TRAUMA YELLOW
  • Clinical
    • Discharge Macros
    • Procedure Macros
    • Exam Macros
    • Pediatric Macros
    • Antibiogram
    • Follow Up
    • 2023 MDM
    • Heart Pathway
    • Jeromy's Macros
  • Education
    • EM Education
    • Critical Care
    • FOAM
  • Orientation
    • Dept Orientation
    • Cerner
    • Dragon
  • Links
    • Clinical Links
    • StatMacros
    • ICU Bootcamp
  • Private
    • MCS
    • GWU Contacts & Map

ToxBits: Cholinesterase Inhibitors

8/2/2017

0 Comments

 
Acetylcholinesterase inhibitors include carbamates, organophosphates, and chemical weapons, which bind to carboxylic esters, such as acetylcholinesterase at the nerve terminals and within RBCs. These are commonly used as pesticides, but have also been utilized as chemical weapons, such as the Tokyo subway poisoning in 1995 which utilized Sarin. 

Additionally, many Alzheimer medications are also acetylcholinesterase inhibitors, and can give the same symptoms when at elevated amounts or overdose, and can present with vague or mild symptoms. 

Symptoms

Symptoms may be minimal or vague, but include increased excretion (diarrhea, emesis, lacrimation) as well as miosis, bradycardia, and lethargy. 
Picture

Treatment

Treatment should focus on decontamination, reversing muscarinic (cholinergic) effects, and antibotal therapy to regenerate acetylcholinesterase.  

Excess muscarinic (cholinergic) activity should be countered with atropine, and the dose of 1-2mg should be repeated every 2-3 minutes as needed to provide drying of bronchial secretions. This may require over 40mg of atropine in severely poisoned patients. 

Antidotal therapy with pralidoxime (2PAM) should be used as early as possible, with the goal to reverse the organophosphate-acetylcholinesterase bond, and inactivates free organophosphates. 2PAM is unable to work once this bond is 'aged', so early administration is important, and should be given even if the patient presents at 24 hours after exposure. 
0 Comments



Leave a Reply.

    Categories

     

    All
    Abx
    Article
    Cardiac
    EKG
    EKG Challenge
    GI Bleed
    Grand Rounds
    Headache
    ICU
    Orthopedic
    Pain
    Peds
    Reading
    Stroke
    Subarachnoid Hemorrhage
    Syncope
    Teaching Pearl
    Trauma
    Travel
    Zika

    Archive

     

    February 2018
    January 2018
    December 2017
    November 2017
    October 2017
    September 2017
    August 2017
    May 2017
    April 2017
    March 2017
    February 2017
    January 2017
    December 2016
    November 2016
    October 2016
    September 2016
    August 2016
    July 2016
    June 2016
    May 2016
    April 2016
    January 2016
    December 2015
    November 2015

    Picture
    Please read our Terms of Use.
Donate
This site is independently owned and operated and not affiliated with the George Washington University, George Washington University Hospital, or Medical Faculty Associates. All information on this site is the opinion of the author alone and in no way should be seen to represent the views of the George Washington University, George Washington University Hospital, or Medical Faculty Associates. The information on this page is for personal use only and should not be see as medical advice or used directly for patient care. The author provides no guarantee of the accuracy of the information provided on this page. ​

​Please refer to our Terms of Use. 
  • Clinical
    • Discharge Macros
    • Procedure Macros
    • Exam Macros
    • Pediatric Macros
    • Antibiogram
    • Follow Up
    • 2023 MDM
    • Heart Pathway
    • Jeromy's Macros
  • Education
    • EM Education
    • Critical Care
    • FOAM
  • Orientation
    • Dept Orientation
    • Cerner
    • Dragon
  • Links
    • Clinical Links
    • StatMacros
    • ICU Bootcamp
  • Private
    • MCS
    • GWU Contacts & Map