Symptom-based treatment following organophosphate poisoning

Authors:

  • Elisabeth Wigenstam
  • Ulrika Bergström
  • Lina Thors
  • Anders Bucht

Publish date: 2014-09-02

Report number: FOI-R--3906--SE

Pages: 29

Written in: English

Keywords:

  • Organophosphate poisoning
  • acetylcholine
  • atropine
  • treatment strategies
  • anticonvulsants
  • cholinergic antagonists
  • GABA

Abstract

Organophosphate (OP) poisoning, either accidental or intentional, is still regarded as a major chemical threat world-wide, both to militaries and civilians. Recent events, such as the sarin attack in Syria in 2013, showed the devastating consequences of nerve agent exposure of unprotected people.The primary symptoms after OP poisoning are dependent on the type of nerve agent, exposure dose and route of exposure. The symptoms are caused by cholinergic overstimulation in the central nervous system and muscles, e.g. in the heart, the vascular and respiratory-related muscles and in the secretory glands (including the respiratory tract). In this report, we have compared the different treatment regimes in Sweden, UK and USA for organophosphate poisoning. We found that they are very similar; they all recommend a combined treatment with oximes, atropine and oxygen with the addition of diazepam to control seizures. The guideline from USA also opens up for use of other benzodiazepines as an alternative to diazepam. Also presented is an overview of the research on possible complementary treatments to those available today. Particular emphasis is given to research concerning existing drugs on the pharmaceutical market used for treatment of other diseases, (e.g. epilepsia and depression) and their potential use in treatment of OP intoxication. Research conducted in animals has shown that some new concepts of combinatory drug treatment may improve survival after exposure to highly toxic nerve agents. Further biomedical research has provided new understanding in the mechanisms by which nerve agents induce injuries in the central nervous system, neuromuscular block and respiratory failure. The improved understanding would open new opportunities in the prevention of OP-induced toxicity.