Pralidoxime chloride with atropine in dimpylate poisoning.

Abstract

To the Editor:— Pralidoxime (Protopam) chloride is a cholinesterase reactivator that has been recommended in the treatment of organic phosphate intoxications. Pralidoxime (2 PAM), however, is contraindicated in carbamate poisoning. It appears to be most effective when used in conjunction with atropine therapy. Dimpylate (Diazinon [Britain]) is an organic phosphate insecticide of intermediate toxicity. Effective against a variety of household pests, it is the most widely used pesticide for roach control. Like other organic phosphate insecticides, it is a cholinesterase inhibitor. A number of published reports state that pralidoxime should not be used in dimpylate poisoning: Although oximes are effective antagonists to many of the cholinesterase inhibitors, there are some such compounds with effects that are either not antagonized by oximes or are made worse by their administration. In this latter group, the effects of Sevin or Diazinon are likely to be enhanced rather than antagonized. 1 In March 1967,