The role of oximes in the management of acute poisoning with cholinesterase inhibitors pesticides:Case reports

摘要

Introduction.-Acute pesticides poisonings is a serious public health problem in Algeria.The indication of oximes in the treatment of poisoning by cholinesterase inhibitors pesticides is still controversial in practice,although it seems theoretically interesting because of the reversibility of the toxic-cholinesterase binding and the atropine-like effect.The interest of oximes in the management of cholinesterase inhibitors pesticides poisoning will be discussed through the study of the observation of 4 patients received at University Hospital Center of Oran(Algeria).Observations and discussion The study of the 4 observations enabled us to highlight the following points.For collapsed cholinesterase activity levels,it is better to administrate the highest recommended doses of Pralidoxime immediately,this will allow a rapid regeneration of an important fraction of inhibited cholinesterase activity,process which is concentration-dependent.Early intake of Pralidoxime with continuous injections appeared to have resulted in a rapid and favourable evolution.The use of oximes in carbamate poisoning is still debatable and needs further research.Conclusion.-In view of the data presented,oximes retain their place in the treatment of acute intoxication with cholinesterase inhibitors.Their indication should be discussed for each case taking into account the anamnesis,clinical presentation and level of cholinesterase activity.