Carbamate and organophosphate poisoning
Peduto, V.A.; D'Uva, R.; Piga, M.
Minerva Anestesiologica 62(1-2): 33-54
1996
ISSN/ISBN: 0375-9393 PMID: 8768022 Document Number: 460906
Carbamate and organophosphate poisoning is a well known toxicological problem in developing countries, but still has, even in industrialized ones, a high mortality rate and a frequent invalidating outcome. Serious problems especially arise from cardiac (toxic myocarditis, QT prolongation, and other ventricular arrhythmias), muscular (intermediate syndrome, OPIDN), and neuro-behavioral (regressive psychosis, cognitive, mnesic and perceptive alterations) sequelae. Such complications, caused by direct neuronal, cardiac, and muscular damage, sneaky appear immediately after resolution of cholinergic crisis. Early establishment of antidotal (atropine + oximes) and supportive therapy, while reducing duration and seriousness of cholinergic crisis, should increase survival rates. In order to improve "quoad valetudinem" prognosis, widespread use of benzodiazepines is still recommended: such drugs antagonize some central signs and symptoms of cholinergic attack insensitive to atropine (fasciculations, muscular spasms, seizures, anxiety, psychomotor agitation). Moreover, they attenuate neuronal, cardiac, and muscular damage, caused by cholinergic overstimulation, which is responsible for invalidating outcome.