Document Detail

Monitoring of neuromuscular transmission in organophosphate pesticide-poisoned patients.
MedLine Citation:
PMID:  19793545     Owner:  NLM     Status:  MEDLINE    
Thirty-four adult patients with severe organophosphorus compounds (OP) poisoning requiring artificial ventilation were enrolled in a clinical study and received atropine and obidoxime (250 mg i.v., followed by 750 mg/24 h) as antidotal treatment. Here, we re-analyzed the cholinesterase status (red blood cell acetylcholinesterase (RBC-AChE) activity, reactivatability of RBC-AChE, and plasma butyrylcholinesterase (Pl-BChE) activity) in relation to the neuromuscular transmission (NMT) data. When RBC-AChE activity ranged between 100% and 30% NMT was unimpaired after tetanic stimulation with frequencies up to 50 Hz. A further decrease in RBC-AChE activity was accompanied by a marked disturbance of NMT, being strongly impaired at AChE activities <5% of normal. Higher stimulation frequencies (>30 Hz) facilitated the discrimination of the types of impairment. The neuromuscular transmission was the best quantified by using the ratio of the ninth to the first amplitude, while the standard method was less discriminative. At RBC-AChE levels higher than 40% of normal weaning from the ventilator may be considered. Completely aged RBC-AChE as indicated by loss of reactivatability loses its guidance function. Then, steadily increasing Pl-BChE activity suggests lack of circulating poison. One-week later, neuromuscular transmission may be largely normal and patients could be weaned from the respirator if other complications are not withstanding.
H Thiermann; T Zilker; F Eyer; N Felgenhauer; P Eyer; F Worek
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-09-28
Journal Detail:
Title:  Toxicology letters     Volume:  191     ISSN:  1879-3169     ISO Abbreviation:  Toxicol. Lett.     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2009-11-20     Completed Date:  2009-12-09     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7709027     Medline TA:  Toxicol Lett     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  297-304     Citation Subset:  IM    
Bundeswehr Institute of Pharmacology and Toxicology, Neuherbergstr. 11, 80937 Munich, Germany.
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MeSH Terms
Acetylcholinesterase / blood
Cholinesterase Reactivators / therapeutic use
Electric Stimulation
Erythrocytes / drug effects,  enzymology
Monitoring, Physiologic
Muscle, Skeletal / drug effects*
Neuromuscular Junction / drug effects*
Obidoxime Chloride / therapeutic use
Pesticides / poisoning*
Phosphoric Acid Esters / poisoning*
Synaptic Transmission / drug effects*
Reg. No./Substance:
0/Cholinesterase Reactivators; 0/Pesticides; 0/Phosphoric Acid Esters; 114-90-9/Obidoxime Chloride; EC

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