Treatment of karbofos poisoning

Treatment  for karbofos poisoning involves resuscitation of patients and the provision of oxygen, a muscarinic antagonist (usually atropine), fluids and an acetylcholinesterase reactant (an oxime that reactivates acetylcholinesterase by removing the phosphate group). [1]Respiratory support is provided as needed. After stabilization of patients, it is necessary to carefully monitor changes in needs for atropine, deterioration in respiratory function due to an intermediate syndrome and recurring cholinergic features that occur with a fat-soluble organophosphorus compound.

In a short form, the treatment regimen can be represented as follows:

1. Emergency care:
   1. cessation of further intake of poison in the body;
   2. removal of poison from the body;
   3. neutralization of the poison that has entered the bloodstream.
2. Maintaining vital body functions
   1. detoxification therapy;
   2. pain medication;
   3. symptomatic treatment;
3. Basic therapy aimed at eliminating the pathological process, the effects of poisoning
   1. pathogenetic therapy;
   2. etiological therapy;
4. Recovery activities.

Consider the treatment in more detail. So, 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 introduced that absorb, mitigate the effects of the negative effects of the poison.

Gastric lavage is often the first intervention that poisoned patients receive upon admission to the hospital, sometimes through resuscitation and the administration of an antidote. [2]There is no evidence of the benefits of any form of gastric decontamination in patients poisoned with organophosphorus compounds. [3]Gastric disinfection should be carried out only after stabilization of the patient's condition and treatment with oxygen, atropine and oxime.

Gastric lavage is the most common form of decontamination for phosphorus poisoning, despite the absence of randomized controlled trials to confirm the benefits. The rate of absorption of organophosphorus from the human intestine is not known; however, with some pesticides, the rapid onset of poisoning in animals [4]and humans indicates that absorption occurs quickly, within a few minutes after ingestion. Therefore, the time interval for effective washing is probably short. Recommendations for the treatment of drug poisoning suggest that flushing should be considered only if the patient arrives within 1 hour after taking the poison. [5]The significance of these guidelines for organophosphate poisoning is unclear [6], but flushing should probably be considered only for patients who take a significant amount of toxic pesticide who are intubated or conscious soon after eating. In China, repeated gastric lavage is recommended to remove pesticides remaining in the stomach,  [7]although it is unlikely that a significant amount of organophosphorus compounds will remain in the stomach after a single lavage.

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

During the recovery period, it is important to follow dietary nutrition (table No. 1 for 1-3 days). Then they switch to a sparing diet, which is especially important when kalbofos gets inside through the digestive system.

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

Several randomized trials of such poisoning have been conducted; therefore, the evidence base is limited. Both atropine and oximes were quickly introduced into clinical practice in the 1950s without clinical trials. [8], [9]

Antagonist, antidote for malathion poisoning

The antidote of kalbofos is atropine, which must be introduced into the body as soon as possible in order to provide emergency assistance to the victim. The drug is administered intramuscularly or intravenously, has a relaxing effect on blood vessels, smooth muscles, which relieves spasm, cramps, normalizes breathing and heartbeat. Also, the drug allows you to maintain normal blood pressure, stimulates the activity of the heart.[10]

Hyoscine has been successfully used to treat a patient with severe extrapyramidal symptoms, but with a small number of peripheral symptoms. [11]Animal studies show that it is more effective than atropine in controlling seizures caused by respirable organophosphorus nerve agents. [12]However, extrapyramidal effects and convulsions are not common signs of organophosphate poisoning.

Atropine is likely to remain the antimuscarinic drug 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 moderately able to penetrate the central nervous system. None of the known randomized controlled trials compared different regimens for taking atropine for exercise therapy or continued treatment. As a result, many different recommendations were made - in a 2004 review, more than 30 dosing regimens were noted, some of which would require many hours to get a full loading dose of atropine.[13]

Oximes reactivate phosphorus inhibited acetylcholinesterase. [14]Pralidoxime was discovered in the mid-1950s by Wilson and his colleagues and was soon successfully introduced into clinical practice for patients with parathion poisoning. [15]Other oximes have been developed, such as obidoxime and trimedoxime, but pralidoxime remains the most widely used. It has four salts: chloride, iodide, methyl sulfate and mesylate. Chloride and iodide salts are widely used, but methyl sulfate and mesylate are mainly used in France, Belgium and the UK. The chloride salt has advantages over iodide, in particular, its lower molecular weight (173 versus 264), which gives 1.5 times more active compound per gram of salt than iodide. High doses of pralidoxime iodide also put patients at risk of toxic effects on the thyroid gland, especially if taken for a long period.[16]

Medication

Usually poisoning is accompanied by severe pain, which forces you to resort to taking painkillers. A solution of novocaine 1% in an amount of 0.5-1 ml is administered intramuscularly.

Organophosphate poisoning patients often develop agitated delirium. The reason is complex, involving the pesticide itself, toxicity of atropine, hypoxia, alcohol absorbed by poison, and medical complications. Although treatment is based on prevention or treatment of the underlying causes, some patients require pharmacotherapy. Acute anxious patients are treated with diazepam.

Diazepam is a first-line therapy for seizures; however, seizures are rare in patients with oxygen and pesticide poisoning. [17],  [18]Cramps are more common in organophosphorus nerve agents (such as soman and tabun). Animal studies show that diazepam reduces damage to the nervous system [19]and prevents respiratory failure and death,  [20]but studies in humans are few.

Magnesium sulfate blocks ligand-driven calcium channels, which reduces the release of acetylcholine from presynaptic terminals, thereby improving function in neuromuscular compounds, and reduces excessive central nervous system stimulation mediated by NMDA receptor activation. [21]A test in people poisoned with organophosphorus pesticides showed a decrease in mortality from magnesium sulfate (0/11 [0%] versus 5/34 [14 · 7%]; p <0.01).[22]

Clonidine, an alpha2-adrenergic receptor agonist, also reduces the synthesis and release of acetylcholine from presynaptic terminals. Animal studies show the benefits of clonidine treatment, especially in combination with atropine, but the effects in humans are unknown.[23]

Sodium bicarbonate is sometimes used to treat phosphorus poisoning in Brazil and Iran, instead of oximes. [24]An increase in blood pH (up to 7 · 45–7 · 55) has been reported to improve dogs outcome using an unknown mechanism; [25]however, the Cochrane Review [26]concluded that there is currently insufficient evidence to establish whether sodium bicarbonate should be used in people poisoned with organophosphorus compounds.

In case of respiratory failure, heart rate, diphenhydramine (0.025 - 0.05 mg orally) is used to quickly remove edema. Injections are also recommended - 2 ml of a 0.5% solution of novocaine and a 0.1% solution of adrenaline.

With cardiac pathology, Corvalol can be used - about 20-20 drops under the tongue. This tool dilates blood vessels, increases tone, increases heart rate.

You can take acetylsalicylic acid, because it dilutes the blood, secret, 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 are prone to bleeding, since this drug dilutes the blood. It is recommended to drink once 1-2 tablets, in the future - in accordance with the recommendations of the doctor.

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.

Physiotherapeutic treatment

Usually, the need for physiotherapeutic methods of therapy arises only at the stage of rehabilitation treatment. Inhalations, thermal procedures, some electrical procedures, KUF, drug administration by electrophoresis may be required.

Herbal treatment

There are a large number of prescriptions that are used in alternative treatment and are no less effective than traditional medications. Often they are included in the complex therapy. Basically, the funds listed below are aimed at providing anti-inflammatory and detoxification effects on the body.

For quick recovery after suffering poisoning, it is recommended to use herbs for treatment in the form of decoctions and infusions inside, since 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 remove the inflammatory process, intoxication, eliminate pain, and in general, improve well-being, increase the body's resistance.

Sage has an anti-inflammatory effect. [27]It is prescribed in the form of a decoction or infusion. To prepare, take a tablespoon of herbs in a glass of boiling water / alcohol, insist, drink 2-3 tablespoons per day;

Chamomile relieves the inflammatory process, prevents the development of infection (antiseptic effect). [28]It is recommended to use grass (flowers) as a decoction for oral administration, as well as a compress on the affected area (with a chemical burn of the skin with a solution of malathion). The broth is made at the rate of 2 tablespoons of the product per glass of boiling water.

Rosehip saturates the body with vitamins, removes toxins, has an antioxidant effect. [29]Rosehip is useful for diseases of the digestive tract, relieves pain. Prepare a decoction: 2-3 tablespoons of fruit pour a glass of boiling water, insist 1-2 hours, drink during the day.