Atropine Dosing for Cholinesterase Inhibitor Toxicity
Doses atropine for cholinesterase inhibitor toxicity (prescribed drugs, nerve gas, insecticides).
This dosing tool is intended to assist with calculation, not to provide comprehensive or definitive drug information. Always double-check dosing of any drug and consult a pharmacist when necessary.
- Use in patients with cholinergic toxicity to determine atropine bolus dose and continuous infusion rate.
- Not for use in treating isolated bradycardia.
- Not for use in AtroPen Atropine Auto-Injector dosing.
- In the United States, the local Poison Control Center can be reached at 1-800-222-1222 to help guide management.
Advice
- Patients suspected of cholinergic toxicity exhibiting signs of neuromuscular dysfunction should also be treated with pralidoxime (2-PAM).
- Doses of atropine delivered intravenously should be given rapidly and in their entirety—slow administration or subtherapeutic doses have been associated with paradoxical bradycardia.
Management
Management of organophosphate / carbamate toxicity includes:
- Prompt, safe, and thorough decontamination.
- Early intubation for airway protection in severe cases.
- Avoid succinylcholine for rapid sequence intubation, given prolonged duration of action in cholinergic poisonings.
- Early atropinization.
- Administration of pralidoxime.
- Administration of benzodiazepines for seizure activity.
- Admission to a higher level of care for close monitoring.
Critical Actions
Patients exposed to organophosphate or carbamate agents should be immediately decontaminated by removing all clothing and abundantly irrigating all exposed areas before initiating treatment.