The use of atropine and oximes in organophosphate intoxications: a modified approach

Usually intoxications with cholinesterase inhibitors are treated with large dosages of atropine. Furthermore oxime treatment, if applicable, is generally discontinued after one to two days. Two cases of severe anticholinesterase intoxication are presented. In both cases administration of oximes were part of the treatment. The first patient showed relapse cholinergic symptoms when administration of oximes was stopped after one day. In the second patient, where oximes were administered continuously during six days, no relapse cholinergic symptoms occurred. Based on pharmacological as well as on toxicokinetic considerations, and supported by animal experimental data, a continued oxime treatment, if appropriate, can be advocated, whereas the use of atropine should be minimized.