TREATMENT OF ANTICHOLINESTERASE INTOXICATION WITH OXIMES

Abstract

Intoxication by anticholinesterase compounds may occur in normal subjects after accidental exposure to organophosphorus insecticides (e. g., parathion¹and tetraethylpyrophosphate [TEPP]²) and chemical warfare agents (e. g., sarin, one of the "nerve gases," isopropyl methyl phosphonofluoridate³). Similar intoxication may occur as a result of overtreatment of patients with myasthenia gravis with anticholinesterase medication, whether organophosphorus (TEPP or octamethyl pyrophosphoramide [OMPA]) or quaternary ammonium (neostigmine [Prostigmin], bis-neostigmine [BC-40], pyridostigmine [Mestinon], bis-pyridostigmine [hexamarium, BC-51], or ambenomium [Mytelase] ).⁴These compounds inhibit cholinesterase enzymes throughout the body, resulting in local accumulation of acetylcholine, which produces increased activity of smooth muscle and secretory glands ( manifested by nausea, vomiting, diarrhea, sweating, and increased salivary and bronchial secretion), bradycardia, central nervous system symptoms, muscular weakness, and fasciculations in normal subjects,³and increased strength which may be followed by weakness in patients with myasthenia gravis.^4aIn the management of the latter disease,