| Written by Dr.Md.Redwanul Huq (Masum) |
| Tuesday, 22 January 2013 08:26 |
Clinical features:
| Type of manifestation | Affected organ/system | Effects |
| MuscarinicManifestation | Pupils | Constriction of pupils (Miosis) |
| GI tract | Anorexia, nausea, vomiting, diarrhea, abdominal cramp, tenesmus, faecal incontinence | |
| Lacrimal gland | Increased Lacrimation | |
| CVS | Bradycardia, hypotension | |
| Salivary gland | Increased salivation | |
| Sweat gland | Increased sweating | |
| Respiratory system | Bronchospasm, increased bronchial secretion, dyspnoea, cyanosis, pulmonary edema | |
| Urinary bladder | Incontinence of urine | |
| NicotinicManifestation | Skeletal muscle | Fasciculation, muscle cramp, weakness, loss of reflexes, muscle paralysis |
| Sympathetic ganglia | Hypertension, tachycardia | |
| CNSManifestation | Early excitation | Headache, restlessness, emotional liability, tremor |
| Late depression | Drowsiness, confusion, depression of respiratory and cardiovascular centers, coma |
Management of OPC poisoning:
I. Immediate management of OPC poisoning
a) Airway clearance
b) Ensuring breathing
c) Maintenance of circulation
II. General measurements of OPC poisoning:
a) Prevention of absorption and also elimination of poison
i) Removal of clothing
ii) Skin wash with soap water
iii) Stomach wash with KMnO4
vi) Whole bowel irrigation
vii) Haemoperfusion
b) Supportive management
i) Aspiration of secretions
ii) O2 therapy
iii) IV infusion
iv) Artificial ventilation if needed
c) Inactivation of the absorbed poison
i) Antidote: Pralidoxime 30 mg /Kg IV (not more than 500 mg/min) and repeated every 30 min as necessary
ii) Antagonist: Atropin sulphate 2-4 mg IV. If no effect, the dose may be doubled at 5-10 min intervals up to atropinization
e) Symptomatic treatment
i) Antipyretics
ii) Antibiotics to prevent pulmonary infection
iii) Anticonvulsant e.g. Benzodiazepines or Barbiturates
f) Maintenance of nutrition– oral (if possible) or parenteral
g) Follow up of the patient to prevent any complication of OPC poisoning.
