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Common Toxicology in Pediatrics 3 :skull_and_crossbones: (:honey_pot…
Common Toxicology in Pediatrics 3 :skull_and_crossbones:
:honey_pot:
Cholinergic poisonings
(Organophosphates & Carbamates)
Organophosphates
:bee:
:gear:
Mechanisms
AchE inhibitor
inactivate
AchE molecule ➯ Continued stimulation
Cholinergic overstimulation @ NMJ ➯
Fasiculation
Paralysis
:alarm_clock: Aging time
depends on type of Organophosphate type
Long aging time
safe enough to use 2PAM pull R from ionic bond (reversible)
Short aging time (war weapons)
time too short for antidote-2PAM to help in covalent bond (
irreversible
)
Organophosphorous compounds (OPs)
permanently bind
with AchE thru
covalent bond
aged complex ➯ permanently deactivated
Highly Lipophilic
Stored in fat tissue ➯ can redistributed outside ➯ so toxicity lasts several days after exposure
crossing BBB
Carbamates
:bee:
No aging time
as it binds with
reversible bond
Enz. activity eventually restored w/o Rx
Poisoning usu. limited to 24-48 hrs only
:dolls:
Less CNS effects
than OPs because of
difficulty in crossing BBB
:woman-boy-boy:
S&S
of
Acute Cholinergic toxidrome
Cholinergic
:silhouette:
Agents
: Organophosphate, Carbamate
:checkered_flag:
Common findings
:skier:
Muscarinic effects
—
SLUDGE 3Bs
: Salivation, Lacrimation, Urination, Defecation, GI motility :arrow_down:, Emesis, Bronchorrhea, Bronchospasm,
Bradycardia*
:skier:
Nicotinic effects
: Muscle fasciculations & weakness
:black_flag:
Other S&S
: Bradycardia, Miosis/Mydriasis, Seizures, Respiratory failures, Paralysis
:skull_and_crossbones:
Death fr
: Respiratory arrest fr paralysis, Bronchorrhea, Seizures
Cholinergic 2nd ver
:dog:
Nicotinic effects
Muscle fasciculations, Cramping, Weakness
:!: may led to Progressive paralysis & respiratory failure
Autonomic effects: HT, Tachycardia, Pupillary dilatation, Pallor
:dog:
CNS effect
มี Restlessness, Tremor, Confusion, Ataxia, Slurred speech and Seizure
:dog:
Muscarinic effects
DUMBBELS
:bell:
Diarrhea, Urination, Miosis, Bradycardia*, Brochospasm, Bronchorrhea, Emesis, Lacrimation, Salivation
:!: Bronchorrhea & Bronchospasms may compromise Pulmonary func
:heartbeat:
Cardiac manifes
Augmented vagal tone
, Bradycardia, :arrow_up: conduction time
3 killer-Bs
Bronchorrhea, Bronchospasm, Bradycardia
:male-scientist::skin-tone-5:
Other useful Inx
For Pulmonary edema & Aspiration pneumonitis ➯ CXR, Oximetry, ABG
pesticides usu contain hydrocarbon
For Dehydration ➯ E'lyte, Renal & Liver function
:evergreen_tree:
Treatment
:diamond_shape_with_a_dot_inside:
Emergency & Supportive Rx
:diamond_shape_with_a_dot_inside:
Specific Rx
:chocolate_bar:
2 modes of Rx
Atropine
as anti-cholinergic
SEs: Dry airway, Raise HR
Dose: 0.5-2 mg initially then double dose q 5 min
2PAM
to prevent aging
:check:
I/C
if
suspected
Organophosphate
Dose: 1-2g bolus (20-40 mg in children, then continuous infusion)
Start before
irreversible
phosphorylation of the enz
:man-wrestling:
Effects
➯ mostly affect on
nicotinic receptor
Clinical like SLUDGE 3B
➯ gives both
2PAM & Atropine
(empirical ไปเลอ)
If Atropine is given ➯ 2PAM should be administered