A prospective comparative cohort study on the dosing pattern of atropine in
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A prospective comparative cohort study on the dosing pattern of atropine in Organophosphorous and Carbamate poisoning in rural Sri lanka. P.M.S. Perera , A.H. Dawson, I.B. Gawarammana , S. Sayed South Asian Clinical Toxicology Research Collaboration Central Province Clinical Unit

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P.M.S. Perera , A.H. Dawson, I.B. Gawarammana , S. Sayed

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P m s perera a h dawson i b gawarammana s sayed

A prospective comparative cohort study on the dosing pattern of atropine in Organophosphorous and Carbamate poisoning in rural Sri lanka

P.M.S. Perera, A.H. Dawson, I.B. Gawarammana, S. Sayed

South Asian Clinical Toxicology Research Collaboration

Central Province Clinical Unit

Peradeniya General Hospital

Sri Lanka


Total hospital admissions and deaths due to poisoning 2005 in sri lanka

Total Hospital Admissions and Deaths Due to Poisoning 2005in Sri-lanka

Source: National Poison Center Sri-Lanka


Atropine dose in organophosphates

Atropine Dose in Organophosphates

  • Sri Lankan ventilated OP patients who survived require

    • Mean initial dose of 23.4 mgs.

    • Maximum initial dose of 75 mgs.

  • 38 texts with 31 different recommendations

    Eddleston et al .Speed of initial atropinisation in significant organophosphorus pesticide poisoning. J ToxClinTox2004;42(6):865-75


Purpose of the study

Purpose of the study

  • To examine the safety and efficacy of atropine in a cohort of patients with acute cholinesterase inhibitor poisoning


Methodology

Methodology

February to July 2006


Scheme of atropinization endpoints to be reached

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Scheme of atropinization (endpoints to be reached)

  • Eddleston M, Buckley NA, Mohamed F, Senarathna L, Hittarage A, Dissanayake W, Azhar S, Sheriff MHR, Dawson AH. Speed of initial atropinisation in significant organophosphorus pesticide poisoning - a comparison of recommended regimens. Journal of Toxicology – Clinical Toxicology 2004;6:865-875.


Atropine outcomes

Atropine Outcomes


P m s perera a h dawson i b gawarammana s sayed

Summary of major outcomes of pesticides

Data are number (%)

£Diazinon, Phethoate, Acephate, Profenopos, Fenthion


Conclusions

Conclusions

  • Titrated atropine dosing was associated with significantly less atropine toxicity

  • There is no difference in patient mortality

  • Atropine doses should be titrated against response and toxicity

  • The use of a structured monitoring sheet may assist in more appropriate atropine use


Acknowledgments

Acknowledgments

Wellcome Trust & NHMRC

Prof Nick Buckley

SACTRC Members

Hospital Doctors

Nurses and Patients


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