Liverpool Hospital Emergency Department
Requires discussion with a clinical Toxicologist
- Organophosphate poisoning – its use is controversial and is no longer routine o Nerve agent poisoning
- Antagonist to anticholinesterases such as neostigmine and pyridostigmine, which are used in the treatment of myasthenia gravis.
- 500mg/20mL ampoule
Dosage and Administration
- Bolus dose:
- In severe poisoning that is unresponsive to other treatments consider ∙ 1g pralidoxime iodide (15mg/kg paediatrics to 1g)
- Use 2.5g (5 ampoules) pralidoxime to give a final concentration of 2.5g in 100ml NaCl 0.9%
- Run at a rate of 250mg/hr (10mg/kg/hr paediatrics)
- Continue for 12 to 24hours and then review with toxicologist.
- The infusion may be weaned over 24 to 48 hours, depending on the severity of symptoms.
- Cessation of the infusion is based upon clinical testing and mixed plasma cholinesterase testing.
- Muscle rigidity
- Dizziness, blurred vision, diplopia, seizure.
- Apnoea, Laryngeal spasm
- Not effective in poisonings due to carbamates
- Dose adjustment is needed in renal impairment
- Use with great caution in treating organophosphate overdose in cases of myasthenia gravis, as it may precipitate a myasthenic crisis.
- Response will depend on agent, severity and time to treatment