The increasing threat of
nerve agent use for terrorist purposes against civilian and military population calls for effective therapeutic preparedness. At present, administration of
atropine and an
oxime are recommended, although effectiveness of this treatment is not proved in clinical trials. Here, monitoring of intoxications with organophosphorus (OP) pesticides may be of help, as their actions are closely related to those of
nerve agents and intoxication and
therapy follow the same principles. To this end, the
clinical course of
poisoning and the effectiveness of antidotal
therapy were investigated in patients requiring artificial ventilation being treated with
atropine and
obidoxime. However,
poisoning with OP pesticides shows extremely heterogeneous pictures of
cholinergic crisis frequently associated with clinical complications. To achieve valuable information for the
therapy of
nerve agent poisoning, cases resembling situations in
nerve agent poisoning had to be extracted: (a) intoxication with OPs forming reactivatable OP-AChE-complexes with short persistence of the OP in the body resembling inhalational
sarin intoxication; (b) intoxication with OPs resulting rapidly in an aged OP-AChE-complex resembling inhalational
soman intoxication; (c) intoxications with OPs forming a reactivatable AChE-OP complex with prolonged persistence of the OP in the body resembling percutaneous
VX intoxication. From these cases it was concluded that sufficient reactivation of
nerve agent inhibited non-aged AChE should be possible, if the
poison load was not too high and the effective
oximes were administered early and with an appropriate duration. When RBC-AChE activity was higher than some 30%, neuromuscular transmission was relatively normal. Relatively low
atropine doses (several milligrams) should be sufficient to cope with
muscarinic symptoms during
oxime therapy.