Aktuelle empfehlungen zur diagnostik und therapie von vergiftungen mit insektiziden organophosphaten

Insecticide organophosphorus poisoning is characterised by ubiquitous inhibition of acetylcholinesterase, resulting in overstimulation of muscarinic and nicotinic receptors requiring immediate therapy. Besides supportive intensive care therapy measurements like primary and secondary elimination techniques such as gastric lavage and activated charcoal are important therapeutic options. The well established early antidotal treatment with atropine should counteract signs and symptoms of uncontrolled activation of muscarinic receptors. Frequent checking on dosage and duration of atropine therapy is recommended. Early oxime therapy should reactivate acetylcholinesterase by removing the phosphoryl group from the enzyme. Oximes are safe, while adverse reactions are rare and transient. Oxime treatment of diethylphosphoryl-AChE is known be effective if the poison load is not too high, whereas the value of oxime therapy in case of diethylphosphoryl-AChE is controversial and most likely only efctive within the first few hours ter ingestion. Determination of EryAChE and neuromuscular nction is recommended for erapy control.