1
|
Peter JV, Jerobin J, Nair A, Bennett A, Samuel P, Chrispal A, Abraham OC, Mathews KP, Fleming JJ, Oommen A. Clinical profile and outcome of patients hospitalized with dimethyl and diethyl organophosphate poisoning. Clin Toxicol (Phila) 2010; 48:916-23. [DOI: 10.3109/15563650.2010.528425] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
2
|
Pichamuthu K, Jerobin J, Nair A, John G, Kamalesh J, Thomas K, Jose A, Fleming JJ, Zachariah A, David SS, Daniel D, Peter JV. Bioscavenger therapy for organophosphate poisoning – an open-labeled pilot randomized trial comparing fresh frozen plasma or albumin with saline in acute organophosphate poisoning in humans. Clin Toxicol (Phila) 2010; 48:813-9. [DOI: 10.3109/15563650.2010.518970] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
3
|
Is there a relationship between the WHO hazard classification of organophosphate pesticide and outcomes in suicidal human poisoning with commercial organophosphate formulations? Regul Toxicol Pharmacol 2010; 57:99-102. [DOI: 10.1016/j.yrtph.2010.01.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2009] [Revised: 01/15/2010] [Accepted: 01/18/2010] [Indexed: 11/22/2022]
|
5
|
Peter JV, Moran JL, Pichamuthu K, Chacko B. Adjuncts and Alternatives to Oxime Therapy in Organophosphate Poisoning—is There Evidence of Benefit in Human Poisoning? A Review. Anaesth Intensive Care 2008; 36:339-50. [DOI: 10.1177/0310057x0803600305] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Organophosphate poisoning is common in developing countries. The morbidity and mortality with organophosphate poisoning is relatively high despite the use of atropine as specific antidotal therapy and oximes to reactivate acetylcholinesterase. Several adjunct and alternative therapies have been explored in animal and human studies. We reviewed the literature to ascertain if there was evidence of benefit of such therapies. Adjunct and alternative therapies included treatments to reduce poison absorption by topical application of creams, enhance toxin elimination by haemoperfusion or bioremediation and neutralise the poison by scavenging free organophosphate with cholinesterase-rich human plasma. In addition, magnesium, clonidine, diazepam, N-acetyl cysteine and adenosine receptor agonists have also been used to counteract poison effects. Detailed assessment was limited by the paucity of trials on adjunct/alternative therapies. The limited evidence from the review process suggested potential benefit from the use of human plasma infusion, early initiation of haemoperfusion and intravenous magnesium, in addition to standard therapy with atropine and pralidoxime. There appeared to be no additional benefit with alkalinisation or use of glycopyrrolate instead of atropine in human trials. Diazepam administration has been advocated by military authorities if symptoms developed following exposure to organophosphate. Bioremediation, clonidine, N-acetyl cysteine and adenosine receptor agonists have been evaluated only in animal models. The impact of adjunct and alternate therapies on outcomes in human poisoning needs to be further explored before implementation as standard treatment.
Collapse
Affiliation(s)
- J. V. Peter
- Department of Medical Intensive Care, Christian Medical College and Hospital, Vellore, India and Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Woodville, South Australia, Australia
- Department of Medical Intensive Care, Christian Medical College and Hospital
| | - J. L. Moran
- Department of Medical Intensive Care, Christian Medical College and Hospital, Vellore, India and Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Woodville, South Australia, Australia
- Department of Intensive Care Medicine, The Queen Elizabeth Hospital
| | - K. Pichamuthu
- Department of Medical Intensive Care, Christian Medical College and Hospital, Vellore, India and Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Woodville, South Australia, Australia
- Department of Medical Intensive Care, Christian Medical College and Hospital
| | - B. Chacko
- Department of Medical Intensive Care, Christian Medical College and Hospital, Vellore, India and Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Woodville, South Australia, Australia
- Department of Medical Intensive Care, Christian Medical College and Hospital
| |
Collapse
|
6
|
Peter JV, Moran JL, Graham PL. Advances in the management of organophosphate poisoning. Expert Opin Pharmacother 2007; 8:1451-64. [PMID: 17661728 DOI: 10.1517/14656566.8.10.1451] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Organophosphate (OP) poisoning is commonly encountered in agricultural communities. The mainstay of therapy in OP poisoning is the use of atropine. However, several other therapies have been evaluated. Although oxime has been the most studied antidote, results in humans have been disappointing and limited by the lack of well-designed, prospective, randomised controlled trials. The key factor in determining outcomes in OP poisoning appears to be the timing of antidote administration. Other adjuvants, such as magnesium, fresh frozen plasma and haemoperfusion appear promising, and need to be explored further. A multi-faceted approach may be the answer to improving outcomes in OP poisoning. This review evaluates the advances in OP management over the last 20 years.
Collapse
Affiliation(s)
- John Victor Peter
- Christian Medical College & Hospital, Department of Medical Intensive Care, Vellore, India.
| | | | | |
Collapse
|