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Original Article
Enteral nutrition in mechanically ventilated patients after organophosphate poisoning
Sang U Bark, Jeong Mi Moon, Byeng Jo Chun
J Korean Soc Clin Toxicol. 2024;22(1):1-9.   Published online June 28, 2024
DOI: https://doi.org/10.22537/jksct.2024.00001
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  • 104 Download
AbstractAbstract PDF
Purpose: Nutritional therapy is a crucial component of therapy for critically ill patients, but there is a lack of nutritional support guidelines for organophosphate (OP) poisoning, likely due to the gastrointestinal effects of atropine, the main antidote for OP. This study investigated whether enteral nutrition (EN) during atropinization is acceptable for mechanically ventilated patients after OP poisoning.
Methods
This retrospective study classified 82 patients with OP poisoning according to whether they were fed during atropinization while on mechanical ventilation (MV). Data on the baseline characteristics, nutritional support, and clinical outcomes were compared. Univariate and multivariate regression models were constructed to analyze the associations between atropine administration for OP poisoning and feeding intolerance-related EN after adjustment for risk factors.
Results
Eighty-two patients received EN after 72 hours on MV, and 40 of them simultaneously received 2 mg/hr atropine for the first 120 hours after EN initiation. The overall incidence of feeding intolerance was 57.3% during the first 12 days after EN initiation and did not differ according to atropine administration. Appropriate atropinization during EN in regression model 1 and the dosage of atropine administered during EN and the duration of EN during atropinization in model 2 were not associated with feeding intolerance in patients on MV after OP poisoning.
Conclusion
Appropriate atropinization is not associated with feeding intolerance after EN provision in patients on MV after OP poisoning. This study will help establish nutritional guidelines for OP poisoning patients. More research on nutritional support is needed to validate our results.
A case of severe organophosphate poisoning used a high-dose atropine
Hyoung Ju Lee, Dae Sik Moon, Young Yun Jung, June Seob Byun, Chong Myung Kim
J Korean Soc Clin Toxicol. 2022;20(1):25-30.   Published online June 30, 2022
DOI: https://doi.org/10.22537/jksct.2022.20.1.25
  • 1,269 View
  • 11 Download
  • 1 Citations
AbstractAbstract PDF
In this study, we report the case of a 59-year-old male patient with organophosphate pesticide poisoning. He visited the local emergency medical center after ingesting 250 ml of organophosphate pesticide. The patient's symptoms improved after the initial intravenous infusion of pralidoxime 5 g and atropine 0.5 mg. However, 18 hours after admission, there was a worsening of the symptoms. A high dose of atropine was administered to improve muscarinic symptoms. A total dose of 5091.4 mg of atropine was used for 30 days, and fever and paralytic ileus appeared as side effects of atropine. Anticholinergic symptoms disappeared only after reducing the atropine dose, and the patient was discharged on the 35th day without any neurologic complications.

Citations

Citations to this article as recorded by  
  • The effects of case management program completion on suicide risk among suicide attempters: A 5-year observational study
    Hyun Jo Shin, Gwan Jin Park, Yong Nam In, Sang Chul Kim, Hoon Kim, Suk Woo Lee
    The American Journal of Emergency Medicine.2019; 37(10): 1811.     CrossRef
Assessment and Methods of Nutritional Support during Atropinization in Organophosphate and Carbamate Poisoning Cases
Jong-uk Park, Young-gi Min, Sangcheon Choi, Dong-wan Ko, Eun Jung Park
J Korean Soc Clin Toxicol. 2020;18(2):123-129.   Published online December 31, 2020
DOI: https://doi.org/10.22537/jksct.2020.18.2.123
  • 257 View
  • 4 Download
  • 1 Citations
AbstractAbstract PDF
Purpose: Atropine is an antidote used to relieve muscarinic symptoms in patients with organophosphate and carbamate poisoning. Nutritional support via the enteral nutrition (EN) route might be associated with improved clinical outcomes in critically ill patients. This study examined the administration of nutritional support in patients undergoing atropinization, including methods of supply, outcomes, and complications. Methods: A retrospective observational study was conducted in a tertiary care teaching hospital from 2010 to 2018. Forty-five patients, who were administered with atropine and on mechanical ventilation (MV) due to organophosphate or carbamate poisoning, were enrolled. Results: Nutritional support was initiated on the third day of hospitalization. Thirty-three patients (73.3%) were initially supported using parenteral nutrition (PN). During atropinization, 32 patients (71.1%) received nutritional support via EN (9) or PN (23). There was no obvious reason for not starting EN during atropinization (61.1%). Pneumonia was observed in both patient groups on EN and PN (p=0.049). Patients without nutritional support had a shorter MV duration (p=0.034) than patients with nutritional support. The methods of nutritional support during atropinization did not show differences in the number of hospital days (p=0.711), MV duration (p=0.933), duration of ICU stay (p=0.850), or recovery at discharge (p=0.197). Conclusion: Most patients undergoing atropinization were administered PN without obvious reasons to preclude EN. Nutritional support was not correlated with the treatment outcomes or pneumonia. From these results, it might be possible to choose EN in patients undergoing atropinization, but further studies will be necessary.

Citations

Citations to this article as recorded by  
  • Enteral nutrition in mechanically ventilated patients after organophosphate poisoning
    Sang U Bark, Jeong Mi Moon, Byeng Jo Chun
    Journal of The Korean Society of Clinical Toxicology.2024; 22(1): 1.     CrossRef

JKSCT : Journal of The Korean Society of Clinical Toxicology