TREATMENT OF ORGANOPHOSPHATE POISONING - EXPERIENCE OF NERVE AGENTS AND ACUTE PESTICIDE POISONING ON THE EFFECTS OF OXIMES

Organophosphate (OP) compounds have been used as pesticides and in che mical warfare (nerve agents). Two nerve agents, tabun and sarine, were used by the Iraqi army against Iranian troops and innocent people. Hu ndreds of the exposed combatants died in the field. Atropine sulphate has been used successfully in large doses to counteract the muscarinic effects of OP poisoning. The effects of oximes in human OP poisoning have not been well studied. Our aim was to study the effects of obidox ime and pralidoxime in OP pesticide poisoning. The patients were divid ed into three groups: atropine (A), obidoxime + atropine (OA) and pral idoxime + atropine (PA). Sixty-three patients (33 males, 30 females) w ith a mean age of 25 years were studied in different groups (43 A, 22 OA and 8 PA). There were no statistical significant differences in maj or clinical findings and acetylcholinesterase (AChE) activity on admis sion between the groups. Significant changes were observed during the treatment. Notwithstanding the severity of intoxication - particularly respiratory complications were more observed in the OA and PA groups - there were no fatalities in the PA group, whereas 4 (9%) and 6 (50%) patients in the A and OA groups died, respectively. AChE reactivation was only observed in the PA group, although it was not statistically significant (r = 0.4747). There was a good relationship between the AC hE reactivation and outcome of the patients. High doses of obidoxime ( 8 mg/kg followed by 2 mg/kg/h) were found to be hepatotoxic and should be avoided. High doses of pralidoxime (30 mg/kg followed by 8 mg/kg/h ) did not induce serious side effects and may be effective in some OP pesticides poisoning. ((C) Elsevier, Paris).