Global & Disaster Medicine

Hospital Treatment Recommendations (Weight-Based) Nerve Agent Poisoning

November 21st, 2019

https://chemm.nlm.nih.gov/nerveagents/FGAMMGHospital.htm

Hospital Treatment Recommendations (Weight-Based) Nerve Agent Poisoning

Patient Age Antidotes Additional Treatment
Mild/Moderate Symptoms Severe Symptoms
Infant
(0-2 yrs)		 Atropine 0.05 mg/kg IV/IO/IM

AND

2-PAM 15-30 mg/kg IV/IO/IM

 Atropine 0.1 mg/kg IV/IO/IM

AND

2-PAM 45 mg/kg IV/IO/IM;

AND

Midazolam 0.15 mg/kg IV/IO/IM

OR

Lorazepam 4 mg IV/IO/IM

OR

Lorazepam 0.1 mg/kg IN

OR

Diazepam 0.2-0.5 mg/kg IV/IO/IM

 For mild/moderate, repeat atropine (2 mg) (for child 3-7 yrs, 1 mg; for infant, 0.25-0.5 mg) at 5-10 minute intervals until secretions have diminished and breathing is comfortable or airway resistance has returned to near normal.

 

For severe, repeat atropine as above but at 2-5 minute intervals.

 

Anticonvulsant should be administered in severe cases whether seizures are apparent or not.

 

If convulsions are present, repeat benzodiazepine until convulsions resolve.

 

Assisted ventilation should be started as needed after administration of antidotes.
Child
(3-7 yrs;
13–25 kg)		 Atropine 1 mg IV/IO/IM

AND

2-PAM 15 -30 mg/kg IV/IO/IM

 Atropine 2 mg IV/IO/IM or Atropine 0.1 mg/kg IV/IO/IM;

AND 2-PAM 45 mg/kg IV/IO/IM;

AND

Midazolam 5 mg IV/IO/IM

OR

Lorazepam 4 mg IV/IO/IM OR

Lorazepam 0.1 mg/kg IN

OR

Diazepam 0.2-0.5 mg/kg IV/IO/IM
Child
(8-14 yrs;
26-50 kg)		 Atropine 2 mg IV/IO/IM

AND

2-PAM 15-30 mg/kg IV/IO/IM

 Atropine 4 mg IV/IO/IM AND 2-PAM 45 mg/kg IV/IO/IM;

AND

Midazolam 5 mg IV/IO/IM

OR

Lorazepam 4 mg IV/IO/IM OR

Lorazepam 0.1 mg/kg IN

OR

Diazepam 0.2-0.5 mg/kg IV/IO/IM
Adolescent
(>14 years)/
Adult		 Atropine 2-4 mg IV/IO/IM

AND
2-PAM 600 mg IV/IO/IM

 Atropine 6 mg IV/IO/IM AND 2-PAM 1800 mg IV/IO/IM;

AND

Diazepam 10 mg IV/IO/IM

OR

Midazolam 10 mg IV/IO/IM

OR

Lorazepam 6 mg IV/IO/IM/IN
Elderly, frail Atropine 2 mg IV/IO/IM

AND

2-PAM 10 mg/kg IV/IO/IM

 Atropine 2-4 mg IV/IO/IM

AND

2-PAM 25 mg/kg IV/IO/IM;

AND

Diazepam 10 mg IV/IO/IM OR

Midazolam 10 mg IV/IO/IM

OR

Lorazepam 6 mg IV/IO/IM/IN

Product Definitions:

DuoDote = ATNAA = Mark 1 kit = Atropine 2 mg + 2-PAM 600 mg AI

AtroPen = Atropine AI, various doses

2-PAM AI = 600 mg 2-PAM

This entry was posted on Thursday, November 21st, 2019 at 5:43 pm and is filed under Novichok .
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