Atropine
Liverpool Hospital Emergency Department
Indications:
- Cholinergic Toxidrome (organophosphates / nerve agents / carbamates)
- Toxin related bradycardia (temporising)
- Increasing heart rate in the case of drug induced torsades de pointes with prolonged QT (temporising measure will require further chronotropy – adrenaline or isoprenaline)
Formulation:
- 600mcg ampoule
- 1200mcg ampoule (1.2mg)
Dosage and Administration
Cholinergic Toxidrome:
- 1.2mg (paediatric 50mcg/kg up to 1.2mg) IV bolus. Double dose every 5 minutes until end points are reached. High doses may be needed
- End points – clear chest / HR >80 BPM / SBP >80mmHg
- Follow with atropine infusion 10-20% of loading dose / hr
- 60mg atropine in a 50mL syringe (50 x 1.2mg ampoules).
- Generally, 0.5 – 5mg/hr
Chronotropy to increase HR in bradycardia or TdP
- 600mcg (20mcg/kg) bolus up to a maximum of 3mg
Side Effects:
Anticholinergic Toxidrome:
- Confusion
- Pyrexia
- Ileus
- Tachycardia
- Urinary retention
- Dry skin & mucous membranes
- Mydriasis
Pit Falls:
- May require very large doses of atropine for cholinergic overdose (requiring stocks from elsewhere)
- Failure to administer enough atropine in cholinergic overdose