Organochlorine Pesticide Toxicity Medication

Author: Jennifer Vyse Pope, MD; Chief Editor: Asim Tarabar, MD more...

Updated: May 11, 2010

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Medication Summary
Benzodiazepines
GI decontaminant
Bile acid sequestrants
Anticholinergic Agent
Bronchodilators
Anticonvulsant, miscellaneous
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Medication Summary

No specific antidote for general hydrocarbon aspiration pneumonia exists. Corticosteroids are controversial. Treatment is essentially supportive.

Class Summary

Mainstay of treatment for hydrocarbon insecticide–induced seizures.

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Lorazepam (Ativan)

Sedative hypnotic with short onset of effects and relatively long half-life. DOC because of its long duration of seizure control. Rate of injection should not exceed 2 mg/min. May be administered IM if unable to obtain IV access.

By increasing the action of GABA, a major inhibitory neurotransmitter in the brain, may depress all levels of CNS, including limbic and reticular formation.

Important to monitor patient's blood pressure after administering dose. Adjust prn.

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Midazolam (Versed)

Used as alternative in termination of refractory status epilepticus. Because water soluble, takes approximately 3 times longer than diazepam to peak EEG effects. Thus, clinician must wait 2-3 min to fully evaluate sedative effects before initiating procedure or repeating dose.

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Diazepam (Valium)

Depresses all levels of CNS (eg, limbic and reticular formation), possibly by increasing activity of GABA.

Class Summary

Adsorbs GI toxins, which are then fecally excreted. May not adsorb hydrocarbons and other toxins. Besides adsorbing toxins, activated charcoal also creates a diffusion gradient in the GI circulation, a "sink" effect, which draws absorbed drug into the GI tract for binding and elimination.

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Activated charcoal (Liqui-Char)

Emergency treatment in poisoning caused by drugs and chemicals. Network of pores present in activated charcoal adsorbs 100-1000 mg of drug per gram of charcoal. Does not dissolve in water.

For maximum effect, administer within 30 min of ingesting poison.

Multiple dose activated charcoal (MDAC) may be administered as 10-20 g q2-4h without a cathartic.

Class Summary

Binding agents are used in the treatment of hypercholesterolemia and have been noted to bind certain lipid-soluble drugs and enterohepatically-recycled drugs.

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Cholestyramine (Questran)

Forms a nonabsorbable complex with bile acids in the intestine, which, in turn, inhibits enterohepatic reuptake of intestinal bile salts.

Class Summary

Competitive inhibitors of acetylcholine and muscarine in the autonomic nervous systems relieve the muscarinic effects, especially bronchorrhea. Inhaled anticholinergic agents (eg, ipratropium) may be considered.

CAVEAT: Conceptually, anticholinergics can precipitate cardiac dysrhythmias in sensitized myocardium and should be used with caution in patients exposed to organochlorines.

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Ipratropium (Atrovent)

Chemically related to atropine. Has antisecretory properties and, when applied locally, inhibits secretions from serous, and seromucous glands lining the nasal mucosa.

Class Summary

CAVEAT: Conceptually, beta-agonists can precipitate cardiac dysrhythmias in sensitized myocardium and should be used with caution in patients exposed to organochlorines.

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Albuterol (Proventil HFA, Ventolin HFA, ProAir HFA)

Relaxes bronchial smooth muscle by action on beta2-receptors with little effect on cardiac muscle contractility.

Class Summary

Additional options include pentobarbital or propofol for seizure control if status epilepticus does not respond to benzodiazepines or phenytoin.

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Pentobarbital (Nembutal)

Short-acting barbiturate with sedative, hypnotic, and anticonvulsant properties and can produce all levels of CNS mood alteration.

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Propofol (Diprivan)

Phenolic compound unrelated to other types of anticonvulsants. Has general anesthetic properties when administered IV. Growing anecdotal reports of use in refractory status epilepticus.

Intubation and ventilation required. Hypotension may require treatment.

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Contributor Information and Disclosures

Author

Jennifer Vyse Pope, MD Staff Physician, Department of Emergency Medicine, Beth Israel Deaconess Medical Center

Jennifer Vyse Pope, MD is a member of the following medical societies: Phi Beta Kappa

Disclosure: Nothing to disclose.

Coauthor(s)

Morgan Skurky-Thomas, MD Resident Physician, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School

Morgan Skurky-Thomas, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, American Medical Association, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Carlo L Rosen, MD Associate Professor of Medicine, Harvard Medical School; Program Director, Vice Chair for Education, Department of Emergency Medicine, Beth Israel Deaconess Medical Center/Harvard Affiliated Emergency Medicine Residency program

Carlo L Rosen, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

David C Lee, MD Research Director, Department of Emergency Medicine, Associate Professor, North Shore University Hospital and New York University Medical School

David C Lee, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Michael J Burns, MD Instructor, Department of Emergency Medicine, Harvard University Medical School, Beth Israel Deaconess Medical Center

Michael J Burns, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

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