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    Attention COACH STUDY participants:

    The principal investigators of the study request that you use the official version of the modified score here.

    Atropine Dosing for Cholinesterase Inhibitor Toxicity

    Doses atropine for cholinesterase inhibitor toxicity (prescribed drugs, nerve gas, insecticides).

    IMPORTANT

    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.

    INSTRUCTIONS

    • 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.
    When to Use
    Pearls/Pitfalls
    Why Use
    • Use for patients with cholinergic toxicity (causative agents are typically organophosphate compounds or carbamate, found in pesticides, or agents used in chemical warfare and terrorist attacks).
    • Many symptoms of cholinergic toxicity are recalled with the “SLUDGE and killer B’s” mnemonic:
      • Salivation.
      • Lacrimation.
      • Urination.
      • Defecation.
      • Gastric Emesis.
      • Bradycardia.
      • Bronchospasm.
      • Bronchorrhea.
    • This dosing guide was created to facilitate early and safe atropinization of the patient exhibiting signs of acute cholinergic toxicity.
    • May be used in patients exposed to either pesticide agents (more common) or agents of chemical warfare/terrorism.
    • Markers of atropinization vary, but the most clinically significant is resolution of bronchorrhea, as assessed by auscultation.
    • Large cumulative doses of atropine may be necessary to treat toxicity. Cases requiring hundreds to thousands of milligrams over the course of treatment have been reported (Hopmann 1974).

    Atropine is a competitive antagonist at muscarinic receptors and can reverse the deleterious or life-threatening symptoms of cholinergic toxicity, particularly bronchospasm and bronchorrhea.

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    Evidence
    Creator Insights
    Dr. Lewis Goldfrank

    About the Creator

    Lewis Goldfrank, MD, FACEP, FAAEM, FAACT, FACMT, FACP, is the Herbert W. Adams Professor of Emergency Medicine at New York University. He is also the medical director of the New York City Poison Control Center. Dr. Goldfrank is perhaps best known as author and editor of the primary toxicology reference Goldfrank's Toxicologic Emergencies.

    To view Dr. Lewis Goldfrank's publications, visit PubMed

    Are you Dr. Lewis Goldfrank? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    Content Contributors
    • Philip DiSalvo, MD
    About the Creator
    Dr. Lewis Goldfrank
    Are you Dr. Lewis Goldfrank?
    Content Contributors
    • Philip DiSalvo, MD