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Clinical Toxicology Volume 52, 2014 - Issue 5
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Research Article

Is oxygen required before atropine administration in organophosphorus or carbamate pesticide poisoning? – A cohort study

L. A. KonickxPharmacology, Toxicology and Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, UK;School of Pharmacy, University of Utrecht, The Netherlands
,
K. BinghamPharmacology, Toxicology and Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, UK
&
M. EddlestonPharmacology, Toxicology and Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, UK;South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Sri LankaCorrespondence[email protected]
Pages 531-537 | Received 07 Jan 2014, Accepted 10 Apr 2014, Published online: 08 May 2014

Figures & data

Fig. 1. Publications linked to the references they cite to underpin this guidance. Circles within the black rectangle: the 28 publications found to state this guidance. By colour: blue, without supporting citations; orange, provide non-relevant supporting citations; green, provide relevant supporting citations. Outside the rectangle, in squares, cited human publications that are not relevant: in light blue, primary OP pesticide papers; in red, primary cardiac disease papers; in purple, primary nerve agent papers. Triangles: animal studies. Numbers correspond with the references. Publications from the same book, with a different edition, are placed together (refs 27 and 29, and 38 and 39). Of the 28 publications, 11 cited a source for their statement while 17 did not provide any supporting evidence. The 11 publications cited 18 sources on 27 occasions. Eleven citations were to relevant but secondary sourcesCitation18,Citation20,Citation22,Citation24,Citation26,Citation29,Citation38 while seven citations were of irrelevant primary or secondary sources (patients with myocardial infarctions, nerve agent studies, or patients with pesticide poisoning but no ventricular dysrhythmiasCitation10,Citation53,Citation62–64). Animal studies with OP nerve agents, pesticide active ingredients, or myocardial infarctionsCitation51,Citation54,Citation55,Citation58,Citation59 were cited on eight occasions (colour version of this figure can be found in the online version at www.informahealthcare.com/ctx).

Fig. 1. Publications linked to the references they cite to underpin this guidance. Circles within the black rectangle: the 28 publications found to state this guidance. By colour: blue, without supporting citations; orange, provide non-relevant supporting citations; green, provide relevant supporting citations. Outside the rectangle, in squares, cited human publications that are not relevant: in light blue, primary OP pesticide papers; in red, primary cardiac disease papers; in purple, primary nerve agent papers. Triangles: animal studies. Numbers correspond with the references. Publications from the same book, with a different edition, are placed together (refs 27 and 29, and 38 and 39). Of the 28 publications, 11 cited a source for their statement while 17 did not provide any supporting evidence. The 11 publications cited 18 sources on 27 occasions. Eleven citations were to relevant but secondary sourcesCitation18,Citation20,Citation22,Citation24,Citation26,Citation29,Citation38 while seven citations were of irrelevant primary or secondary sources (patients with myocardial infarctions, nerve agent studies, or patients with pesticide poisoning but no ventricular dysrhythmiasCitation10,Citation53,Citation62–64). Animal studies with OP nerve agents, pesticide active ingredients, or myocardial infarctionsCitation51,Citation54,Citation55,Citation58,Citation59 were cited on eight occasions (colour version of this figure can be found in the online version at www.informahealthcare.com/ctx).

Table 1. Baseline demographic and clinical characteristics of all patients who died and patients who died with a primary cardiac arrest.

Fig. 2. Plot of time from admission to death for each patient (A and B) and cumulative percentage of death post admission (C and D). A: patients with any cause of death. B: patients dying from a primary cardiac arrest. See legend for a list of other OP insecticides. Cumulative percentage of patients who died with any cause of death (broken blue), and patients dying from a primary cardiac arrest (solid red). C: up to 6 h post atropine administration; D: up to 100 h post atropine administration (colour version of this figure can be found in the online version at www.informahealthcare.com/ctx).

Fig. 2. Plot of time from admission to death for each patient (A and B) and cumulative percentage of death post admission (C and D). A: patients with any cause of death. B: patients dying from a primary cardiac arrest. See Table 1 legend for a list of other OP insecticides. Cumulative percentage of patients who died with any cause of death (broken blue), and patients dying from a primary cardiac arrest (solid red). C: up to 6 h post atropine administration; D: up to 100 h post atropine administration (colour version of this figure can be found in the online version at www.informahealthcare.com/ctx).

Table 2. Time of death since admission for OP or carbamate-poisoned patients treated with atropine.

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