Atrovent with atropine for OP poisoning

[dantheman423]

I had a thought the other day wondering about organophosphate poisoning. Obviously in a true case of OP poisoning you're going to give atropine but could it also be benficial to use an updraft of atrovent in conjunction with the IV atropine. I would think the anticholinergic effects of atrovent on the airways could only help in trying to reverse the SLUDGE effects of OP poisoning. What are yalls thoughts?

 

[STXmedic]

Interesting idea. A quick search turned up this study. I'll have to check more when I get home.

 

[Gurby]

It's pretty cool thought! There is a lot of relevant info on the wikipedia page: https://en.wikipedia.org/wiki/Ipratropium_bromide

It is a nonselective muscarinic antagonist,[5] and does not diffuse into the blood, which prevents systemic side effects. Ipratropium is a derivative of atropine[10] but is a quaternary amine and therefore does not cross the blood–brain barrier, which prevents central side effects (anticholinergic syndrome)

According to this it "doesn't diffuse into the blood", which would mean it only acts locally in the lungs.

Probably it wouldn't do much of anything, but I don't imagine it could hurt? Chances are good that you'll have more important things to worry about if you ever get that patient, though!

 

[jwk]

At best, it's probably in the "won't hurt, might help" category. We use AChEi's (acetylcholinesterase inhibitors) every day in the OR to reverse neuromuscular blocking agents like roc or vec. Most organophosphates, and most "nerve gases" are also ACHEi's. To counteract the cholinergic effects of these reversal agents, we always give them with atropine, or more commonly, glycopyrrolate (Robinul). Giving an AChEi by itself causes impressive and life-threatening effects - like asystole - never a good thing in the OR - and unpleasant effects like "code brown".