Evidence-based management of Organophosphate Poisoning according to Uganda Clinical Guidelines 2023

Clinical Features — Cholinergic Toxidrome

Patient may smell of chemicals. Constricted pupils (miosis). Cold sweat, anxiety, restlessness. Abdominal pain, diarrhoea, vomiting. Muscle twitching, convulsions. Bradycardia. Excessive salivation, difficulty breathing, abundant respiratory secretions. Headache, hypotension, urinary incontinence. Coma.

Decontamination

Remove contaminated clothing (wear gloves). Wash contaminated skin with large amounts of water.

Airway Management

Establish and maintain the airway. Assisted respiration with air or oxygen may be required.

Antidote — Atropine (HC3)

Atropine 2 mg IV immediately, repeat every 10–15 minutes until secretions dry and breathing improves. Cumulative doses of 10–20 mg or more may be required. Goal: atropinisation (dry secretions, HR >80, pupils normal/dilated).

Antidote — Pralidoxime (HC4)

Pralidoxime (if available) 1–2 g IV over 15–30 minutes, then infusion of 200–400 mg/hour. Must be given early (within 24–48 hours) before cholinesterase "ageing" occurs.

Convulsions

Diazepam 5–10 mg slow IV or 10 mg rectally.

Refer

Refer urgently to hospital after initial stabilisation.