Recent Advances in Treatment of Acute Organophosphorous Nerve Agents Poisoning

Organophosphorous (op) chemical warfare nerve agents mainly sarin and tabun wereused during the iran-iraq war with high mortalities. in addition to atropine and oximes , thefollowings have recently been used successfully for the treatment ofop poisoning .1. sodium bicarbonate: infusion of high doses of sodium bicarbonate (5 meq/kg in 60min. followed by 5-6 meq/kg/day to obtain arterial blood ph of7.45 to 7.55) revealed positiv eeffects in pati ents with acute op poisoning in mashhad.2. magnesium sulfate: intravenous magnesium sulfate in a dose of 4 g only on the first dayafter admissi on was also effective in acute human op poison ing.3. antioxidants: the toxicity ofop compounds is mediated by generation ofnitric oxide andother free radicals. these toxic molecules can be counteracted by antioxidants such as vitaminsc and e, spin traps, melatonin and low molecule weight thiols. the latter compounds canalso increase the synthesis of glutathione, which can both ameliorate the op-induced oxidativestress and enhance op detox ification.it is concluded sodium bicarbonate, magnesium sulfate and the antioxidants should beadded to the standard treatment of op poisonings.