Treatment of carbophos poisoning

Treatment of malathion poisoning involves resuscitating patients and providing oxygen, a muscarinic antagonist (usually atropine), fluids, and an acetylcholinesterase reactivator (an oxime that reactivates acetylcholinesterase by removing a phosphate group).[ 1 ] Respiratory support is provided as needed. Once patients are stabilized, they should be closely monitored for changes in atropine requirements, worsening respiratory function due to the intermediate syndrome, and recurrent cholinergic features that occur with a lipid-soluble organophosphate.

In brief, the treatment plan can be presented as follows:

1. Providing emergency care:
   1. stopping further entry of poison into the body;
   2. removal of poison from the body;
   3. neutralization of poison that has entered the blood.
2. Maintaining vital functions of the body
   1. detoxification therapy;
   2. pain relief treatment;
   3. symptomatic treatment;
3. Basic therapy aimed at eliminating the pathological process, the consequences of poisoning
   1. pathogenetic therapy;
   2. etiologic therapy;
4. Recovery activities.

Let's consider the treatment in more detail. Thus, at the stage of emergency care, it is necessary to neutralize the poison, stop its effect on the body. Then stabilization is carried out (pulse, pressure, body temperature, respiratory rate, heart rate). Then detoxification therapy is carried out, sorbents are administered that absorb, mitigate the consequences of the negative impact of the poison.

Gastric lavage is often the first intervention poisoned patients receive upon admission to hospital, sometimes at the expense of resuscitation and administration of antivenom.[ 2 ] There is no evidence to suggest that any form of gastric decontamination is beneficial in patients poisoned by organophosphates. Gastric decontamination should only be performed after the patient has been stabilized and treated with oxygen, atropine, and oxime.

Gastric lavage is the most common form of decontamination for phosphorus poisoning, despite the lack of randomized controlled trials to confirm benefit. The rate of absorption of organophosphates from the human gut is not known; however, with some pesticides, the rapid onset of poisoning in animals [ 3 ] and humans suggests that absorption is rapid, within minutes of ingestion. Therefore, the time window for effective lavage is likely to be short. Guidelines for the treatment of drug poisoning suggest that lavage should only be considered if the patient presents within 1 hour of poison ingestion. [ 4 ] The significance of these guidelines for organophosphate poisoning is unclear [ 5 ], but lavage should probably only be considered for patients who ingest a significant amount of toxic pesticide shortly after ingestion and who are intubated or conscious. In China, repeated gastric lavage is recommended to remove pesticides remaining in the stomach, [ 6 ] although it is unlikely that a single lavage will leave significant amounts of organophosphates in the stomach.

The introduction of vitamin complexes, minerals, glucose, Ringer's solution, and other supporting substances into the body is envisaged. The necessary medications are used.

During the recovery period, it is important to follow a diet (table No. 1 for 1-3 days). Then switch to a gentle diet, which is especially important when karbofos is ingested through the digestive system.

Patients with reduced immunity are prescribed antiviral, antibacterial, or anti-inflammatory therapy. In case of a tendency to allergic reactions, antiallergic, antihistamines are prescribed. Often poisoning is accompanied by a vitamin deficiency, therefore vitamin therapy is prescribed, sometimes hormone therapy is required.

Few randomized trials of such poisoning have been conducted; therefore, the evidence base is limited. Both atropine and oximes were rapidly introduced into clinical practice in the 1950s without clinical trials.[ 7 ],[ 8 ]

Antagonist, antidote for poisoning with malathion

The antidote to malathion is atropine, which must be administered to the body as quickly as possible in order to provide emergency care to the victim. The drug is administered intramuscularly or intravenously, has a relaxing effect on blood vessels, smooth muscles, which relieves spasms, cramps, normalizes breathing and heartbeat. The drug also helps maintain normal blood pressure, stimulates heart activity. [ 9 ]

Hyoscine has been used successfully to treat a patient with severe extrapyramidal signs but few peripheral signs.[ 10 ] Animal studies show that it is more effective than atropine in controlling seizures induced by inhaled organophosphate nerve agents.[ 11 ] However, extrapyramidal effects and seizures are not common features of organophosphate poisoning.

Atropine will likely remain the antimuscarinic agent of choice until high-quality randomized trials show that another muscarinic antagonist has a better benefit-to-harm ratio because it is widely available, affordable, and has moderate CNS penetration. No known randomized controlled trials have compared different atropine regimens for loading or continuation therapy. As a result, many different recommendations have been made—a 2004 review noted over 30 dosing regimens, some of which would require many hours to obtain the full loading dose of atropine.[ 12 ]

Oximes reactivate phosphorus-inhibited acetylcholinesterase.[ 13 ] Pralidoxime was discovered in the mid-1950s by Wilson and colleagues and was soon successfully introduced into clinical practice for patients with parathion poisoning. Other oximes such as obidoxime and trimedoxime have been developed, but pralidoxime remains the most widely used. It has four salts: chloride, iodide, methyl sulfate, and mesylate. The chloride and iodide salts are widely used, but the methyl sulfate and mesylate are used mainly in France, Belgium, and the UK. The chloride salt has advantages over the iodide, notably its lower molecular weight (173 vs. 264), giving 1.5 times more active compound per gram of salt than the iodide. High doses of pralidoxime iodide also put patients at risk of thyroid toxicity, especially if taken over a long period.[ 14 ]

Medicines

Usually poisoning is accompanied by severe pain, which forces one to resort to taking painkillers. A 1% solution of novocaine in the amount of 0.5-1 ml is injected into the body intramuscularly.

Patients poisoned with organophosphates often develop excited delirium. The cause is complex, involving the pesticide itself, atropine toxicity, hypoxia, alcohol ingested by the poison, and medical complications. Although the mainstay of treatment is prevention or treatment of the underlying cause, some patients require pharmacotherapy. Acutely agitated patients are treated with diazepam.

Diazepam is first-line therapy for seizures; however, seizures are rare in patients with oxygen and pesticide poisoning.[ 15 ],[ 16 ] Seizures are more common with organophosphate nerve agents (such as soman and tabun). Animal studies suggest that diazepam reduces nervous system damage[ 17 ] and prevents respiratory failure and death,[ 18 ] but human studies are limited.

Magnesium sulfate blocks ligand-gated calcium channels, resulting in decreased acetylcholine release from presynaptic terminals, thereby improving function at neuromuscular junctions, and reduces CNS overstimulation mediated by NMDA receptor activation.[ 19 ] A trial in humans poisoned by organophosphate pesticides showed a reduction in mortality with magnesium sulfate (0/11 [0%] vs. 5/34 [14 7%]; p < 0.01).[ 20 ]

Clonidine, an alpha2-adrenergic receptor agonist, also reduces the synthesis and release of acetylcholine from presynaptic terminals. Animal studies show benefit from clonidine treatment, especially when combined with atropine, but the effects in humans are unknown.[ 21 ]

Sodium bicarbonate is sometimes used to treat phosphorus poisoning in Brazil and Iran, instead of oximes.[ 22 ] Increasing blood pH (to 7 45–7 55) has been reported to improve outcome in dogs by an unknown mechanism;[ 23 ] However, a Cochrane review[ 24 ] concluded that there is currently insufficient evidence to determine whether sodium bicarbonate should be used in humans poisoned by organophosphates.

In case of respiratory and cardiac arrhythmia disorders, diphenhydramine (0.025 - 0.05 mg orally) is used to quickly relieve swelling. It is also recommended to make injections - 2 ml of 0.5% novocaine solution and 0.1% adrenaline solution.

In case of cardiac pathology, Corvalol can be used - approximately 20-20 drops under the tongue. This remedy dilates blood vessels, increases tone, and increases heart rate.

You can take acetylsalicylic acid, as it thins the blood, secretion, normalizes the condition of the mucous membrane, relieves pain, stimulates smooth muscles. The only precaution is that the drug should not be taken by people who have a tendency to bleeding, as this drug thins the blood. It is recommended to take 1-2 tablets once, then - in accordance with the doctor's recommendations.

If allergic edema develops, you can take suprastin - 1 tablet (150 mg) once.

Vitamins

It is recommended to take vitamins in the following daily concentrations:

• Vitamin B 2-3 mg
• Vitamin D – 1000 mg
• Vitamin PP – 60 mg
• Vitamin A – 240 mg
• Vitamin E – 45 mg
• Vitamin C – 1000 mg.

Physiotherapy treatment

Usually, the need for physiotherapeutic methods of therapy arises only at the stage of rehabilitation treatment. Inhalations, thermal procedures, some electrical procedures, UF, and the introduction of drugs using electrophoresis may be required.

Herbal treatment

There are many recipes that are used in folk medicine and are no less effective than traditional medications. They are often included in complex therapy. Basically, the following remedies are aimed at providing anti-inflammatory and detoxifying effects on the body.

For quick recovery after poisoning, it is recommended to use herbs in the form of decoctions and infusions internally, as they have a complex effect on the body. This quickly removes toxins, cleanses the body, saturates it with vitamins, nutrients, which allows you to quickly relieve inflammation, intoxication, eliminate pain, and generally improve well-being, increase the body's resistance.

Sage has an anti-inflammatory effect. [ 25 ] It is prescribed in the form of a decoction or infusion. To prepare, take a tablespoon of the herb per glass of boiling water/alcohol, infuse, drink 2-3 tablespoons per day;

Chamomile relieves inflammation and prevents infection (antiseptic effect). [ 26 ] It is recommended to use the herb (flowers) as a decoction for internal use, as well as a compress on the affected area (for chemical burns of the skin with a solution of malathion). The decoction is made at the rate of 2 tablespoons of the product per glass of boiling water.

Rose hips saturate the body with vitamins, remove toxins, and have an antioxidant effect. [ 27 ] Rose hips are useful for diseases of the digestive tract and relieve pain. Prepare a decoction: pour 2-3 tablespoons of fruit with a glass of boiling water, leave for 1-2 hours, and drink throughout the day.