J Korean Soc Emerg Med.  2004 Oct;15(5):360-367.

Effect of High-dose Pralidoxime in Organophosphate Intoxication

• Jeong ST
• Lee JK
• Lee BG
• Wi JS
• Chun BJ
• Heo T
• Min YI

Abstract

PURPOSE
Pralidoxime(2-PAM) is the mainstay of organophosphate intoxication management as an antidote. We investigated the usefulness of high-dose pralidoxime therapy.
METHODS
From January 2000 to July 2003, 86 patients presented with organophosphate insecticide intoxication to the emergency medical center of Chonnam National University Hospital. They were randomized into two groups: Group I was given continuous IV infusion of pralidoxime in dose of 500 mg/hr after an initial bolus dose of 2 g and Group II was given continuous IV infusion of pralidoxime in dose of 1000 mg/hr after an initial bolus dose of 2 g. Both groups were given same therapeutic interventions, including the duration of atropine administration. The plasma cholinesterase activites were monitored at admission and at 24 hr and 48 hr after infusion of pralidoxime. The effectiveness of the two treatment modalities were gauged by comparing the durations of mechanical ventilation and intensive care unit (ICU) stay.
RESULTS
The mean durations of mechanical ventilation were 9.82+/-6.45 days in group I and 6.51+/-4.50 days in group II. The mean durations of ICU stay were 12.82+/- 7.69 days in group I and 9.15+/-5.38 days in group II. group I showed that longer durations of mechanical ventilation (p=0.03) and ICU stay( p<0.001). The plasma cholinesterase reactivation rate were higher in group II than in group I.
CONCLUSION
The results suggest that continuous high-dose pralidoxime therapy may be helpful in the treatment of organophosphate intoxication.

Keyword

Organophosphate; Intoxication; Pralidoxime; Cholinesterase

MeSH Terms

Atropine
Cholinesterases
Emergencies
Humans
Intensive Care Units
Jeollanam-do
Plasma
Respiration, Artificial
Atropine
Cholinesterases