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