Monitoring of neuromuscular transmission in organophosphate pesticide-poisoned patients

Thirty-four adult patients with severe organophosphorus compounds (OP) poisoning requiring artificial ventilation were enrolled in a clinical study and received atropine and obidoxime (250mg i.v., followed by 750mg/24h) as antidotal treatment. Here, we re-analyzed the cholinesterase status (red bloo...

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Veröffentlicht in:Toxicology letters 2009-12, Vol.191 (2-3), p.297-304
Hauptverfasser: Thiermann, H., Zilker, T., Eyer, F., Felgenhauer, N., Eyer, P., Worek, F.
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container_issue 2-3
container_start_page 297
container_title Toxicology letters
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creator Thiermann, H.
Zilker, T.
Eyer, F.
Felgenhauer, N.
Eyer, P.
Worek, F.
description Thirty-four adult patients with severe organophosphorus compounds (OP) poisoning requiring artificial ventilation were enrolled in a clinical study and received atropine and obidoxime (250mg i.v., followed by 750mg/24h) as antidotal treatment. Here, we re-analyzed the cholinesterase status (red blood cell acetylcholinesterase (RBC-AChE) activity, reactivatability of RBC-AChE, and plasma butyrylcholinesterase (Pl-BChE) activity) in relation to the neuromuscular transmission (NMT) data. When RBC-AChE activity ranged between 100% and 30% NMT was unimpaired after tetanic stimulation with frequencies up to 50Hz. A further decrease in RBC-AChE activity was accompanied by a marked disturbance of NMT, being strongly impaired at AChE activities 30Hz) facilitated the discrimination of the types of impairment. The neuromuscular transmission was the best quantified by using the ratio of the ninth to the first amplitude, while the standard method was less discriminative. At RBC-AChE levels higher than 40% of normal weaning from the ventilator may be considered. Completely aged RBC-AChE as indicated by loss of reactivatability loses its guidance function. Then, steadily increasing Pl-BChE activity suggests lack of circulating poison. One-week later, neuromuscular transmission may be largely normal and patients could be weaned from the respirator if other complications are not withstanding.
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identifier ISSN: 0378-4274
ispartof Toxicology letters, 2009-12, Vol.191 (2-3), p.297-304
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source MEDLINE; Elsevier ScienceDirect Journals Complete
subjects Acetylcholinesterase
Acetylcholinesterase - blood
Adult
Cholinesterase Reactivators - therapeutic use
Electric Stimulation
Erythrocytes - drug effects
Erythrocytes - enzymology
Humans
Monitoring, Physiologic
Muscle, Skeletal - drug effects
Neuromuscular Junction - drug effects
Neuromuscular transmission
Obidoxime Chloride - therapeutic use
Organophosphate Poisoning
Oximes
Pesticide
Pesticides - poisoning
Synaptic Transmission - drug effects
title Monitoring of neuromuscular transmission in organophosphate pesticide-poisoned patients
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