A review of nerve agent exposure for the critical care physician*

Leikin, Jerrold B.; Thomas, Richard; Walter, Frank G.; Klein, Raymond L.; Meislin, Harvey W.

doi:10.1097/00003246-200210000-00026

Cited by 95 publications

(69 citation statements)

References 26 publications

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“…In a roughly dose-dependent manner, this translates primarily into miosis, blurred or dim vision with a headache, tearing, bronchoconstriction, excessive upper and lower respiratory secretions, nausea with vomiting or diarrhea, fasciculations progressing to paralysis, altered mental status, loss of consciousness, seizures, and apnea [19,21]. In a substantial exposure, patients are wet, tight, weak, and encephalopathic with pinpoint pupils.…”

Section: Clinical Symptoms and Signs Of Nerve Agent Intoxicationmentioning

confidence: 99%

The acute treatment of nerve agent exposure

Cannard

2006

Journal of the Neurological Sciences

131

106

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Section: Clinical Symptoms and Signs Of Nerve Agent Intoxicationmentioning

confidence: 99%

The acute treatment of nerve agent exposure

Cannard

2006

Journal of the Neurological Sciences

131

106

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“…1,2 They are also called the G-series nerve agents, because German scientists first synthesized them, starting with tabun (GA) in 1936. Sarin (GB) was discovered in 1938, followed by soman (GD) in 1944 and finally the less known cyclosarin (GF) in 1949.…”

Section: Introductionmentioning

confidence: 99%

Reactivation of Cyclosarin-inhibited Rat Brain Acetylcholinesterase by Pyridinium–Oximes

Kuča¹,

Patočka²

2004

Journal of Enzyme Inhibition and Medicinal Chemistry

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Cyclohexyl methylphosphonofluoridate (cyclosarin, cyclosin, GF) is a highly toxic organophosphate, which is resistant to conventional oxime therapy. To gain insight into the reactivation kinetics, rat brain acetylcholinesterase (AChE) was inhibited in vitro by cyclosarin (pH 8.0, 25 degrees C) and reactivated with 22 different pyridiniumoximes. Three compounds were shown to be superior to the other oximes: 4-carbamoyl-4'-[(hydroxyimino)methyl]-1,1'-(oxydimethylene)dipyridin-1-ium dichloride (HS-6), 4'-carbamoyl-2-[(hydroxyimino)methyl]-1,1'-(oxydimethylene)dipyridin-1-ium dichloride (HI-6), and 4'-carbamoyl-2-[(hydroxyimino)-methyl]-1,1'-(but-2-ene-1,4-diyl)dipyridin-1-ium dichloride (BI-6).

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“…Thus, administration of oximes is time dependent and the treatment should be started as early as possible. Generally this time period is 48 to 72 h. Oximes may not reactivate the muscarinic symptoms of organophosphate poisoning [25,26] . Similarly atropine does not have any effects on nicotinic receptors.…”

Section: Current Treatment Optionsmentioning

confidence: 99%

Can Galantamine Act as an Antidote for Organophosphate Poisoning? A Review

Indu¹,

Danasekaran²,

Manjunatha³

et al. 2016

ijps

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Indu, et al.: Galantamine in the Management of Organophosphate PoisoningOrganophosphate compounds are commonly used as insecticides in rural areas and powerful warfare agents by military personnel. These agents inhibit cholinesterases especially acetylcholinesterase and accumulate acetylcholine causing muscarinic, nicotinic and central nervous system manifestations. Currently, drugs such as atropine, oximes and benzodiazepine are used to treat these symptoms. But these drugs are associated with certain drawbacks and have found to be ineffective in preventing the delayed symptoms. This review analyses the rationalities in considering galantamine as an effective choice in the management of organophosphate toxicity. The mechanism is based on reversible competitive inhibiting property of galantamine on acetylcholinesterase without affecting butylcholinesterase. The drug can prevent the delayed cognitive effects and neurodegeneration by acting as a nicotinic allosteric potentiating ligand. It can cross the blood brain barrier and reversibly inhibit acetylcholinesterase in the brain and decrease the incidence of central nervous system manifestations such as convulsions. The drug is associated with good pharmacokinetic profile, minimal side effects and has been found to be effective as a pretreatment and post treatment agent. Thus, galantamine can be considered as an effective therapeutic agent in management of organophosphate toxicity.Key words: Acetylcholinesterase, galantamine, organophosphate compound, poisoning management, therapeutic approachesOrganophosphate compounds are used as insecticides and powerful warfare agents worldwide. The differences in the properties are based on the substituents attached to the basic moiety. The highly toxic compounds were developed as warfare agents and lesser toxic agents as insecticidal agents [1,2] . Among the commonly used agrochemicals, organophosphates were found to be the most preferred one due to their wide spectrum bioactivity and easy availability [3] . Parathion, fenthion, malathion, diazinon, chlorpyrifos (Dursban), terbufos, acephate, phorate, methyl parathion, phosmet, azinphos-methyl and dimethoate are the commonly used insecticidal agents. World Health Organization (WHO) has described that these agents belong to the extremely hazardous category, yet no law or policies exist to restrict their availability to the public [4][5][6] . Organophosphate compounds are responsible for large scale accidental poisoning and suicidal poisoning in developed countries [7] . Compounds such as soman (1,2,2-trimethyl propylmethyl phosphono fluoridate), sarin (isopropyl methyl phosphono fluoridate), tabun (ethyl dimethyl phosphoramidocyanidate) and VX (ethyl-S-diisopropylamino ethyl methyl phosphono thioate) are used as warfare agents, capable of causing mass destruction in war [8] . Thus, organophosphate poisoning became a major public health hazard to be therapeutically managed effectively. MECHANISM OF ACTION AND CLINICAL SYMPTOMSOrganophosphate compounds may enter into the human ...

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A review of nerve agent exposure for the critical care physician*

Abstract: Nerve agents are discussed. The article discusses their properties, routes of exposure, toxicodynamics, targets of toxicity, and treatment. It is concluded that a focused organized approach to the treatment of nerve agents is key to its successful management.

Cited by 95 publications

References 26 publications

The acute treatment of nerve agent exposure

The acute treatment of nerve agent exposure

Reactivation of Cyclosarin-inhibited Rat Brain Acetylcholinesterase by Pyridinium–Oximes

Can Galantamine Act as an Antidote for Organophosphate Poisoning? A Review

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