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Nerve agent toxicity and treatment

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Opinion statement

  • The clinical syndrome of nerve agent toxicity varies widely, ranging from the classic cholinergic syndrome to flaccid paralysis and status epilepticus.

  • All nerve agents are capable of producing marked neuropathology. Seizure control is strongly associated with protection against acute lethality and brain pathology.

  • The mainstays of therapy of nerve agent poisoned patients are atropine, pralidoxime, and benzodiazepines.

  • Fosphenytoin provides little therapeutic anticonvulsant effectiveness for nerve agent-induced status epilepticus.

  • Tachycardia is not a contraindication to treatment with atropine in nerve agent toxicity.

  • Atropine should be administered to alleviate respiratory distress, symptomatic bradycardia, and as an adjunct to benzodiazepines and pralidoxime to alleviate seizure activity.

  • In significant nerve agent toxicity, a continuous pralidoxime infusion may be considered.

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References and Recommended Reading

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Authors and Affiliations

  1. Division of Medical Toxicology, University of Virginia, P.O. Box 800774, 22908, Charlottesville, VA, USA

    Christopher P. Holstege MD, FACMT & Stephen G. Dobmeier BSN, CSPI

Authors
  1. Christopher P. Holstege MD, FACMT
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  2. Stephen G. Dobmeier BSN, CSPI
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Holstege, C.P., Dobmeier, S.G. Nerve agent toxicity and treatment. Curr Treat Options Neurol 7, 91–98 (2005). https://doi.org/10.1007/s11940-005-0018-y

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  • DOI: https://doi.org/10.1007/s11940-005-0018-y

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