Early Death Due to Severe Organophosphate Poisoning Is a Centrally Mediated Process
Version of Record online: 8 JAN 2008
Academic Emergency Medicine
Volume 10, Issue 4, pages 295–298, April 2003
How to Cite
Bird, S. B., Gaspari, R. J. and Dickson, E. W. (2003), Early Death Due to Severe Organophosphate Poisoning Is a Centrally Mediated Process. Academic Emergency Medicine, 10: 295–298. doi: 10.1111/j.1553-2712.2003.tb01338.x
- Issue online: 8 JAN 2008
- Version of Record online: 8 JAN 2008
- received August 19, 2002 revision received November 25, 2002 accepted November 26, 2002.
Objective: To distinguish whether early death from severe organophosphate (OP) poisoning with dichlorvos is mediated through peripheral or central nervous system (CNS) actions. Methods: Wistar rats (n= 72) were randomized to pretreatment with either: normal saline (controls), peripheral anticholinergics (glycopyrrolate [low, medium, or high dose] or nebulized ipratropium bromide), or CNS + peripherally acting anticholinergics (diphenhydramine, nebulized atropine, or injected atropine). All treatments were given prior to a subcutaneous injection of 25 mg/kg dichlorvos (n= 8 per group). Survival was assessed at 10 minutes (early death) and 24 hours (delayed death). Kaplan-Meier (95% confidence intervals [95% CIs]) and chi-squared analysis was then performed to determine differences between treatments. Results: Regardless of treatment, all animals exhibited profound nicotinic effects (fasciculations) without obvious seizures within 2 minutes of poisoning. In rats pretreated with peripherally acting agents, the fasciculations were rapidly followed by reduced motor activity, sedation, and death. Mortality at 10 minutes for saline controls, glycopyrrolate, and ipratropium was 88%, 96%, and 100%, respectively. The single control animal surviving beyond 10 minutes went on to develop peripheral cholinergic manifestations, including hypersalivation, urination, and defecation. Only one of 24 animals treated with injected atropine, nebulized atropine, or diphenhydramine died during the early phase of poisoning; all others survived to 24 hours (p < 0.01). Conclusions: Death in acute, severe OP poisoning is prevented by pretreatment with anticholinergic agents that cross the blood–brain barrier, but not by agents with only peripheral actions. Early death due to OP poisoning appears to be a centrally mediated process.