions/side effects are much more common with high-dose/long-term therapy
CNS: depression, euphoria, hallucinations, headache, intracranial pressure (children only), insomnia, personality changes, psychoses, restlessness.
EENT: cataracts, intraocular pressure.
CV: hypertension, edema.
GI: PEPTIC ULCERATION, anorexia, nausea, appetite, vomiting.
Derm: acne, wound healing, ecchymoses, hirsutism, petechiae.
Endo: adrenal suppression, hyperglycemia.
F and E: amenorrhea, hypokalemia, alkalosis.
Hemat: THROMBOEMBOLISM, thrombophlebitis.
Metab: weight ga ...
Clinical symptoms and management of Arsenic poisoningSoujanya Pharm.D
This presentation includes Introduction & physical appearance of arsenic, usual fatal dose, toxicokinetics and mode of action of arsenic, Clinical (toxic) symptoms, diagnosis and management of Arsenic poisoning
Gut decontamination or methods of poison removal in clinical toxicology Soujanya Pharm.D
This presentation includes various methods of poison removal like emesis, gastric lavage (stomach wash), catharsis, activated charcoal, whole bowel irrigation.
This presentation includes definition, epidemiology, etiology, pathophysiology (life cycle), diagnosis, clinical features of uncomplicated & severe malaria and treatment of malaria.
Liver function tests for Pharm.D (Medicinal biochemistry & Clinical pharmacy)Soujanya Pharm.D
Introduction, Major functions of liver, Tests to assess liver function, Classification of liver function tests, Interpretation of results (Medicinal biochemistry & Clinical pharmacy)
Definition, Epidemiology, Etiology, Aspects of anxiety, Classification/types of anxiety, Pathophysiology of anxiety disorders, Management of anxiety disorders along with treatment algorithms
Definition, Patterns/types and mechanisms of drug induced liver disorders, assessment of drug induced liver disorders and its treatment (pharmacotherapeutics-3)
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
3. INTRODUCTION:
Organophosphates are among the
most popular and most widely used
insecticides in India.
These compounds are available as
dusts, granules, or liquids.
Some products need to be diluted
with water before use, and some are
burnt to make smoke that kills
insects.
4. USUAL FATAL DOSE:
Toxicity Rating:
The following compounds are extremely toxic (LD50: 1 to 50 mg/kg), or
highly toxic (LD50: 51 to 500 mg/kg):
Chlorfenvinphos, Chlorpyriphos, Demeton, Diazinon, Dichlorvos, Dimethoate,
Disulfoton, Ediphenphos, Ethion, Fenitrothion, Fensulfothion, Fenthion,
Fonophos, Formothion, Methyl Parathion, Mevinphos, Monocrotophos,
Oxydemeton Methyl, Phenthoate, Phorate, Phosphamidon, Quinalphos, TEPP,
and Thiometon.
5. CONTD…
The following compounds are moderately toxic (LD50:501 to 5000 mg/kg), or
slightly toxic (LD50: more than 5000mg/kg):
Abate, Acephate, Coumaphos, Crufomate, Famphur, Glyphosate, Malathion,
Phenthoate, Primiphos Methyl, Ronnel, Temephos, Triazophos, and
Trichlorphon.
Even in cases where treatment was begun early with atropine and oximes,
mortality in organophosphate poisoning is generally to the extent of 7 to 12%.
6. MECHANISM OF ACTION:
Organophosphates are powerful inhibitors of acetylcholinesterase which is
responsible for hydrolyzing acetylcholine to choline and acetic acid after its
release and completion of function (i.e. propagation of action potential).
As a result, there is accumulation of acetylcholine with continued stimulation
of local receptors and eventual paralysis of nerve or muscle.
Acetylcholine choline + acetic acid
Acetyl cholinesterase
Organophosphates
7. Organophosphate compounds
Inhibits acetylcholinesterase
by phosphorylation
Accumulation of acetylcholine
Central nervous
system
Peripheral nervous
system
Neuromuscular
junction
Neuromuscular junction
Clinical manifestations
Initial cholinergic
crisis
Intermediate
syndrome
Delayed syndrome
8. TOXICOKINETICS:
Organophosphates can be absorbed by any route including transdermal,
transconjunctival, inhalational, across the GI and GU mucosa, and through
direct injection.
Manifestations usually begin within a few minutes to few hours, but may be
delayed upto 12 hours or more in the case of certain compounds (e.g. fenthion,
parathion).
9. CLINICAL (TOXIC) SYMPTOMS:
1. ACUTE POISONING:
a) Cholinergic Excess:
Muscarinic Effects (hollow organ parasympathetic manifestations):
Common manifestations include bronchoconstriction with wheezing and
dyspnea, cough, pulmonary oedema, vomiting, diarrhoea, abdominal cramps,
increased salivation, lacrimation, and sweating, bradycardia, hypotension,
miosis, and urinary incontinence.
Some of these can be remembered by the acronym:
SLUDGE: Salivation, Lacrimation, Urination, Diarrhoea, Gastrointestinal
distress and Emesis.
10. CONTD…
Nicotinic Effects (autonomic ganglionic and somatic motor effects):
Fasciculations, weakness, hypertension, tachycardia, and paralysis. Muscle
weakness, fatiguability, and fasciculations are very common. Hypertension can
occur in up to 20 per cent of patients. Tachycardia is also common.
b) CNS Effects:
Restlessness, headache, tremor, drowsiness, delirium, slurred speech,
ataxia, and convulsions. Coma supervenes in the later stages.
11. CONTD…
2. CHRONIC POISONING:
It usually occurs as an occupational hazard in agriculturists, especially
those who are engaged in pesticide spraying of crops. Route of exposure is
usually inhalation or contamination of skin. The following are the main features:
a. Polyneuropathy: paraesthesias, muscle cramps, weakness, gait disorders.
b. CNS Effects: drowsiness, confusion, irritability, anxiety.
c. Sheep Farmer’s Disease: psychiatric manifestations encountered in sheep
farmers involved in long-term sheep-dip operations.
12. DIAGNOSIS:
1. Depression of cholinesterase activity:
a) If the RBC cholinesterase level is less than 50% of normal.
b) Depression of plasma cholinesterase level (to less than 50%).
2. P-Nitrophenol Test.
3. Thin Layer Chromatography (TLC).
4. High performance thin layer chromatography (HPLC).
13. MANAGEMENT:
1. ACUTE POISONING:
a. Decontamination:
If skin spillage has occurred, it is imperative that the patient be stripped and
washed thoroughly with soap and water.
Shower is preferable. Make the patient stand (if he is able to) under the
shower, or seated in a chair.
Wash with cold water for 5 minutes from head to toe using non-germicidal
soap. Rinse hair well.
Repeat the wash and rinse procedure with warm water.
14. CONTD…
Repeat the wash and rinse procedure with hot water.
Treating personnel should protect themselves with water-impermeable gowns,
masks with eye shields, and shoe covers. Latex and vinyl gloves provide
inadequate protection, unless a double pair is used.
If ocular exposure has occurred, copious eye irrigation should be done with
normal saline or Ringer’s solution. If these are not immediately available, tap
water can be used.
In the case of ingestion, stomach wash can be done, though this is often
unnecessary because the patient would have usually vomited several times by
the time he is brought to hospital. Activated charcoal can be administered in
the usual way.
15. CONTD…
b. Antidotes:
i) Atropine:
Mode of action: It is a competitive antagonist of acetylcholine at the
muscarinic postsynaptic membrane and in the CNS, and blocks the muscarinic
manifestations of organophosphate poisoning.
Diagnostic dose: Adult - 1 mg intravenously or intramuscularly; Child - 0.25
mg (about 0.01 mg/kg) intravenously or intramuscularly.
Therapeutic dose: 1 to 2 mg IV or IM (adult); 0.05 mg/kg IV (child); every 15
minutes until the endpoint is reached, i.e. drying up of tracheobronchial
secretions. Pupillary dilatation and tachycardia are not reliable indicators of the
endpoint.
16. CONTD…
ii) Pralidoxime (Pyridine-2-aldoxime methiodide; 2-PAM)
Mode of action: It is usually given along with atropine. Pralidoxime competes
for the phosphate moiety of the organophosphorus compound and releases it
from the acetylcholinesterase enzyme, thereby liberating the latter and
reactivating it.
Dose: For adults: 1 to 2 gm in 100 to 150 ml of 0.9% sodium chloride, given
IV over 30 minutes. This can be repeated after 1 hour, and subsequently every
6 to 12 hours, for 24 to 48 hours.
For children: 20 to 40 mg/kg to a maximum of 1 gm/dose given IV, and
repeated every 6 to 12 hours for 24 to 48 hours. Alternatively, iv infusion can
be resorted to, at a rate of 9 to 19 mg/kg/hr.
17. CONTD…
iii) Diazepam
Some studies indicate that the addition of diazepam to atropine and 2-PAM
improves survival. it reduces the risk of seizure-induced brain and cardiac
damage.
Dose: For adults: 5 to 10 mg IV slowly, every 15 minutes, upto a maximum of
30 mg.
For children: 0.25 to 0.4 mg/kg IV slowly, every 5 to 10 minutes, upto a
maximum of 10 mg.
If diazepam is ineffective, phenytoin or phenobarbitone can be used instead
18. CONTD…
c. Supportive Measures:
Administer IV fluids to replace losses.
Maintain airway patency and oxygenation. Suction secretions. Endotracheal
intubation and mechanical ventilation may be necessary. Monitor pulse
oximetry or arterial blood gases to determine need for supplemental oxygen.
Oxygenation/intubation/positive pressure ventilation.
The following drugs are contraindicated: parasympathomimetics,
phenothiazines, antihistamines and opiates.
19. CONTD…
Treat convulsions with benzodiazepines or barbiturates.
Antibiotics are indicated only when there is evidence of infection.
Hemoperfusion, haemodialysis, and exchange transfusion have not been
shown to affect outcome or duration of toxicity in controlled trials of
organophosphate poisoning.