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Atropine Refractoriness in Acute Organophosphorus and Carbamate Poisoning

18 Pages Posted: 11 Sep 2020

See all articles by Abhishek Samprathi

Abhishek Samprathi

Christian Medical College - Medical Intensive Care Unit

Binila Chacko

Christian Medical College - Division of Critical Care

Shilpa Reynal D'sa

Christian Medical College - Medical Intensive Care Unit

Grace Rebekah

Christian Medical College - Department of Biostatistics

Vignesh Kumar

Christian Medical College - Department of Medicine

Mohammad Sadiq

Christian Medical College - Department of Medicine

Punitha Victor

Christian Medical College - Department of Medicine

John Prasad

Christian Medical College - Department of Medicine

Jonathan Arul Jeevan Jayakaran

Christian Medical College - Department of Medicine

John Victor Peter

Christian Medical College - Division of Critical Care

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Abstract

Background: In acute Organophosphorus (OP) or Carbamate poisoning, some patients require high dose atropine to achieve atropinisation targets. This study evaluated the incidence and factors associated with atropine refractoriness.

Methods: Consecutive patients, admitted to the intensive care unit (ICU) with OP and Carbamate, were prospectively recruited. Atropine refractoriness was defined as failure to achieve target heart rate (100/min) or systolic BP >90 mm Hg with either a cumulative atropine dose of 100-mg within 6-h following admission or an infusion of 30 mg/h for at least 3-h. Demographic data, treatment and outcomes were recorded. Factors associated with atropine refractoriness were explored using logistic regression analysis and expressed as Odds ratio (OR) with 95% Confidence Intervals (CI).

Findings: Of the 181 patients admitted with OP or Carbamate poisoning, 155 patients fulfilled inclusion criteria. The mean (SD) age was 35·7 (15·8) years; admission APACHE-II score was 14·6 (7·5). Atropine refractoriness occurred in 13·6%. In these patients, target heart rate was achieved after adding adrenaline infusion at 2-4 mcg/min. Ventilation duration (11·6±6·3 vs. 8·4±6·9 days, P=0·05) and ICU stay (12.3±5·8 vs. 8·9±5·8 days, P=0·01) were longer in atropine refractory patients when compared with non-refractory patients. On multivariate logistic regression analysis, shorter time to presentation to hospital (p=0·04) was associated with atropine refractoriness. Overall mortality was 9% and similar in refractory and non-refractory patients (P=0·41).

Interpretation: Atropine refractoriness is not uncommon in OP and Carbamate poisoning and is associated with longer ventilation duration and ICU stay. Adrenaline infusion improves hemodynamics in these patients.

Funding Statement: None.

Declaration of Interests: There is no conflict of interest or any financial disclosures for all the authors listed in the submission.

Ethics Approval Statement: The study was approved by the institutional review board (IRB) and ethics committees of the institution (IRB Min. No. 10100, dated 10.06.2016).

Keywords: Poisoning, Organophosphorus, Carbamate, mortality, Atropine, Refractory

Suggested Citation

Samprathi, Abhishek and Chacko, Binila and D'sa, Shilpa Reynal and Rebekah, Grace and Kumar, Vignesh and Sadiq, Mohammad and Victor, Punitha and Prasad, John and Jayakaran, Jonathan Arul Jeevan and Peter, John Victor, Atropine Refractoriness in Acute Organophosphorus and Carbamate Poisoning. Available at SSRN: https://ssrn.com/abstract=3666867 or http://dx.doi.org/10.2139/ssrn.3666867

Abhishek Samprathi

Christian Medical College - Medical Intensive Care Unit ( email )

Vellore
India

Binila Chacko

Christian Medical College - Division of Critical Care ( email )

Shilpa Reynal D'sa

Christian Medical College - Medical Intensive Care Unit ( email )

Vellore
India

Grace Rebekah

Christian Medical College - Department of Biostatistics ( email )

Vellore
India

Vignesh Kumar

Christian Medical College - Department of Medicine ( email )

Vellore
India

Mohammad Sadiq

Christian Medical College - Department of Medicine ( email )

Vellore
India

Punitha Victor

Christian Medical College - Department of Medicine ( email )

Vellore
India

John Prasad

Christian Medical College - Department of Medicine ( email )

Vellore
India

Jonathan Arul Jeevan Jayakaran

Christian Medical College - Department of Medicine ( email )

Vellore
India

John Victor Peter (Contact Author)

Christian Medical College - Division of Critical Care ( email )