Early management after self-poisoning with an organophosphorus or carbamate pesticide – a treatment protocol for junior doctors

doi:10.1186/cc2953

Critical Care
Volume 8
Issue 6

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Eddleston M
Dawson A
Karalliedde L
Dissanayake W
Hittarage A
Azher S
Buckley NA

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Eddleston M
Dawson A
Karalliedde L
Dissanayake W
Hittarage A
Azher S
Buckley NA
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Early management after self-poisoning with an organophosphorus or carbamate pesticide – a treatment protocol for junior doctors

Michael Eddleston¹^,2 , Andrew Dawson³^,4 , Lakshman Karalliedde⁵ , Wasantha Dissanayake⁶, Ariyasena Hittarage⁶, Shifa Azher⁷ and Nick A Buckley⁸

¹South Asian Clinical Toxicology Research Collaboration, Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, UK

²Department of Clinical Medicine, University of Colombo, Sri Lanka

³Department of Pharmacology, University of Newcastle, Australia

⁴Department of Clinical Medicine, University of Peradeniya, Sri Lanka

⁵Medical Toxicology Unit, Guy's and St Thomas's Hospitals, London, UK

⁶Anuradhapura General Hospital, North Central Province, Sri Lanka

⁷Polonnaruwa General Hospital, North Central Province, Sri Lanka

⁸Department of Clinical Pharmacology and Toxicology, Canberra Clinical School, ACT, Australia

author email corresponding author email

Critical Care 2004, 8:R391-R397doi:10.1186/cc2953


Published:	22 September 2004

Abstract

Severe organophosphorus or carbamate pesticide poisoning is an important clinical problem in many countries of the world. Unfortunately, little clinical research has been performed and little evidence exists with which to determine best therapy. A cohort study of acute pesticide poisoned patients was established in Sri Lanka during 2002; so far, more than 2000 pesticide poisoned patients have been treated. A protocol for the early management of severely ill, unconscious organophosphorus/carbamate-poisoned patients was developed for use by newly qualified doctors. It concentrates on the early stabilisation of patients and the individualised administration of atropine. We present it here as a guide for junior doctors in rural parts of the developing world who see the majority of such patients and as a working model around which to base research to improve patient outcome. Improved management of pesticide poisoning will result in a reduced number of suicides globally.