Template:Cholinergic Toxicity Treatment

Protection

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

Decontamination

• Dispose of all clothes
• Wash patient with soap and water

Airway

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

Breathing

• Use O2 100% NRB

Antidotes

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