Recent advances in treatment of acute organophosphorous nerve agents poisoning

ABSTRACT

Organophosphorous [OP] chemical warfare nerve agents mainly sarin and tabun were used during the Iran-Iraq war with high mortalities. In addition to atropine and oximes, the followings have recently been used successfully for the treatment of OP poisoning. 1. Sodium Bicarbonate Infusion of high doses of sodium bicarbonate [5 mEq/kg in 60 min. followed by 5-6 mEq/kg/day to obtain arterial blood pH of 7.45 to 7.55] revealed positive effects in patients with acute OP poisoning in Mashhad. 2. Magnesium Sulfate Intravenous magnesium sulfate in a dose of 4 g only on the first day after admission was also effective in acute human OP poisoning. 3. Antioxidants The toxicity of OP compounds is mediated by generation of nitric oxide and other free radicals. These toxic molecules can be counteracted by antioxidants such as vitamins C and E, spin traps, melatonin and low molecule weight thiols. The latter compounds can also increase the synthesis of glutathione, which can both ameliorate the OP-induced oxidative stress and enhance OP detoxification. It is concluded Sodium bicarbonate, Magnesium sulfate and the antioxidants should be added to the standard treatment of OP poisonings