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Erschienen in:
21.11.2017 | Correction
Correction to: A primer on nerve agents: what the emergency responder, anesthesiologist, and intensivist needs to know
Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Ausgabe 1/2018
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In the article entitled: “A primer on nerve agents: what the emergency responder, anesthesiologist, and intensivist needs to know” published in the October 2017 issue of the Journal, Can J Anesth 2017; 64: 1059-1070, two doses in Table 3 contained errors and have now been corrected (and highlighted in bold) in the revised Table 3. In the table on page 1064, next to “Pralidoxime/Obidoxime/HI-6”, the second column should read: “Pralidoxime- Mild cases: 1-2 g iv over 5-10 min or im”. Also in the same row, the third column should read: “Individual doses should not exceed 2 g”.
Table 3
Antidotal treatment of nerve agent-exposed patients (adapted from reference)31
|
Drug
|
Dosage
|
Additional information
|
|---|---|---|
|
Atropine
|
-Mild case: 2 mg iv repeated every 20 min until full atropinization
Children: 0.02 mg·kg−1
-Moderate/Severe exposure: 2 mg iv repeated every 5-10 min until full atropinization
Children: 2 mg or 0.02-0.08 mg·kg−1
|
-In elderly patients, after initial 2-mg dose, consider decreased repeat doses of 1 mg
-MARK 1 autoinjector is a 2-mg im dose
-In severe intoxication, 6 mg may be needed in first hour, 10-20 mg in the first 2-3 hr, and 50-100 mg over 24 hr in severe cases
-Glycopyrrolate may be useful to treat peripheral symptoms. It does not cross to the CNS
|
|
Scopolamine
|
-Mild cases: 0.25 mg im every 4-6 hr
-Moderate/Severe exposure: 0.25 mg iv repeated every 30 min for 2 doses. Then q4-6 hr as needed
|
-Do not use in children
|
|
Pralidoxime/Obidoxime/HI-6
|
Pralidoxime-Mild cases: 1-2 g iv , over 5-10 min or im
Children: 15-25 mg·kg−1 iv or im
Infants: 15 mg·kg−1 iv
-Moderate/Severe cases: Same dose but intravenously preferred
Obidoxime-Mild cases: 250 mg im every 2 hr to a maximum of 3 doses
-Children < 2 yr: 62.5 mg im every 2 hr to a maximum of 3 doses. 2-10 yr: 125 mg every 2 hr to a maximum of 3 doses. Over 10 yr as an adult
-Moderate/Severe exposure: 250 mg iv over 30 min, maximum 3 doses typically but up to 2 g if clinically effective
-Children: 250 mg every 2 hr (maximum of 3 doses but an additional 5 doses may be given if proving effective)
HI-6: Autoinjector dose is 500 mg, typically a single dose may prove efficacious in mild poisoning. Higher dosing may be required in more significant exposure. (3 doses)
|
-MARK 1 autoinjector is a 600-mg im dose
-Individual doses should not exceed 2 g
-If given intravenously should be given slowly
|
|
Benzodiazepines
|
-Diazepam: 0.2 mg·kg−1 or 2-10 mg iv in adults
Children 0.2-0.4 mg·kg−1
-Midazolam 0.1-0.2 mg·kg−1 im or iv
|
-Diazepam autoinjector is a 10-mg im dose
-Individual diazepam doses should not exceed 10 mg
-Total doses of diazepam to suppress seizures in adults may be as high as 30-40 mg
|