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Mackey CL: Anticholinesterase insecticide poisoning. Heart Lung. 1982 Sep-Oct;11(5):479-84.
Anticholinesterase insecticides can be lethal, especially to small children. Prevention, not treatment, is the key to lowering the mortality rate. However, treatment, when necessary, can be effective if the poisoning agent is identified quickly as an anticholinesterase insecticide and therapy is begun immediately and aggressively. Large doses (up to 5 gm) of atropine, which block the parasympathetic effects of the poison, in conjunction with pralidoxime, a cholinesterase regenerator, need to be administered, second only in priority to establishing an airway. The second line of attack after adequate atropinization is supportive. Assistance with ventilation is individualized according to the degree of patient need. Intake with cautiously vigorous fluid therapy and output via Foley catheter are essential. Gastric lavage, seizure precautions and control as necessary, good body hygiene, and frequent turning are also part of necessary nursing intervention. Prognosis is fairly good if improvement is shown after therapy is begun. Maintaining adequate atropinization seems to be difficult yet essential to the success of the treatment and a good prognosis for the patient. |
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