Organophosphate poisoning: Grading the severity and comparing treatment between atropine and glycopyrrolate

P. G. Bardin, S. F. Van Eeden

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Organophopshate poisoning occurs worldwide and often requires admission to an ICU. Grading of patients may be of value to identify high-risk cases but this has never been prospectively evaluated. Conventional treatment with atropine may lead to CNS toxicity, although control of secretions may still be inadequate. We conducted a randomized, controlled trial in 44 patients to compare atropine with glycopyrrolate, a drug that may provide better control of secretions and does not cross the blood-brain barrier. Grading was performend prospectively and compared to outcome. Thirty-nine cases were evaluated (atropine 22, glycopyrrolate 17); the treatment groups were comparable at baseline. No differences could be detected in outcome except for a trend to fewer respiratory infections in the glycopyrrolate group. Thus, treatment with atropine and glycopyrrolate was equally effective. A grading of serious was associated with ventilation, complications, and a prolonged ICU stay. A revised simplified grading is proposed.

Original languageEnglish
Pages (from-to)956-960
Number of pages5
JournalCritical Care Medicine
Issue number9
Publication statusPublished - 1 Jan 1990
Externally publishedYes

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