General Measures in the Management of Acute Pesticide Poisoning

I. Emergency stabilization

E. Correct metabolic abnormalities

Hypokalemia is treated based on restoring the lower limits of acceptable serum potassium: KCI solution - up to 40 mEq/hour, not to exceed 60 mEq/liter.
Acceptable Limits of Serum K+ pH K+ level (mEq) acidosis 4.7 normal 3.7 alkalosis 2.7
Hyperkalemia is managed using the following drugs: Glucose-insulin infusion 50 mL D50-50 and 10 units of Regular Insulin Sodium bicarbonate Follow after glucose infusion. 1 mEq/kg/dose 10% Calcium gluconate As an alternative to sodium bicarbonate 5-10 mL slow IV push under cardiac monitoring. Intractable hyperkalemia may require dialysis. Hypomagnesemia, in severe cases, is treated with: Magnesium sulfate Loading dose: 600 mg of elemental Mg++ in D5W over 3 hours Maintenance dose: 600-900 mg of elemental Mg++ per 24 hours. In emergency situations, the loading dose should not exceed 15 mg/minute. MgSO4 can be administered IM at 200 mg q 4 hours for 24 hours then 100 mg q 4 hours. To avoid toxicity, monitor the following parameters: heart rate, respiratory rate, deep tendon reflexes and urine output. ECG monitoring is also recommended. Hypoglycemia is managed with infusion of glucose at 50-100 mL D50-50 (Adult); D10 (Pediatric). Hypocalcemia is particularly seen in zinc phosphide poisoning. Calcium Salt For parenteral administration of calcium, calcium chloride is the preferred preparation because it has better and more predictable retention in the body, compared to calcium gluconate. Adults: 2.25 to 4.5 mmol calcium by slow IV push Repeat as required. Pedia: 100-300 mg/kg/day IV
Calcium Preparations with Respective Calcium Contents Calcium Salt Approximate Calcium Content per g mg mmol mEq Calcium carbonate 253 6.3 12.6 Calcium chloride (dihydrate) 273 6.8 13.6 Calcium glubionate (monohydrate) 66 1.6 3.3 Calcium gluconate 89 2.2 4.5 Calcium lactate 184 4.6 9.2 Calcium lactate gluconate(dihydrate) 129 3.2 6.4 Calcium lactobionate (dihydrate) 51 1.3 2.5 Calcium phosphate 388 9.7 19.3 Metabolic acidosis is a common acid-base abnormality in acute pesticide poisoning. Management consist of administration of 8.4% Sodium bicarbonate at a dose of 1 mEq/kg or computed based on acid-base deficit formula.