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treatment_atropine [2025/03/03 23:52] – jkohtstreatment_atropine [2025/07/17 20:40] (current) – [2.1 Cholinergic Toxidrome Excluding Organophosphate Toxicity] kharris
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-====== Atropine (treatment) ======+====== Atropine (Treatment) ======
  
-===== 1. Overview =====+===== - Overview =====
  
 Atropine is an anticholinergic agent which acts as a competitive antagonist at autonomic postganglionic muscarinic receptors. It is used to treat organophosphate and carbamate toxicity, symptomatic bradycardia (e.g. in β-blocker toxicity), and chemical weapons nerve agent toxicity. Atropine is an anticholinergic agent which acts as a competitive antagonist at autonomic postganglionic muscarinic receptors. It is used to treat organophosphate and carbamate toxicity, symptomatic bradycardia (e.g. in β-blocker toxicity), and chemical weapons nerve agent toxicity.
  
-===== 2. Toxicologic indications & dosing =====+===== - Toxicologic Indications & Dosing ===== 
 +==== 0.1 Cholinergic Toxidrome in Organophosphate Toxicity ====
  
-==== 2.1 Adult ==== +  * Also see: [[wikitox:cholinergictoxicity|Cholinergic Toxicity]], [[wiki:2.2.7.4.5_organophosphates|organophosphate toxicity]].
- +
-**[[:cholinergic_toxidrome|Cholinergic toxidrome]] in [[:organophosphate_toxicity|organophosphate toxicity]] **+
   * A rapid loading protocol and infusion is used.   * A rapid loading protocol and infusion is used.
-  * 💊 **Atropine 1.2 mg IV**, double the dose q5min until target end points for atropinization reached, then start infusion; very high doses (up to 100 mg) may be required. +  * **Adult:** 
-  * 💊 **Atropine 10-20% of total loading dose per hour IV infusion**, usually 0.5-5 mg/hr.+      * 💊 **Atropine 1.2 mg IV**, double the dose q5min until target end points for atropinization reached, then start infusion; very high doses (up to 100 mg) may be required. 
 +      * 💊 **Atropine 10-20% of total loading dose per hour IV infusion**, usually 0.5-5 mg/hr. 
 +  * **Child:** 
 +      * 💊👶 **Atropine 0.05 mg/kg (up to 1.2 mg) IV**, double the dose q5min until target end points for atropinization reached, then start infusion; very high doses may be required. 
 +      * 💊👶 **Atropine 10-20% of total loading dose per hour IV infusion**.
   * Titrate to atropinization target end points:   * Titrate to atropinization target end points:
       * Clear chest, no auscultatory wheeze       * Clear chest, no auscultatory wheeze
-      * HR > 80 bpm +      * Resolution of symptomatic bradycardia (e.g. in adults HR > 80bpm, systolic BP >80 mmHg)
-      * Systolic BP > 80 mmHg+
   * Observe for signs of over-atropinization:   * Observe for signs of over-atropinization:
       * Confusion       * Confusion
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       * Absent bowel sounds       * Absent bowel sounds
  
-**[[:cholinergic_toxidrome|Cholinergic toxidrome]] __excluding__  organophosphate toxicity ** 
  
-  * 💊 **Atropine 0.6 mg IV**, double the dose q5min until target end points for atropinization reached; max cumulative dose 3 mg.+==== - Cholinergic Toxidrome Excluding Organophosphate Toxicity ==== 
 +  * Also see: [[wikitox:cholinergictoxicity|cholinergic toxidrome]]. 
 +  * **Adult:** 💊 **Atropine 0.6 mg IV**, double the dose q5min until target end points for atropinization reached; max cumulative dose 3 mg. 
 +  * **Child:** 💊👶 **Atropine 0.02 mg/kg (up to 0.6 mg) IV**, double the dose q5min until target end points for atropinization reached; max cumulative dose 3 mg.
   * Titrate to atropinization target end points:   * Titrate to atropinization target end points:
       * Clear chest, no auscultatory wheeze       * Clear chest, no auscultatory wheeze
-      * HR > 80 bpm +      * Resolution of symptomatic bradycardia (e.g. in adults HR > 80bpm, systolic BP >80 mmHg)
-      * Systolic BP > 80 mmHg+
   * Observe for signs of over-atropinization:   * Observe for signs of over-atropinization:
       * Confusion       * Confusion
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       * Absent bowel sounds       * Absent bowel sounds
  
-**Bradycardia **  (e.g. [[:beta_blocker_toxicity|Beta Blocker Toxicity]])+==== - Bradycardia ==== 
 +  * Also see: [[:beta_blocker_toxicity|Beta Blocker Toxicity]]. 
 +  * **Adult:** 💊 **Atropine 0.6 mg IV**, q15min; max cumulative dose 3 mg. 
 +  * **Child:** 💊👶 **Atropine 0.02 mg/kg (up to 0.6 mg) IV**; max cumulative dose 3 mg.
  
-  * 💊 **Atropine 0.6 mg IV**, q15min; max cumulative dose 3 mg. 
  
-==== 2.2 Pediatric ====+===== - Cautions & Contraindications =====
  
-**[[:cholinergic_toxidrome|Cholinergic toxidrome]] in [[:organophosphate_toxicity|organophosphate toxicity]] ** +===== - Special Populations =====
-  * A rapid loading protocol and infusion is used. +
-  * 💊👶 **Atropine 0.05 mg/kg (up to 1.2 mg) IV**, double the dose q5min until target end points for atropinization reached, then start infusion; very high doses may be required. +
-  * 💊👶 **Atropine 10-20% of total loading dose per hour IV infusion**. +
-  * Titrate to atropinization target end points: +
-      * Clear chest, no auscultatory wheeze +
-      * Resolution of symptomatic bradycardia +
-  * Observe for signs of over-atropinization: +
-      * Confusion +
-      * Pyrexia +
-      * Absent bowel sounds +
- +
-**[[:cholinergic_toxidrome|Cholinergic toxidrome]] __excluding__  organophosphate toxicity ** +
- +
-  * 💊👶 **Atropine 0.02 mg/kg (up to 0.6 mg) IV**, double the dose q5min until target end points for atropinization reached; max cumulative dose 3 mg. +
-  * Titrate to atropinization target end points: +
-      * Clear chest, no auscultatory wheeze +
-      * Resolution of symptomatic bradycardia +
-  * Observe for signs of over-atropinization: +
-      * Confusion +
-      * Pyrexia +
-      * Absent bowel sounds +
- +
-**Bradycardia **  (e.g. [[:beta_blocker_toxicity|Beta Blocker Toxicity]]) +
- +
-  * 💊👶 **Atropine 0.02 mg/kg (up to 0.6 mg) IV**; max cumulative dose 3 mg. +
- +
-===== 3. Cautions & contraindications ===== +
- +
-===== 4. Special populations =====+
  
 **Pregnancy rating:**  A (AU/NZ) **Pregnancy rating:**  A (AU/NZ)
  
-**Lactation:**  Small amounts excreted in breast milk+**Lactation:**  Small amounts excreted in breast milk.
  
-===== 5. Adverse effects =====+===== - Adverse Effects =====
  
   * **CV:**  Paradoxical bradycardia (with low doses or given slowly), tachyarrhythmia   * **CV:**  Paradoxical bradycardia (with low doses or given slowly), tachyarrhythmia
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   * **GI:**  Nausea, vomiting, constipation, xerostomia   * **GI:**  Nausea, vomiting, constipation, xerostomia
   * **GU:**  Urinary retention   * **GU:**  Urinary retention
-===== 6. Pharmacology ===== 
  
-==== 6.1 Pharmacodynamics ====+===== - Pharmacology ===== 
 + 
 +==== - Pharmacodynamics ====
  
 **Mechanism of action:**  Atropine is a competitive antagonist at autonomic postganglionic muscarinic receptors. Its clinical effects manifest primarily with ↑ heart rate, ↓ secretions, bronchodilation, and mydriasis. **Mechanism of action:**  Atropine is a competitive antagonist at autonomic postganglionic muscarinic receptors. Its clinical effects manifest primarily with ↑ heart rate, ↓ secretions, bronchodilation, and mydriasis.
  
-==== 6.2 Pharmacokinetics ====+==== - Pharmacokinetics ====
  
 **Absorption:** **Absorption:**
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   * Renal clearance: 90% excreted in urine over 24 hours. 30-50% as unchanged drug.   * Renal clearance: 90% excreted in urine over 24 hours. 30-50% as unchanged drug.
  
-==== 6.3 Pharmaceutics ====+==== - Pharmaceutics ====
  
 **Formulation:** **Formulation:**
 +  * Tablets: 0.4 mg.
 +  * Ampoules of 0.5-0.6 mg/mL or 3 mg/10mL.
 +  * Eye drops: atropine sulfate 1%.
 +  * IM autoinjector: 2mg/0.7mL.
 +===== - References =====
  
-===== 7. References ===== +Further Reading:
- +
-Useful general references:+
  
 ~~REFNOTES~~ ~~REFNOTES~~