The influence of sodium bicarbonate combined with ulinastatin on cholinesterase activity for patients with acute phoxim pesticide poisoning / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To observe the effect of sodium bicarbonate combined with ulinastatin on cholinesterase activity for patients with acute phoxim pesticide poisoning.</p><p><b>METHODS</b>A total of 67 eligible patients with acute phoxim pesticide poisoning, Who were admitted to the emeryency department of hospital from March 2011 to February 2014, Acording to different treatments au patients were randomly divided into the conventional treatment group (n=34) and the sodium bicarbonate+ulinastatin group (n=35) . The conventional treatment group were given thorough gastric lavage with water, the sodium bicarbonate + ulinastatin group were given gastric lavage with 2% sodium bicarbonate solution. Both groups were given such treatments as catharsis, administration of oxygen, fluid infusion, diuresis, and antidotes such as atropine and pralidoxime methylchloride. On the basis of comprehensive treatment, people in the sodium bicarbonate+ulinastatin group were given 5% sodium bicarbonate injection and ulinastatin. The clinical effect of the two groups were compared.</p><p><b>RESULTS</b>The serum cholinesterase activity of the sodium bicarbonate+ulinastatin group was significantly higher than the conventional treatment group from the 5th day, and the difference was statistically significant (P<0.05) . The total atropine dosage, total pralidoxime methylchloride dosage and hospitalization days were better than the conventional treatment group, and the differences were statistically significant (P<0.05) . The difference in the time of atropinization between the two groups was not statistically significant (P>0.05) . The results of arterial blood pH, HCO3- of the sodium bicarbonate + ulinastatin group were higher than the conventional treatment group, and the difference of HCO3- at the 10th day was statistically significant (P<0.05) .</p><p><b>CONCLUSIONS</b>Sodium bicarbonate combined with ulinastatin can improve the therapeutic effect and reduce complications in the treatment of acute phoxim pesticide poisoning, and have beneficial effects on the recovery of cholinesterase activity.</p>

Agua alcalinizante y con alto contenido de magnesio: los posibles efectos beneficiosos para la salud / Alkaline water and with high level of magnesium: possible benefits for health

Introducción: el consumo de dietas con un potencial alcalinizante ha sido asociado con varios efectos beneciosos sobre la salud. El potencial alcalinizante de un alimento en particular puede evaluarse mediante el cálculo del PRAL, una fórmula que tiene en cuenta el contenido de sulfato, fosfato, cloruro, sodio, calcio, potasio y magnesio de los alimentos. Objetivos: revisar la literatura para vericar el efecto del magnesio y alimentos/agua con potencial alcalinizante para la salud. También evaluar la capacidad de un filtro comercial para hacer el agua más alcalinizante y aumentar su contenido de magnesio. Materiales y métodos: se utilizaron cuatro filtros y el PRAL se calculó para todas las muestras; los valores se expresaron como media ± desviación estándar. Resultados: se encontró un aumento en el pH (IC 95%: 2,702 a -2,548; p<0,0001) y una reducción en el valor de PRAL (IC 95%: 1,418 a 2,081; p<0,0001). El magnesio fue el mayor predictor de un valor de PRAL alcalinizante dado que hubo un incremento estadísticamente significativo (IC 95%: 54,00 a -39,16; p<0,0001) en el contenido de magnesio después del proceso de filtración independiente de la fuente de agua. Conclusiones: la mayoría de los estudios sugiere que el consumo de alimentos alcalinizantes se asocia con una reducción de la resorción ósea y la inhibición de la actividad de los osteoclastos. El consumo de magnesio se relaciona con un menor riesgo de enfermedad cardiovascular, diabetes tipo II y determinados tipos de demencia como la enfermedad de Alzheimer.

Introduction: the intake of alkalizing potential diets has been associated with various bene¬cial effects on health. The alkalizing potential of a particular food can be evaluated by the PRAL calculation, a formula considering the content of sulfate, Phosphate, chloride, sodium, calcium, potassium and magnesium in food. Objectives: to check the scientific literature to verify the effect of magnesium and food/water with alkalizing potential for health. The capacity of a commercial filter to make water more alkalizing and increase the content of magnesium was also evaluated. Materials and methods: four filters were used and PRAL was calculated for all samples, and the values were reported as mean ± standard deviation. Results: an increase in pH was observed (CI 95%: -2,702 to -2,548; p<0,0001) and a reduction in the PRAL value (CI 95%: 1,418 to 2,081; p<0,0001). Magnesium was the major predictor of an alkalizing PRAL value, since there was a statistically significant increase (CI 95%: -54,00 to -39,16; p<0,0001) in the content of magnesium after the independent filtration process of water source. Conclusions: most of the studies suggest that the consumption of alkalizing water is associated with a reduction in bone resorption and inhibition of osteoclast activity. The consumption of magnesium is associated with a less risk of cardiovascular disease, type II diabetes and certain types of dementia such as Alzheimer.

Antidote for organophosphate insecticide poisoning: atropine and pralidoxime

Acute organophosphate (OP) poisoning produces cholinergic symptoms resulting from the inhibition of cholinesterase, and the overstimulation of muscarinic and nicotinic receptors in the synapses. The dominant clinical features of acute cholinergic toxicity include bradycardia, miosis, lacrimation, salivation, bronchorrhea, and bronchospasm. All symptomatic patients should receive therapy with oxygen, atropine, and pralidoxime. Atropine works as a physiologic antidote by competitively occupying muscarinic receptor sites, reducing the effects of excessive acetylcholine. Atropine should be immediately administered, and the dose can be titrated according to the severity of OP poisoning. A large dose may be necessary to overcome the excessive cholinergic state in case of severe poisoning. Pralidoxime is a biochemical antidote that reactivates acetylcholinesterase by removing OP from it. It is effective in treating both muscarinic and nicotinic symptoms. After some period of time, the acetylcholinesterase-OP compound undergoes a conformational change, known as aging, which renders the enzyme irreversibly resistant to reactivation by a pralidoxime. There has been a great deal of controversy over the effectiveness of pralidoxime in acute OP poisoning. However, it may be beneficial to administer pralidoxime for a sufficient period in case of severe poisoning with a large quantity of OP, which is common in Korea.

Recent advances in the treatment of organophosphorous poisonings

Organophosphorous compounds have been employed as pesticides and chemical warfare nerve agents. Toxicity of organophosphorous compounds is a result of excessive cholinergic stimulation through inhibition of acetyl cholinesterase. Clinical manifestations include cholinergic syndromes, central nervous system and cardiovascular disorders. Organophosphorous pesticide poisonings are common in developing worlds including Iran and Sri Lanka. Nerve agents were used during the Iraq-Iran war in 1983-1988 and in a terrorist attack in Japan in 1994-1995. Following decontamination, depending on the severity of intoxication the administration of atropine to counteract muscarinic over-stimulation, and an oxime to reactivate acetyl cholinesterase are indicated. Supportive and intensive care therapy including diazepam to control convulsions and mechanical respiration may be required. Recent investigations have revealed that intravenous infusion of sodium bicarbonate to produce mild to moderate alkalinization is effective. Gacyclidine; an antiglutamatergic compound, was also proved to be beneficial in conjunction with atropine, pralidoxime, and diazepam in nerve agent poisoning. Intravenous magnesium sulfate decreased hospitalization duration and improved outcomes in patients with organophosphorous poisoning. Bio-scavengers including fresh frozen plasma or albumin have recently been suggested as a useful therapy through clearing of free organophosphates. Hemofiltration and antioxidants are also suggested for organophosphorous poisoning. Recombinant bacterial phosphotriesterases and hydrolases that are able to transfer organophosphorous-degrading enzymes are very promising in delayed treatment of organophosphorous poisoning. Recently, encapsulation of drugs or enzymes in nanocarriers has also been proposed. Given the signs and symptoms of organophosphorous poisoning, health professionals should remain updated about the recent advances in treatment of organophosphorous poisoning poisonings

Clinical Experiences Treating Edifenphos and Iprobenfos Intoxication Patients

Organophosphate fungicides include edifenphos, iprobenfos and tolclofos-methyl. Edifenphos inhibits cell wall synthesis by reduction in chitin synthase activity and inhibits the action of acetylcholinesterase. Thus, exposure to this chemical results in excessive salivation, lacrimation, urination, defecation, gastrointestinal motility and emesis symptoms, just like other organophosphate insecticides. Although edifenphos is an organophosphate fungicide, it is the only agricultural chemical which inhibits the action of pralidoxime and atropine, an activity which in turn, inhibits treatment. Thus, we have to treat these cases as soon as possible with atropine and pralidoxime, using the same approach as used for exposure to other organophosphate insecticides. In this report we evaluate the results of treatment of 4 patients who were intoxicated by fungicides (3 cases with edifenphos and 1 case with iprobenfos).

Clinical Outcome for High-dose Pralidoxime in Treating Organophosphate Intoxication

PURPOSE: The optimal dose of oximes for use in the treatment of organophosphorus pesticide poisoning has not been conclusively established. In this retrospective study, we assessed the effectiveness of the use of high-dose pralidoxime infusion in treating organophosphorus pesticide poisoning. METHODS: From January 1998 to December 2009, 71 patients visited the hospital Emergency Department (ED) as a result of organophosphate pesticide intoxication. All of these patients received an initial bolus of 2 g of pralidoxime as the first step of treatment. Patients who then received continuous infusion of pralidoxime at a dose of 500 mg/hr were entered into study group 1 (low dose), and those treated by continuous infusion of pralidoxime at a dose of 1000 mg/hr were entered into study group 2 (high-dose). Plasma cholinesterase activities for each patient were evaluated at ED arrival and re-evaluated 24 hours after pralidoxime infusion. The effectiveness of the two treatment modalities was gauged by comparing the required duration of mechanical ventilation, time spent in the intensive care unit (ICU) and total time spent in the hospital. RESULTS: The mean duration of mechanical ventilation was 9.98+/-6.47 days for group 1 and 4.39+/-6.44 days for group 2. The respective mean duration of time spent in ICU and the total number of days in the hospital were 16.38+/-18.84 days and 21.87+/-20.16 days for group 1, and 7.83+/-9.99 days and 11.71+/-13.53 days for group 2. High-dose pralidoxime treatment was associated with shorter required durations for mechanical ventilation, ICU and hospital stay. In addition, plasma cholinesterase reactivation rates were higher for those patients receiving high-dose pralidoxime treatment. CONCLUSION: The results suggest that high-dose pralidoxime treatment has greater efficacy for patients suffering from organophosphorus pesticide poisoning.

The Variations in Clinical Features According to Intoxicants in High Toxicity Organophosphorus Intoxication

PURPOSE: Organophosphorus (OP) pesticides are differentiated into 3 groups according to their toxicity. The differences in chemical composition of each OP pesticide determines its toxicokinetic characteristics. There are few human studies that address the clinical results of poisoning according to the OP pesticide. In this study, we aimed to examine the differences in clinical features among self-poisoning from 4 highly toxic OP pesticides. METHODS: The 4 kinds of OP poisonings included 17 cases of Dichlorvos, 17 cases of EPN, 17 cases of methidathion, and 13 cases of phosphamidon. We set primary outcomes as GCS, atropine dose required, duration of patient need for atropine, proportion who required ventilation, duration on ventilation, and the interval from ingestion to ventilation. Secondary outcomes were the proportion of OP-induced delayed neuropathy, duration of ICU stay, and proportion who required additional infusion of pralidoxime chloride (PAM). RESULTS: The EPN group required the largest amount of atropine, the longest duration of atropine use, the longest duration for support of mechanical ventilation, and the longest ICU stay. Furthermore the proportion who required additional PAM and neuropathy were in the EPN group. However, the EPN group had the longest interval from ingestion to ventilatory support. Meanwhile, the Dichlorvos group exhibited comparatively mild clinical features. CONCLUSION: Throughout this study, we found different clinical features to each OP pesticide poisoning. It can be explained by differences in chemical composition, which determined the speed of aging, the reactivation rate of OPenzyme, the metabolism, the fat solubility, and other characteristics of the pesticides.

Acute organophosphate insecticide poisoning

To describe the clinical course, diagnosis, out come of acute organophosphate [OP] insecticide poisoning. Descriptive study. At National Poisoning Control Centre [NPCC], Medical unit 1, Jinnah Post Graduate Medical Centre, Karachi, from 1st January 2000 to 31st December 2007. A total of 6539 pts were admitted to the ICU of NPCC, out of which 2708 [41%] were of organophosphate poisoning. Lab investigations done included blood complete picture, urea, creatinine, ABG's and serum cholinesterase levels. Data was retrieved from the files on a structured performa. Variables of the study include gender, mode of exposure, clinical course, management and complications. There were 1391[51%] were males and 1317 [48%] females. 713 [26%] had accidental exposure, while 1995 [73%] attempted suicide. The majority of patients exhibited the classic clinical features of parasympathetic over activity. 1608 patients received atropine, while pralidoxime alone was given to only 399 patients and atropine along with pralidoxime was given to 701 patients. Complications encountered during their treatment and stay in the hospital included aspiration pneumonia observed in 310 patients, hyperglycemia in 982 patients. 102 patients had respiratory failure and thus required mechanical ventilation with mean ventilation duration of 2.3 +/- 1.5 days. 500 patients had urinary tract infection and 789 patients developed cellulitis or phlebitis. A total of 147 patients died making a mortality rate of 0.05%. The widespread use of organophosphates as a household and agricultural pesticide, in the absence of adequate regulations and education in their use is probably the most important reason for OP poisoning in an agricultural country like Pakistan. Despite severe toxicity in most of our cases, there were very few fatalities. This reflects the necessity of early diagnosis, treatment and the implementation of advanced supportive care in ICU

Clinical Characteristics of Acute Dichlorvos Poisoning in Korea

Purpose: Dichlorvos has been in widespread use as an organophosphate (OP) insecticide compound. The purpose of this study was to access the epidemiology and clinical features of dichlorvos in Korea. Methods: This was a 38 multi-center prospective study of dichlorvos poisoning using surveys, a structural reporting system and review of hospital records from August 2005 to July 2006. A total of 54 patients with acute dichlorvos poisoning on a national basis were enrolled. We analyzed the epidemiologic characteristics and clinical manifestations of dichlorvos poisoning. In addition, the clinical features of dichlorvos poisoning were compared with others OP compounds. Results: During the study period, compounds involving pure OP poisoning were dichlorvos (22.7%), methidathion (8.4%), and phosphamidon (6.7%). In acute dichlorvos poisoning, all ingestion routes were oral. Intentional poisoning involved 74.1% of cases. The common initial complaints involved gastrointestinal (64.8%), systemic (61.1%), central or peripheral nervous system (53.7%), and respiratory symptoms (50.0%). The median arrival time to hospital after dichlorvos poisoning was 2.6 hours and mean hospitalization duration was 7.1 days. 2-PAM was administered in 35 patients in mean doses of 6.3 g/day intravenously. Atropine was administered in 30 patients with a mean dose of 62.8 mg/day (maximal 240 mg/day). Overall mortality rate for dichlorvos poisonings were 14.8% (8/54). Immediate causes for death included sudden cardiac arrest or ventricular dysrhythmias (50%), multi-organ failure (25%), acute renal failure (12.5%), and unknown causes (12.5%). Conclusion: When compared to previous reports, dichlorvos poisoning displayed relatively moderate severity. The presence of a lower GCS score, altered mental status, serious dysrhythmias, systemic shock, acute renal failure, and respiratory complications upon presentation were associated with a more serious and fatal poisoning.

Different therapeutic efficacy of pralidoxime chloride PAM-Cl on AChE against acute toxicity of methamidophos, dichlorvos and omethoate / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To observe the treatments on the patients with acute methamidophos dichlorvos (DDV) and omethoate poisoning and provide the reliable basis for the rational treatments on these three organophosphorus pesticides poisoning.</p><p><b>METHODS</b>101 patients with AOPP in 7 hospitals were divided into three groups: Group A, 59 patients with acute methamidophos poisoning, Group B, 32 patients with acute DDV/dipterex (DEP) poisoning, Group C, 10 patients with acute omethoate/dimethoate poisoning. The levels of erythrocyte AChE and the therapeutic efficacies of pralidoxime chloride (PAM-Cl) were compared among the three groups.</p><p><b>RESULTS</b>The AChE activities of all the three groups were inhibited on level of (9.12 +/- 7.99) U/g Hb (group A), 7.32 +/- 4.62 U/g Hb (group B) and (12.01 +/- 9.53) U/g Hb (group C), among which no significant difference was found (P > 0.05). All the patients recovered from acute cholinergic excitation or crisis after the treatment of PAM-Cl. The erythrocyte AChE activities were obviously reactivated in group A three hours later after admission to hospital, each on level of (11.37 +/- 8.67) U/g Hb, (12.51 +/- 6.98) U/g Hb, (15.90 +/- 7.31) U/g Hb, (18.33 +/- 4.78) U/g Hb and (18.91 +/- 7.00) U/g Hb at the 12th, 24th, 48th, 72nd hour and discharge (P < 0.05), and the upgrade tendency was continuous. AChE activities in group B were also reactivated after treatment, each on level of (8.91 +/- 5.89) U/g Hb, (1.31 +/- 6.61) U/g Hb, (13.00 +/- 7.55) U/g Hb, (14.22 +/- 7.80) U/g Hb, (12.78 +/- 7.07) U/g Hb and (16.87 +/- 7.06) U/g Hb at the 3rd, 12th, 24th, 48th, 72nd hour and discharge, but the upgrade tendency turned slowly after 12 hours, the inhibited AChE activities were not reactivated in group C from the beginning to the end.</p><p><b>CONCLUSION</b>After the treatment of PAM-Cl, the AChE activities of the patients with acute methamidophos poisoning could be continuously reactivated, the AChE activities of the patients with acute DDV/DEP poisoning could also be reactivated in 12 hours, and then keep stable, but the AChE activities of the patients with acute omethoate/dimethoate poisoning could not be reactivated. However, PAM-Cl has therapeutic efficacy against acute toxicity of all the three organophosphorus pesticides. Oximes should be vigorously used in the treatment of AOPP, including acute omethoate/dimethoate poisoning.</p>

reactivation effect of pralidoxime in human blood on parathion and paraoxon-induced cholinesterase inhibition

In this investigation the reactivation of cholinesterases by pralidoxime in parathion and paraoxon intoxication in plasma and erythrocytes were studied. For this purpose, human plasma and erythrocytes were incubated with various concentrations of parathion [0.1-10 micro M] and paraoxon [0.03-0.3 micro M] at 37 °C for 10 min. Then, pralidoxime [10-300 micro M] was added to the samples and incubated for 10 min before cholinesterases assay. The results showed that effects of parathion and paraoxon were dose dependent. These agents inhibited more than 85% of butyrylcholinesterase [BChE] and acetylcholinesterase [AChE] activity and the inhibitory effect of paraoxon was 10 times more than parathion. BChE activity was significantly higher than the control at 100 micro M of pralidoxime and it reduced inhibitory effects of parathion to less than 50% and of paraoxon to 42% of control. When pralidoxime [10 micro M] was added to erythrocytes, the inhibitory effects of two organophosphates were reduced to less than 15%. At higher concentrations of pralidoxime [>100 micro M], both BChE and AChE activities were inhibited

One year-study of patients with acute organophosphate insecticide poisoning admitted to the intensive care unit of Hamad General hospital, Doha, State of Qatar

Organophosphate poisoning continues to be one of the important problems of poisoning presenting to the intensive care unit. To describe the clinical course, diagnosis, out come of acute organophosphate [OP] insecticide poisoning and to review the management measures taken in intensive care unit [ICU]. Descriptive prospective observational study. Intensive Care Unit of Hamad General Hospital, State of Qatar. Patients with acute OP poisoning admitted to the ICU from 1st January to 31st December 2005. Eight patients were admitted to the ICU; six males and two females. Seven had accidental exposure, while one was attempted suicide. The majority of patients exhibited the classic clinical features of patasympathetic overactivity. No patient had features of intermediate syndrome or Organophosphate Induced Delayed Neuropathy [OPIDN]. All patients received atropine, while pralidoxime was given to only 6 patients. Mechanical ventilation was required in 3 patients for respiratory failure, with mean ventilation duration of 2.3 +/- 1.5 days. No mortalities were recorded. The widespread use of organophosphates as a household and agricultural pesticide, in the absence of adequate regulations and education in their use is probably the most important reason for OP poisoning in a non-agricultural country like Qatar. Despite severe toxicity in most of our cases, there were nofatalities. This reflects the necessity of early diagnosis, treatment and the implementation of advanced supportive care in ICU

Evaluation of antidotal effect of pralidoxime on prevention or reversal of a paraoxon- induced increasing response of chicken biventer cervices to electrical stimulation

One of the most toxic effects of organophosphate [OP] poisoning has been the paralysis of skeletal muscles that can lead to paralysis of respiratory muscles and death. However, oximes are the only antidotes available to reverse or prevent such toxic effects of OP insecticides and nerve chemical warfare agents. In the present study, the effect of different concentrations of paraoxon [as an OP] on the function of skeletal muscle and reversal or prevention of these effects by an oxime [pralidoxime, 2-PAM] were studied in chicken biventer cervices nerve-muscle preparation using twitch tension recording technique. For this purpose, twitches of the biventer cervices were evoked by stimulating the motor nerve at 0. 1 Hz with pulses of 0.2 msec duration and a voltage of greater than that required to produce maximum response. Twitches and contractures were recorded isotonically using Narco Biosystems. The results showed that paraoxon [0.1 micro M] induced a great increase [more than 100%] in the twitch amplitude, while higher concentrations [0.3 and 1 micro M] could induce partial or total contractures. In this study, paraoxon at a concentration of 0.1 micro M was used to examine the capability of pralidoxime to reverse or prevent its effects. Pralidoxime at doses of 300 and 100 micro M almost fully reversed [when it was used as post treatment] or prevented [when it was used as pretreatment or at the same time as toxin] the effect of paraoxon. While oxime at doses of 30 and 10 micro M could only reverse or reduce this effect to about 25 and 75% respectively, pralidoxime alone had no significant effect on the function of the muscle. These results suggest that this method is of high value in studying the functional effects of OPs on skeletal muscle tissues and the reversal effects of antidotes, and pralidoxime by itself can fully reverse such effects

The "intermediate syndrome" as critical sequelae of organophosphate poisoning: the first report of two cases in Thailand.

The authors report 2 cases of organophosphate poisoning which developed intermediate syndrome. The first case was a man who took an organophosphate insecticide, monocrotophos, and developed severe organophosphate poisoning. Respiratory support was needed. He was treated with atropine and 2-PAM. Weakness of neck muscles, proximal limb and respiratory muscle developed in the 3rd day after ingestion. By supportive treatment and careful monitoring, however, he recovered after 11 days of the poisoning. The second case was a lady who took dicrotophos. She developed severe organophosphate poisoning for which respiratory support was also needed High dose of atropine, but without 2-PAM, was administered. She developed bulbar palsy, proximal muscle and respiratory weakness 3 day after the ingestion. Ventilation support was needed for 13 days before weaning was successful. This report did not support an efficacy of pralidoxime (2-PAM) in alleviation of the intermediate syndrome, but aims to alert physicians to recognize the intermediate syndrome for which adequate respiratory care is the crucial key for its management.

Biochemical and clinical profile after organophosphorus poisoning--a placebo-controlled trial using pralidoxime.

BACKGROUND: Organophosphorus (OP) compounds are the most common suicidal poison in developing countries and mortality continues to be high. METHODS: A study was done to see butyryl cholinesterase (BuChE) profile after OP poisoning in pralidoxime (P2AM) and placebo treated cases. Highest recommended dose of P2AM was used to study the reactivation of cholinesterase. Clinical outcomes like, correlation of BuChE and severity of poisoning, mortality and complications like Type I and II paralysis, need for ventilation and ICU stay were also studied. RESULTS: Twenty one cases of moderate and severe poisoning with OP compounds were included in the study. Mean BuChE levels came up gradually over 6-7 days, some taking up to two weeks. There was no. difference between the treatment and placebo groups. BuChE levels did not correlate with severity of poisoning nor did it correlate with Type I or II paralysis, need for ventilation, ICU stay or mortality. CONCLUSIONS: Treatment with P2AM does not make any difference in BuChE reactivation or complications of moderate and severe OP poisoning. We have not been using P2AM for OP poisoning in our medical ICU with good patient outcomes.

Therapeutic efficacy of pralidoxime chloride on acute dichlorvos poisoning / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To study the therapeutic efficacy and mechanism of oxime drug, pralidoxime chloride (PAM-Cl), on acute dichlorvos (DDV) poisoning.</p><p><b>METHODS</b>The toxic signs and survival rate were recorded and ChE activity in blood was determined in treatment group with PAM-Cl and non-treatment group after DDV was given to rats and mice by gastrogavage; the therapeutic efficacy and reactivation of DDV-inhibited ChE by PAM-Cl were observed on the patients with acute DDV poisoning.</p><p><b>RESULTS</b>(1) The alleviated and delayed toxic signs as well as higher survival rate were found in PAM-Cl treatment group compared with non-treatment group. (2) After the rats were exposed to DDV, the ChE activities of whole blood in different time within 24 h were statistically significantly higher in PAM-Cl treatment group than in non-treatment group (P < 0.05). (3) After PAM-Cl treatment, muscular fasciculation and other nicotinic signs in poisoned patients were disappeared and the inhibited blood ChE activities were gradually reactivated to normal level.</p><p><b>CONCLUSION</b>PAM-Cl has therapeutic efficacy against acute toxicity of DDV through its reactivation of inhibited ChE.</p>

Intoxicação por chumbinho: um desafio para o diagnóstico clínico e para o tratamento / Chumbinho poisoning: challenge to clinical diagnosis and treatment

As intoxicações por chumbinho, principalmente pela população adulta e em tentativas de suicídio, são consideradas importante causa de morbi/mortalidade no Brasil, e estão relacionadas ao comércio ilegal de praguicidas inibidores da colinesterase, com o propósito de uso domissanitário, como raticida, desviando-se do uso agrícola autorizado no país. Do ponto de vista toxicológico, existem variações no quadro clínico e diferenças significantes na forma de tratamento quando se considera os inseticidas carbamatos e os organofosforados, tornando-se motivo de extrema preocupação pois, em grande parte dos casos emergenciais, o diagnóstico clínico é de difícil reconhecimento. Isso se torna um desafio no caso do chumbinho, uma vez que, na maioria das vezes, não se conhece exatamente o ingrediente ativo presente na sua formulação. Sendo assim, o propósito do presente artigo foi realizar uma abordagem crítica e atualizada sobre a problemática de uso irregular do chumbinho, incluindo a descrição de dados epidemiológicos e aspectos de avaliação clínica e das formas de tratamento mais adequadas nos casos de intoxicação por este produto