Managment of Organophosphate Poisoning Without Pralidoxim- Is It Possible?

Introduction: Organophosphate compounds are used as insecticides, nerve gases, ophthalmic agents, and antihelmintics.The primary mechanism of action of organophosphate pesticides is inhibition of acetylcholinesterase (AChE). However Pralidoxim has been introduced as organophosphate `s antidote but recent studies establish that pralidoxim has unclear benefit in treatment of organophosphate poisoning.We explain two cases of organophosphate poisoning that they treaeted well without pralidoxim. The first case was a 36-years old man with history of organophosphates poisoning. He was under mechanical ventilation. Atropine was initiated due to muscarinic signs such as salivation, bronchorrhea and auscultation of alveolar rhales. On admission day, the pseudocholine esterase level was 235 unit per liter. Pralidoxime was not available, so we did not use it for management of this patient.The patient was discharged when he was in free symptom completely on the 22th day. The second case was a 23 years old woman with the history of deliberate self poisoning with organophosphate compounds. Atropine was started and she was under mechanical. However, pralidoxim was not available. The pseudocholine esterase level was 1690 unit per liter on the first day which dropped to 952 unit per liter on the 2nd day. After 9 days the discharged from the hospital. Discussion: Pralidoxim has been introduced as organophosphate`s antidote, on the other hand, it has benefit in organophosphate poisoning theoretically, but patients can be treated without it.