Therapy for acute nerve agent poisoning: An update

Acute nerve agent poisoning was last reviewed in the neurology literature in 2004. As neurologists may expect to be called upon by non-neurologist colleagues as local experts, it is timely to update the 2004 review.

Acute antidotal therapy for nerve agent poisoning has been rendered simpler and faster by the FDA approval and introduction of the dual-dose autoinjector. Although there are no truly new fielded antidotes, midazolam recently received FDA approval for treatment against seizures, and will replace diazepam in most acute situations when the FDA approves it in the autoinjector form. Information on acute therapy is much more easily accessed in real time now than in 2004, thanks to efforts by the National Library of Medicine and the American College of Medical Toxicology.

Since 2004, there have been changes in antidotal therapy and a robust expansion in familiarity with nerve agent management principles in the civilian sector. These advances are somewhat offset by the increased use of nerve agents for nefarious purposes.