New Treatment Options in Acute Organophosphate Toxicity

Acute organophosphate (OP) toxicity is a common health problem in developing agricultural countries. Toxicity may develop as a result of accidental or suicidal use of OP. Moreover, OP toxicity is an important problem not only in developing agricultural countries but also in the whole world since OPs are used as chemical weapons in wars and terrorist attacks and cause mass deaths. Mortality rates in acute severe OP toxicity are high despite treatment. In addition, long treatment and intensive care hospitalization in OP toxicity lead to high treatment costs. In the treatment of OP toxicity, pralidoxime (PAM) is still used as a chemical antidote. PAM has an anticholinergic effect by reacting acetylcholinesterase. However, it has no significant effect on respiratory depression and muscarinic receptors. Atropine reverses serious cholinergic effects associated with OP by acting through muscarinic receptors. It is used to reduce glycopyrrolate, salivation, another antimuscarinic agent, and bronchorrhea. Nonetheless, since it does not break through the blood-brain barrier (BBB), it does not affect central cholinergic findings. Therefore, benzodiazepines are preferred for seizure control and prophylaxis caused by OP toxicity. The fact that these drugs used in the treatment of acute OP toxicity have some side effects, their inability to prevent delayed toxic effects, and their lack of effects on central nervous system toxicity findings have had the scientists tend to develop new drugs and antidotes for treatment. Important studies have been carried out on this subject in recent years. As a result of these studies, it has been found that some drugs and molecules (magnesium sulfate, intralipid) can be used clinically in the treatment of OP toxicity. Some of these studies have remained in the experimental stage (melatonin, antioxidants, new oximes). In this section, new treatment options in the treatment of acute OP toxicity will be presented.