Combined atropine and glycopyrrolate in organophosphate poisoning: The right solution for an old problem.

ABSTRACT

Unintentional and intentional organophosphate (OP) poisonings continue to be a significant cause of morbidity and mortality in India. Conventional treatment with atropine may lead to CNS toxicity, although control of secretions may still be inadequate. The aim of this study was to assess the effectiveness of atropine along with glycopyrrolate in organophosphate poisonings. A prospective randomized double-blinded, placebo-con-trolled trial was done in an emergency department of a university hospital. Patients who consumed OP compounds were included. Pregnant women, hypothermic adults, mixed poisonings, and concomitant alcoholic intoxications were excluded. The subjects received either atropine and glycopyrrolate, or atropine and a matching placebo as a bolus through a peripheral IV line. All other aspects of treatment were carried out as per standard procedure. Seventy six victims were involved during a six month period, 38 belonging to the study group, and the remaining to the control group. There were no significant differences in demographic data, time of arrival, or time of starting treatment. Results revealed that the duration on ventilator was reduced in 60% of the study group as compared to the control group, reduction in the duration of ICU stay occurred in 20% of control group, while it was 72% of the study group. CNS toxicity occurred in 40% of control group, and 2% of study group. Intermediate syndrome developed in 8 of 38 subjects in the control group, and 1 of 38 in the study group. Development of respiratory tract infection was seen in 12% of the control group, while it occurred in only 5% of the study group. Addition of glycopyrrolate appears to be a promising new intervention in the management of OP poisoning.