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Atropine dosing for cholinesterase-inhibitor toxicity
Initial atropine dose for organophosphate/carbamate poisoning.
Atropine dosing for cholinesterase-inhibitor toxicity
Patient
Weight (child only)
kg
Result2–5 mg IV initial
Adult starting dose 2–5 mg IV. Double the dose every 3–5 minutes until secretions dry, chest is clear on auscultation and SBP >80 mmHg; then start an infusion at 10–20% of the total loading dose per hour.
When to use
- Reversing the muscarinic (cholinergic) crisis of organophosphate or nerve-agent poisoning.
Formula
Adult: 2–5 mg IV, doubled every 3–5 min until atropinisation. Child: 0.05 mg/kg IV, doubled on the same schedule.
Pearls and pitfalls
- Titrate to clearing chest secretions, not to pupil size or heart rate.
- Give a pralidoxime/oxime alongside atropine for organophosphate (but not carbamate) poisoning.