![]() Pneumonia and multiple organ failure led to in-hospital mortality in 8 patients (12.9%). The median total admission and ICU admission days were 15.5 and 9.0 days, respectively. Pneumonia and hypotension were found in 23 patients (37.1%) and 19 patients (30.6%), respectively. Endotracheal intubation due to respiratory failure or unprotected airway due to decreased mental status (53 patients, 85.5%) were the most common complications during hospitalization. The median initial Glasgow Coma Scale was 8, and initial PChE and serum lactate levels were 322 U/L and 4.38 mmol/L, respectively. The median ingested amount was 100 mL and intentionality was present in 52 patients (83.9%). The diethyl subtype included chlorpyrifos (13 patients), parathion (1 patient), and diazinon (2 patients). The dimethyl subtype included dichlorvos (10 patients), phosphamidon (14 patients), methidathion (4 patients), and fenthion (2 patients). The dimethyl subtype was the most common type of OP poisoning (30 patients, 48.8%). The mean age was 60 years (range, 18 to 91 years). Of the 62 analyzed patients, 47 (75.8%) were male. Baseline characteristics and laboratory findings are shown in Table 1. 17.5.3 (MedCalc Software, Ostend, Belgium).Ī total of 95 atropine discontinuation attempts were made in 62 patients. 23 (IBM Corp., Armonk, NY, USA) and MedCalc Statistical Software ver. P-values of <0.05 were considered statistically significant, and analyses were performed using IBM SPSS Statistics ver. The area under the curve (AUC) for the predictive ability of variables was determined using receiver operating characteristic curves. ![]() Variables with P-values of <0.05 by univariate analysis were entered into the multiple logistic regression analysis to factors predicting successful discontinuation of atropine infusion in patients with severe OP poisoning, and the results are expressed as odds ratio with 95% confidence interval (CI). The chi-square test or Fisher exact test was used to compare categorical variables, while the 2-sample t-test or the Mann-Whitney U-test was used to compare continuous variables. ![]() Normality was assessed using the Shapiro-Wilk test. ![]() Therefore, it would be helpful for clinicians if a laboratory test could predict successful discontinuation of atropine infusion.Ĭategorical variables are presented as frequencies and percentages, and continuous variables are presented as means and standard deviations or as medians and interquartile ranges. Repeated failure to discontinue atropine infusion may lead to increased morbidity and mortality related to atropine toxicity, and intensive care unit (ICU) admission may be prolonged. However, even when the IV atropine infusion is successfully titrated and then discontinued with satisfying therapeutic end-points, cholinergic symptoms and signs often recur. Then, we usually titrate IV atropine infusion after checking the end-points for atropine therapy: clearance of respiratory secretions and cessation of bronchoconstriction. Severe OP poisoning requires large doses of atropine after early atropinization, administration of atropine via continuous intravenous (IV) infusion is typically considered. Atropine competes with acetylcholine at muscarinic receptors and prevents cholinergic activation. Because of respiratory failure due to bronchorrhea and respiratory muscle weakness in OP poisoning, use of an antidote such as pralidoxime or atropine is very important. The clinical features of acute cholinergic overstimulation include bronchorrhea, bronchospasm, bradycardia, lacrimation, salivation, miosis, urination, emesis, and diarrhea. Because organophosphate (OP) insecticides irreversibly inhibit acetylcholinesterase (AChE), they cause accumulation of acetylcholine and overstimulation of cholinergic synapses in the central nervous system, somatic nerves, parasympathetic nerve endings, and sweat glands.
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