Treatment

Poisoning by organophosphorus compounds can be treated, and although the acute symptoms can be alleviated, the delayed neuropathy cannot. There are two treatments which may be used both involving antidotes:

i The compound pralidoxime (figure 7.33) is administered in order to regenerate the acetylcholinesterase. This it does by acting in place of the serine hydroxyl group in the enzyme and forming a complex with the organophosphorus moiety (figure 7.33). Pralidoxime must be

European Medical Treatment

FIGURE 7.34 Comparison of the pharmacological and toxic effects of digitoxin in man. The pharmacological effect was a 40-50% decrease in heart rate; the toxic effect, nausea and vomiting, occurred after a single oral dose. Adapted from Marsh (1951) Outline of Fundamental Pharmacology (Springfield, Ill.: Charles C.Thomas).

FIGURE 7.34 Comparison of the pharmacological and toxic effects of digitoxin in man. The pharmacological effect was a 40-50% decrease in heart rate; the toxic effect, nausea and vomiting, occurred after a single oral dose. Adapted from Marsh (1951) Outline of Fundamental Pharmacology (Springfield, Ill.: Charles C.Thomas).

administered quickly after the poisoning as if the phosphorylated enzyme is allowed to age then it will no longer be an effective antidote. The reactivation rate will depend on the particular organophosphorus compound. ii The physiological effects of the accumulation of acetylcholine can be antagonized by the administration of atropine and the symptoms alleviated.

If both atropine and pralidoxime are given together there is a much greater effect than if either are given alone. Thus, when used after experimental parathion poisoning, each treatment alone only increased the LD50 about twice, whereas in combination the LD50 was increased 128 times.

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