Paper I
2013 April (2010 Scheme) · 40 marks · 180 min

Question

Drug treatment of anti cholinesterase poisoning

Q43 marksShort Notes

Answer

Anticholinesterase (organophosphate) poisoning causes accumulation of acetylcholine at muscarinic and nicotinic sites, producing the classic muscarinic (SLUDGE), nicotinic, and CNS toxicity picture.

General measures

  • Remove patient from source; remove contaminated clothing, wash skin
  • Maintain airway, breathing, circulation; suction secretions, give oxygen
  • Gastric lavage if ingested (within a safe time window)

Specific antidotes

  • Atropine sulphate: IV, titrated to effect (dose repeated every 5–10 min until secretions dry / atropinisation achieved); blocks muscarinic effects — bradycardia, bronchospasm, secretions
    • Does NOT reverse nicotinic effects (muscle weakness/paralysis)
  • Pralidoxime (2-PAM): Cholinesterase reactivator — regenerates active enzyme by removing the phosphate group from it
    • Most effective if given early, before “ageing” of the enzyme-inhibitor complex occurs
    • Reverses both muscarinic and nicotinic (neuromuscular) effects
    • Given IV along with atropine

Supportive care

  • Diazepam for convulsions
  • Assisted ventilation if respiratory muscle paralysis occurs
  • Monitor and correct electrolyte disturbances

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