A severe organophosphate poisoning requiring the use of an atropine drip

A 68-year-old male attempted suicide by drinking three ounces of concentrated Cygon 2-E (23.4% dimethoate). He was immediately brought to the hospital, responded to standard treatment (ipecac, activated charcoal, 2-PAM, atropine), and was transferred from the ICU to general care 24 hours after the exposure. Within eight hours of the transfer, he relapsed and was moved to the CCU, where he required five milligrams of atropine every ten minutes for 24 hours, before being started on an atropine drip. The patient was maintained on the atropine drip (0.5-2.4 mg/kg/hr) for five weeks. He required a total atropine dose of 30 grams, the largest amount ever reported to have been administered to a human. Although S-ChE activities gradually increased they were not found to be helpful in determining when the drip could be safely stopped. Control of hypersecretions served as the best monitoring parameter for titration of the drip rate. The patient recovered completely with the exception of a detectable sensorineural hearing deficit, a slight, nonspecific personality change, and minimal spastic rigidity thought to be secondary to several anoxic episodes.