Adherence to the National Guidelines on the Management of Organophosphorus Poisoning

Abstract

Background: The National Guidelines on the Management of Organophosphorus (OP) poisoning include resuscitation, gastric lavage, administration of atropine and pralidoxime. Atropine should be commenced in the presence of cholinergic features and maintained to reverse them. Pralidoxime therapy in OP poisoning should be continued until clinical recovery or seven days, whichever is longer. The aim of this study was to explore the adherence to the National Guidelines on atropine and pralidoxime in OP poisoning in two selected hospitals in the Southern province.

Materials: A cross sectional survey was conducted at the Teaching Hospital, Galle and the General Hospital, Matara between June 2008 and September 2009. The details of administration of atropine, atropine adequacy during the therapy and pralidoxime were collected.

Results: A total of 149 patients were recruited. Eighty (54%) patients were direct admissions to the collaborating hospitals. Among them, 35 (44%) did not have cholinergic features at the time of presentation to hospital and 32 patients were treated with atropine before the appearance of cholinergic features. Seventeen (12%) patients neither showed features of atropine toxicity nor inadequacy. The number of patients who developed features of atropine toxicity and inadequacy in the two hospitals were 109 (73%) and 11 (7%), respectively. Seventy-eight (52%) patients did not receive the loading dose while 39 (26%) did not receive the maintenance dose of pralidoxime respectively. None of the patients received pralidoxime for the recommended duration.

Conclusions:

Atropine was commenced in some patients without cholinergic features. Majority of the patients received toxic doses of atropine. None of the patients received the maintenance therapy of pralidoxime for the recommended duration. Further education of ward staff on the management of OP poisoning may be required.

DOI: http://dx.doi.org/10.4038/gmj.v17i1.4359

Galle Medical Journal, Vol 17: No. 1, March 2012 37-42