Neurology Book

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Pralidoxime chloride

Aka: Pralidoxime chloride, Protopam chloride, 2-PAMCl
  1. Indications
    1. Nerve Agent Exposure
    2. Organophosphate Exposure
    3. Not indicated for pure carbamate Poisoning
  2. Pharmacokinetics
    1. Binds Nerve Agent and breaks agent-enzyme bond
    2. Less effective after Nerve Agent aging occurs
      1. Soman (GD) ages in 2 minutes
      2. Other Nerve Agents age over 24-48 hours
  3. Dosing: Emergency Department
    1. Initial IV bolus
      1. Adult: 1-2 grams IV over 10 minutes
      2. Child age < 12 years: 20-50 mg/kg IV over 30 minutes
    2. Maintenance Protocol 1 (bolus)
      1. Repeat dosing above in 1-2 hours
      2. May re-administer q10-12 hours prn symptoms
    3. Maintenance Protocol 2 (Continuous infusion)
      1. Continuous IV 10-20 mg/kg/hr up to 500 mg per hour
      2. Discontinue at 24 hours
  4. Dosing: Military (MARK I Kit)
    1. MARK I Kit Autoinjector contains 2-PAMCl 600 mg
    2. Atropine usually administered prior to 2-PAMCl
  5. Precautions
    1. Do NOT administer more than 3
    2. Cardiac Arrest risk

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