For organophosphate poisoning

SLE systemic lupus erythematosus SLUDGE mnemonic for organophosphate poisoning... 

Martinez-Chuecos J, Del Carmen JM, Gimenez MP, Martinez D, Menendez M. Experience with hemoperfu-sion for organophosphate poisoning. Crit Care Med 1992 20(ll) 1538-43. 

SLE systemic lupus erythematosus SLUDGE mnemonic for organophosphate poisoning symptoms Salivation, Lacrimation, Urination, Defecation, Gastrointestinal motility, Emesis SMX sulfamethoxazole SNRIs serotonin-norepinephrine reuptake inhibitors (class of drugs used to treat depression, e.g., venlafaxine)... 

It has been possible to devise antidotes for organophosphate poisoning because the underlying mechanism by which they cause acute toxicity is understood. These are very effective for the rapid treatment of acute poisoning episodes but are ineffective for peripheral neuropathy or if poisoning occurred some days previously. 

Saxena, A., Maxwell, D.M., Quinn, D.M., Radic, Z., Taylor, P., Doctor, B.P. (1997a). Mutant acetylcholinesterases as potential detoxification agents for organophosphate poisoning. Biochem. Pharmacol. 54 269-74. 

Miller, S.A. et al. Efficacy of physostigmine as a pretreatment for organophosphate poisoning, Pharmacol. Biochem. Behav., 44, 343, 1993. 

Acetylcholinesterase regenerator (antidote for organophosphate poisoning) very high affinity for phosphorus in organophosphates. Tox neuromuscular weakness. 

Abedin, M.J., Sayeed, A.A., Basher, A., et al, 2012. Open-label randomized clinical trial of atropine bolus injection versus incremental boluses plus infusion for organophosphate poisoning in Bangladesh. J. Med. Toxicol. 8,108-117. 

Diagnosis of organophosphate poisoning (including methyl parathion) can be confirmed by evaluation of serum (plasma) cholinesterase and erythrocyte cholinesterase. However, cholinesterase inhibition is not specific for organophosphates. For example, carbamate insecticides also result in cholinesterase inhibition, which is usually transitory. Erythrocyte cholinesterase measurement is a specific test for... 

Buckley NA, Eddleston M, Szinicz L. Oximes for acute organophosphate poisoning. Cochrane Database Syst Rev 2005. Issue 1. Art. No. CD005085. DOI 10.1002/14651858.CD005085. 

Organophosphate poisoning IV l 2g initially in 100 ml 0.9 NaCl infused over 15-30 minutes or 5% solution in sterile water for injection over not less than 5 minutes. Repeat l-2gin 1 hr if muscle weakness persists. 

It should be noted that serum cholinesterase activity has been reported to be a more sensitive marker for diazinon exposure than erythrocyte acetylcholinesterase (Endo et al. 1988 Hayes et al. 1980). In light of this, it has been suggested that in the absence of baseline values for cholinesterase activity, sequential post-exposure cholinesterase analyses be used to confirm a diagnosis of organophosphate poisoning (Coye et al. 1987). 

Still another experimental route to introducing otherwise excluded molecules into the brain is to chemically modify them so that they are lipophilic and therefore can passively diffuse. The brain, just as most other organs and tissues of the body, has enzymes to metabolize or biotransform metabolites in order to use and then get rid of them. Many of these pathways are oxidative. A reduced species or derivative which is lipophilic can enter the brain by simple passive diffusion there to be oxidatively transformed into an active state. Compounds which have been tested in animals include derivatives of 2-PAM (an antidote for organophosphate insecticide poisoning) and phenylethylamine (similar to amphetamine type molecules). Figure 5 illustrates the general concept behind this method. 

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