Nerve Agent Poisoning: Antidotes (Atropine, Pralidoxime) and Supportive Care
Nerve agents (sarin, VX, tabun, soman) inhibit acetylcholinesterase (AChE), causing cholinergic crisis. Treatment combines antidotes and supportive care.
Antidotes
| Class | Agents | Mechanism |
|---|---|---|
| Anticholinergic | Atropine | Competitive muscarinic antagonist; reverses bronchoconstriction, bronchorrhea, bradycardia, hypersalivation. |
| Oxime (AChE reactivator) | Pralidoxime (2-PAM), Obidoxime, HI-6 | Reactivates phosphorylated AChE (if given before "aging"); restores neuromuscular transmission. |
Dosing (Adult)
- Atropine: 2–6 mg IV q5–10 min until secretions clear, HR >80; no max dose in severe poisoning.
- Pralidoxime: 1–2 g IV over 15–30 min, then infusion 500 mg/hr; adjust for renal function.
Supportive Care
- Airway management: intubation, mechanical ventilation for respiratory failure.
- Seizure control: benzodiazepines (midazolam, diazepam).
- Decontamination: remove clothing, wash skin with soap/water or 0.5% hypochlorite.
- Monitoring: continuous ECG, SpO₂, EtCO₂, neurologic status.
Auto-injectors (e.g., MARK I, ATNAA) enable rapid field use. Early administration is lifesaving.
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