Symptombaserad behandling efter förgiftning med organiska fosforföreningar Elisabeth Wigenstam Forskare
flyktighet OP-föreningar Insekticider/pesticider Nervgaser Sarin Soman Tabun VX Parathion Phosphamidon Monocrotophos Methamidophos
Tidslinje behandlingsmöjligheter
Syfte Beskriva metoder för symptombaserad behandling vid OP-förgiftning Jämföra behandlingsstrategier mellan olika länder Forskning Nya behandlingar
Verkningsmekanism Organophosphates AChE inhibition ACh accumulation Glutamate release Nicotinergic stimulation Muscarinic stimulation Glutamatergic response Increased muscle power Muscle weakness due to overstimulation Twitching CNS effects Cardiac insufficiency Respiratory distress Seizures Anxiety Respiratory depression Salivation Lacrimation Urination/diarrhea AMPA receptor NMDA receptor Maintenance and propagation of seizures
Verkningsmekanism Organophosphates AChE inhibition ACh accumulation Glutamate release Nicotinergic stimulation Muscarinic stimulation Glutamatergic response Increased muscle power Muscle weakness due to overstimulation Twitching CNS effects Cardiac insufficiency Respiratory distress Seizures Anxiety Respiratory depression Salivation Lacrimation Urination/diarrhea AMPA receptor NMDA receptor Maintenance and propagation of seizures
Verkningsmekanism Organophosphates AChE inhibition ACh accumulation Glutamate release Nicotinergic stimulation Muscarinic stimulation Glutamatergic response Increased muscle power Muscle weakness due to overstimulation Twitching CNS effects Cardiac insufficiency Respiratory distress Seizures Anxiety Respiratory depression Salivation Lacrimation Urination/diarrhea AMPA receptor NMDA receptor Maintenance and propagation of seizures
Behandling Oximes Organophosphates AChE inhibition ACh accumulation machr antagonists Glutamate release Nicotinergic stimulation Muscarinic stimulation Glutamatergic response Increased muscle power Muscle weakness due to overstimulation Twitching CNS effects Cardiac insufficiency Respiratory distress Seizures Anxiety Respiratory depression Salivation Lacrimation Urination/diarrhea AMPA receptor NMDA receptor Maintenance and propagation of seizures GABA A positive modulators Oxygen
Behandling Organophosphates Oximes nachr antagonists AChE inhibition machr antagonists Nicotinergic stimulation ACh accumulation Muscarinic stimulation Glutamate release Glutamatergic response NMDA antagonists AMPA receptor NMDA receptor Increased muscle power Muscle weakness due to overstimulation Twitching CNS effects Cardiac insufficiency Respiratory distress Seizures Anxiety Respiratory depression Salivation Lacrimation Urination/diarrhea Maintenance and propagation of seizures GABA A positive modulators Oxygen
Jämförelse behandlingsrekommendationer Syrgas Atropin Kramplösande Åldersindelad rekommendation Sverige Diazepam USA Diazepam (eller annan benzodiazepin) (väldigt detaljerad) UK Diazepam
Alternativ o Lorazepam o Valproat o Fenobarbital o Scopolamin o Galantamin o Caramiphen o Ketamin o Bupropion o Mecamylamin
Kombinationsbehandling HI-6 + atropin + diazepam HI-6 + procyclidin + levetiracetam Diazepam + valproat Ketamin + atropin (+diazepam)
Slutsatser Liknande rekommendationer i Sverige, USA och England Oxim, antikolinergikum, syrgas, kramplösande Symptombaserad behandling fortsatt mycket viktigt Nya alternativ behövs
Tack! Ulrika Bergström Lina Thors Anders Bucht