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Case Study 30: Aldicarb Poisoning: A Case Report with Prolonged Cholinesterase Inhibition and Improvement After Pralidoxime Therapy
Pages 558-561

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From page 558...
... Carbamate poisoning causes the same excess in muscarinic stimulation and nicotinic stimulation followed by weakness seen in organophosphate poisonings, but for a relatively shorter duration. Pralidoxime is generally not used for treating carbamate poisonings, and in some animal studies has reportedly worsened the clinical course.' 2 Aldicarb (2-methyl-2- [ methylthio ]
From page 559...
... Over a 2-hour period he received potassium supplements, 4 mg of atropine, and 1 g of pralidoxime intravenously prior to being transported to a tertiary facility. ON ARRIVAL at the tertiary hospital his vital signs had normalized with a blood pressure of 13(~/1(~(' mm Hg, a pulse rate of 90 beats per minute, a respiratory rate of 20, and a temperature of 34.8°C.
From page 560...
... Both aldicarb sulfoxide and aldicarb sulfone are pharmacologically active, with the potency of aldicarb sulfoxide roughly equivalent to its parent compound. The potency of aldicarb sulfone is much less that of aldicarb.'° As with most carbamates, aldicarb has a short half life, and in 24 hours 80% to 90% of an ingested dose in the rat is excreted in the urine." Because of its method of application as a treatment injected into the soil, aldicarb is unlikely to cause inadvertent acute toxic effects to bystanders.
From page 561...
... Since the binding to cholinesterase enzymes is reversible, there is usually no need for oxime therapy. Clinical worsening after administration of pralidoxime, toxogonin, and obidoxime to animals has been described in animal experiments with the carbamate pesticide carbaryl.t 2 Obidoxime also interfered with the protective effect of atropine in carbaryl poisonings.2 However, for aldicarb poisoning, pralidoxime and obidoxime have been shown to improve mortality in rats,2 and toxogonin reduced toxicity in 561 rats.' In our patient we noted hy pertension with the bolus adminis tration of pralidoxime, but not with continuous intravenous infusion.


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