Emergency
Organophosphate Poisoning (Spray Intake)
سپرے کا زہر
A poisoning emergency managed with gastric lavage, IV access, repeated atropine to atropinisation, pralidoxime (Contrathion), antibiotics and monitoring. The book says poisonings must be dealt with at a government set-up.
- ICD-10
- —
- Source
- OPD handbook p.177
- Status
- Draft
Not yet reviewed by a clinician. Check doses and brands against current national guidelines before use.
Symptoms
- History of spray intake
Red flags Refer urgently if any are present
- Chest crepitations (add nebulization, prop up, oxygen, monitor saturation)
Diagnosis
- Complete medicolegal aspects
- Send baselines
- Keep an eye on vitals
Treatment
Step 1 of 5
1. Gastric lavage and access
- Gastric lavage with 2 litres of normal saline
- Pass 2 IV lines; attach normal saline 1 litre through one IV line
Prescription
Step 2 of 5
2. Atropine
- Atropine 2 cc stat, then after 2 minutes, 5 minutes, 10 minutes, half an hour, until the signs of atropinisation
Prescription
AtropineAntimuscarinic antidote
Dose2 cc stat, repeat at 2, 5, 10 minutes and half an hour until atropinisation
Brands Generic / hospital supply
Step 3 of 5
3. Contrathion
- Contrathion 4 ampoules in a microburette over half an hour, then 4 ampoules every 6th hour (RTC) for 24 hours
Prescription
Pralidoxime (as Contrathion)Organophosphate antidote (cholinesterase reactivator)
Dose4 ampoules in a microburette over 30 min, then 4 ampoules every 6 hours
Brand Contrathion
24 hours
Step 4 of 5
4. Antibiotic and PPI
Prescription
Ceftriaxone3rd-generation cephalosporin
Dose1 g BD
Brand Inj Ceftriaxone
Also sold as Rocephin, Dayline, Oxidil
Resistance is widespread in Salmonella Typhi in Sindh and Punjab; use culture guidance.
Step 5 of 5
5. Monitoring and support
- Keep an eye on vitals
- If chest crepitations: add nebulization with Clenil-C QID, prop up, oxygen, and watch saturation
- Complete medicolegal aspects
- Sick counselling of the attendants
- Send baselines and proceed accordingly
Prescription
Beclometasone (nebulizer)Inhaled corticosteroid
DoseNebulization QID if chest crepitations
Brand Clenil-C
Also sold as Clenil, Clenil-C