A comparative study of atropine and atropine plus pralidoxime in the management of organo-phosphorous poisoning
DOI:
https://doi.org/10.18203/2349-3933.ijam20232919Keywords:
Organophosphorus, Atropine, PralidoximeAbstract
Background: Poisoning with organophosphorus compounds (OP) is a common problem throughout the world particularly in developing countries. Standard treatment involves resuscitation, administration of the anti-muscarinic agent atropine, an acetylcholinesterase reactivator (pralidoxime) and assisted ventilation if necessary. In this study we compared the efficacy of add-on pralidoxime therapy over therapy with atropine alone in OP poisoning.
Methods: The study included 103 patients, out of 103 OP poisoning cases, 54 patients received both atropine and PAM (group A) and 49 received only atropine (group B). Main outcome parameters of the study were total hospital stay and mortality. The data was compared using ‘t’ test while mortality was compared using Fisher’s exact test. Data was tabulated, analysed, reviewed and evaluated.
Results: There was no difference in duration of hospital stay between the two group. The mean hospital stay in group A was 3.71±1.92 days and in group B was 3.14±2.01 days (p value >0.05). No difference in mortality was seen between the two group. Out of 54 in group A, 8 died and in group B out of 49, 7 died (p value >0.05). Importantly cost burden is very high in the pralidoxime added group.
Conclusions: There is no significant difference in use of atropine alone or atropine-pralidoxime combination in terms of morbidity and mortality in OP poisoning rather the later incurs more economic burden which may not be practicable in poor countries like India. However, a larger multicentric prospective study needs to be conducted, to be able to draw a definitive conclusion.
References
Eddleston M, Eyer P, Worek F, Juszczak E, Alder N, Mohamed F, et al. Pralidoxime in acute organophosphorus insecticide poisoning—a randomised controlled trial. PLoS Med. 2009;6(6):e1000104.
Eyer P. The role of oximes in the management of organophosphorus pesticide poisoning. Toxicol Rev. 2003;22(3):165-90.
Srivastava A, Peshin SS, Kaleekal T, Gupta SK. An epidemiological study of poisoning cases reported to the national poisons information centre, All India Institute of Medical Sciences, New Delhi. Hum Exp Toxicol. 2005;24(6):279-85.
Eddleston M, Buckley NA, Eyer P, Dawson AH. Management of acute organophosphorus pesticide poisoning. Lancet (London, England). 2008;371(9612):597-607.
Jeyaratnam J. Acute pesticide poisoning: a major global health problem. World Heal Stat Q. 1990;43:139-44.
Van Der Hoek W, Konradsen F, Athukorala K, Wanigadewa T. Pesticide poisoning: a major health problem in Sri Lanka. Soc Sci Med. 1998;46(4-5):495-504.
Eddleston M, Phillips MR. Self-poisoning with pesticides. BMJ. 2004;328(7430):42-4.
Eddleston M. The pathophysiology of organophosphorus pesticide self-poisoning is not so simple. Neth J Med. 2008;66(4):146-8.
Eddleston M, Dawson A, Karalliedde L, Dissanayake W, Hittarage A, Azher S, et al. Early management after self-poisoning with an organophosphorus or carbamate pesticide–a treatment protocol for junior doctors. Crit Care. 2004;8(6):1-7.
Buckley NA, Eddleston M, Li Y, Bevan M, Robertson J. Oximes for acute organophosphate pesticide poisoning. Cochrane Database Syst Rev. 2011;(2).
Salame RN, Wani AS. Study of serum amylase levels in organophosphate poisoning. Int J Biomed Adv Res. 2017;8(12):450-4.
Raddi D, Anikethana GV. Clinical profile of organophosphorus poisoning in a tertiary care hospital. Indian J Basic Appl Med Res. 2014;4(1):14-22.
Chaturvedi A, Dutta S, Sarkar S, Saha TK, Adhikary S, Das S, et al. Prevalence of hyperamylasemia and acute pancreatitis in organophosphate poisonings. J Dent Med Sci. 2014;13(1):59-62.
De Silva HJ, Wijewickrema R, Senanayake N. Does pralidoxime affect outcome of management in acute organophosphorus poisoning? Lancet. 1992;339(8802):1136-8.
Duval G, RANKOUER JM, Tillant D, Auffray JC, Nigond J, Deluvallee G. Intoxications aigues par insecticides a actioin anticholinesterasique. Evaluation de l efficacite d un reactivateur des cholinesterases, le pralidoxime. J Toxicol Clin Expérimentale. 1991;11(1):51-8.
Chugh SN, Aggarwal N, Dabla S, Chhabra B. Comparative evaluation of atropine alone and atropine with pralidoxime (PAM) in the management of organophosphorus poisoning. J Indian Acad Clin Med. 2005;6(1):33-7.
