doc4life
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Pralidoxime is given for the treatment of organophosphate poisoning but not for carbamate poisoning. WHY?
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| filiz
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Doctors use massive doses of atrophine sulfate to treat organophosphate and carbamate poisoning. They also use 2-PAM to treat organophosphate poisoning, but it should not be used for carbamate poisoning.
Since the specific antidote for organophosphate poisoning is different than carbamate poisoning it is important to give the name of the insecticide that was ingested.Cholinesterase reactivators are contraindicated in carbamate poisoning.
Cholinesterase blood levels may remain low for several weeks and cannot always be relied on to monitor recovery. Beware of relapse!
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Organophosphates irreversibly bind to cholinesterase causing the phosphorylation and deactivation of acetylchoinesterase. The subsequent accumulation of acetylcholine at the neural synapse causes an initial overstimulation followed by eventual exhaustion and disruption of neural transmission in the central and peripheral nervous systems (CNS and PNS).
If the organophosphate/cholinesterse bond is not broken by pharmacologic intervention within 24 hours, large amounts of cholinesterase are destroyed causing long-term morbidity or death.
Carbamate poisoning exhibits a similar clinical picture to organophosphates. However, it temporarily binds cholinesterase for approximately six hours with no permanent damage. Carbamates have poor CNS penetration and cause minimal CNS symptoms.
Pralidoxime (2-PAM) is indicated for patients with or at risk for muscular weakness.
The definitive antidote for organophosphate poisoning is 2-PAM.
Pralidoxime reverses the phosphorylation of cholinesterase, improves neural synaptic transmission, and, hence, muscle weakness and paralysis.
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| doc4life
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Thanks
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