Comparison of atropine and pralidoxime therapy with intravenous intralipid therapy in the management of organophosphorus compound poisoning at a tertiary care center

Abstract Background: For the last 10–15 years, there are reports that intravenous lipid emulsion is effective in the treatment of organophosphorus compound poisoning. It reverses toxicity due to poisoning, reduces demand for antidote, removes poisonous compounds, and reduces the degree of side effects. Objective: The objective of this study was to compare atropine and pralidoxime therapy with intravenous intralipid therapy in the management of organophosphorus compound poisoning. Materials and Methods: Prospective-comparative study was carried out among 90 patients fulfilling eligibility criteria. They were divided into three groups. In Group A patients, Atropine and Pralidoxime were given. In Group B, only intravenous intralipid was given. In Group C, both were given. The dosage of intralipid was a bolus dose of 1.5 ml/kg (100 ml). Investigations such as electrocardiogram (ECG), serum potassium, magnesium, ionised calcium, and pseudocholinesterase were done. Results: All three groups were comparable for age and sex. Serum potassium levels and serum ionized levels at 0, 1, 2, and 3 h were not significantly different in the three groups. Serum magnesium level was significantly more in Group A patients compared to Group B and C at zero hours. However, at 1, 2, and 3 h were not significantly different. Conclusion: Response of ECG changes was better when intralipid was combined with atropine and pralidoxime than intralipid alone or atropine and pralidoxime alone. Response of serum potassium, magnesium, ionized calcium, and serum pseudocholinesterase was better when intralipid was combined with atropine and pralidoxime than intralipid alone or atropine and pralidoxime alone but showed statistically insignificant when compared between groups. Overall, intralipid was proved to be effective in reversing ECG changes and cardiac toxicity in acute insecticide poisoning.