![]() The South Asian Clinical Toxicology Research Collaboration is funded by a Wellcome Trust/National Health and Medical Research Council International Collaborative Research Grant 071669. This work was funded by grant 063560 from the Wellcome Trust's Tropical Interest Group to ME. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.įunding: ME is a Wellcome Trust Career Development Fellow. Received: DecemAccepted: Published: June 30, 2009Ĭopyright: © 2009 Eddleston et al. PLoS Med 6(6):Īcademic Editor: Mervyn Singer, University College London, United Kingdom (2009) Pralidoxime in Acute Organophosphorus Insecticide Poisoning-A Randomised Controlled Trial. To reduce confounding due to ingestion of different insecticides, we further analysed patients with confirmed chlorpyrifos or dimethoate poisoning alone, finding no evidence of benefit.Ĭitation: Eddleston M, Eyer P, Worek F, Juszczak E, Alder N, Mohamed F, et al. The need for intubation was similar in both groups (pralidoxime 26/121, placebo 24/114, adjusted HR 1.27 ). Incorporating the baseline amount of acetylcholinesterase already aged and plasma OP concentration into the analysis increased the HR for patients receiving pralidoxime compared to placebo, further decreasing the likelihood that pralidoxime is beneficial. Mortality was nonsignificantly higher in patients receiving pralidoxime: 30/121 (24.8%) receiving pralidoxime died, compared with 18/114 (15.8%) receiving placebo (adjusted hazard ratio 1.69, 95% confidence interval 0.88–3.26, p = 0.12). Pralidoxime produced substantial and moderate red cell acetylcholinesterase reactivation in patients poisoned by diethyl and dimethyl compounds, respectively. Two hundred thirty-five patients were randomised to receive pralidoxime (121) or saline placebo (114). We measured baseline markers of exposure and pharmacodynamic markers of response to aid interpretation of clinical outcomes. ![]() Mortality was the primary outcome secondary outcomes included intubation, duration of intubation, and time to death. We speculate that in a mass casualties event, the benefits of using oximes outweigh the low level of potential risk.We performed a double-blind randomised placebo-controlled trial of pralidoxime chloride (2 g loading dose over 20 min, followed by a constant infusion of 0.5 g/h for up to 7 d) versus saline in patients with organophosphorus insecticide self-poisoning. ![]() According to this algorithm, treatment should consist of atropine and oxime regardless of the exact toxic compound involved. We also propose a new decision-making algorithm for the medical first responders in a mass casualties event suspected to be caused by a cholinergic substance (organophosphate or carbamate). In this article, we review the current data regarding the pros and cons of using oximes against carbamates poisoning in a mass casualties event scenario. However, recent data suggest that this concern may be unwarranted. The administration of oximes, acetylcholinesterase reactivators, in carbamate poisoning is controversial because of the potential toxicity of oximes in conjunction with carbamate especially in the case of the carbamate-"carbaryl" poisoning. ![]() The medical management of carbamate poisoning consists of supportive measures and specific antidotal treatment, that is, the anticholinergic compound atropine. Carbamates, a group of reversible acetylcholinesterase inhibitors, could be potentially involved in such toxic mass casualty events because they can cause cholinergic crisis that could lead to fatality, similar to that of organophosphate poisoning. The threat of using chemical compounds by terrorists as weapons of mass casualties has been a rising concern in recent years.
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