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General Measures in the Management of Acute Pesticide Poisoning
V. Antidotes
The use of specific antidotes are seldom necessary except when their administration is beneficial and life saving. Administration of antidotes should be dependent on the assessment of the patient’s clinical state, laboratory results and pharmacodynamics
of the substance.
The following antidotes are useful in the following pesticide poisonings:
- Organophosphate and carbamate poisoning:
- Atropine is the physiologic antidote for both organophosphate and carbamate poisonings. Atropine reverses the muscarinic effects of both organophosphate and carbamate poisonings.
- Pralidoxime is the pharmacologic antidote and it should be used only in organophosphate poisoning. It is effective if given within 24 hours, prior to irreversible phosphorylation of acetylcholinesterase. It reverses the nicotinic effects (muscle weakness and fasciculations) induced by organophosphates.
- Dinitrophenol poisoning
Ascorbic acid is given in cases of methemoglobinemia induced by dinitrophenol. Methemoglobinemia of > 20% is manifested with cyanosis, dyspnea and confusion. Concurrent with ascorbic acid is the administration of oxygen.
- Coumatetralyl/warfarin poisoning
Vitamin K1 or phytonadione is the antidote for warfarin poisoning. It reverses the anticoagulant effect of coumatetralyl/warfarin.
- Zinc phosphide poisoning
N-acetylcysteine has been effective in preventing the hepatotoxic effect of zinc phosphide.
- Mixed pesticide poisoning
In water-based formulations of household mixed pesticides, where isopropanol is of significantly high concentration, administration of thiamine is most beneficial.
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Copyright ?2003
National Poison Control and Information
Service
