Atropine antidote neostigmine8/15/2023 ![]() ![]() Infants and Children: Initial: 0.05 to 0.1 mg/kg repeat every 3 to 5 minutes as needed, double the dose if previous dose does not induce atropinization ( Ref). Pralidoxime is a component of the management of organophosphate insecticide and nerve agent toxicity refer to pralidoxime for the specific route and dose. Once patient is stable for a period of time, the dose/dosing frequency may be decreased. Titrate to pulmonary status (decreased bronchial secretions) consider administration of atropine via continuous IV infusion in patients requiring large doses of atropine ( Ref). Severely poisoned patients may exhibit significant tolerance to atropine ≥2 times the suggested doses may be needed. The total amount of atropine used for carbamate poisoning is usually less than with organophosphate insecticide or nerve agent poisoning. ![]() The dose of atropine required varies considerably with the severity of poisoning. Note: If exposure is known or suspected, antidotal therapy should be given as soon as symptoms appear do not wait for confirmation. Severe symptoms: Breathing difficulties (severe), confused/strange behavior, defecation (involuntary), muscular twitching/generalized weakness (severe), respiratory secretions (severe), seizure, unconsciousness, urination (involuntary).Įndotracheal: Usual dose: 2 to 2.5 times IV dose diluted in 5 to 10 mL of 0.9% sodium chloride or sterile water ( Ref). Mild symptoms: Blurred vision, bradycardia, breathing difficulties, chest tightness, coughing, drooling, miosis, muscular twitching, nausea, runny nose, salivation increased, stomach cramps, tachycardia, teary eyes, tremor, vomiting, or wheezing. Symptoms of insecticide or nerve agent poisoning, as provided by manufacturer in the AtroPen product labeling, to guide therapy: Severe symptoms (≥1 severe symptoms): Immediately administer three 2 mg doses in rapid succession. If profound anticholinergic effects occur in the absence of excessive bronchial secretions, further doses of atropine should be withheld. If severe symptoms develop after the first dose, 2 additional doses should be repeated in rapid succession 10 minutes after the first dose do not administer more than 3 doses. Mild symptoms (≥2 mild symptoms): Administer 2 mg as soon as an exposure is known or strongly suspected. IV continuous infusion: After desired response is achieved with IV boluses, administer 10% to 20% of the total cumulative IV bolus dose as an IV continuous infusion per hour (eg, if 18 mg given by IV bolus is required to achieve the desired response, start an IV continuous infusion of 1.8 mg per hour) adjust infusion rate as needed to maintain adequate response without causing atropine toxicity ( Ref). After the desired response is achieved with bolus dosing, consider starting an IV continuous infusion for improved clinical outcomes ( Ref). Maintain atropinization by administering repeat doses as needed for ≥2 to 12 hours based on recurrence of symptoms ( Ref). Severe symptoms: Initial: 3 to 5 mg bolus ( Ref) repeat by doubling the dose every 3 to 5 minutes if previous dose did not induce a response ( Ref). Mild to moderate symptoms: Initial: 1 to 2 mg bolus ( Ref) repeat by doubling the dose every 3 to 5 minutes if previous dose did not induce a response ( Ref). Pralidoxime is an essential component of the management of organophosphate insecticide and nerve agent toxicity refer to Pralidoxime monograph for the specific route and dose. ![]() Note: The dose of atropine required varies considerably with the severity of poisoning. Organophosphate or carbamate insecticide or nerve agent poisoning: ![]()
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