Template:Cholinergic Toxicity Treatment

Protection

1. Wear protective clothing to prevent secondary poisoning
2. Use neoprene or nitrile gloves (not latex)

Decontamination

1. Dispose of all clothes
2. Wash patient with soap and water

Airway

1. Suction as needed
2. Intubation often needed due to significant respiratory secretions / bronchospasm
3. Use nondepolarizing agent (Rocuronium or Vecuronium)

Breathing

1. Use O2 100% NRB

Antidotes

1. Atropine
   • May require massive dosage (hundreds of milligrams)
   • Does not reverse muscle weakness due to nicotinic binding
   • Dosing
   1. Adult: 1mg or more IV; repeat q5min until tracheobronchial secretions attenuate
   2. Child: 0.01-0.04mg/kg (but never <0.1mg) IV
2. Pralidoxime
   • For Organophosphate poisoning only.
   • Has no use in Nicotinic poisoning
   • Displaces an organophosphate from acetylcholinesterase (if given early)
   • Dosing
   1. Adult: 1-2gm IV over 5-10min; continuous infusion of 500mg/hr if no initial response
   2. Child: 20-40mg/kg (up to 1gm) IV over 5-10min; 5-10mg/kg/hr if no initial response