1. IntroductionOrganophosphorus pes

1. IntroductionOrganophosphorus pesticide poisoning causes approximately 200000 deaths each year worldwide [1]. The standard treatment of acuteorganophosphorus pesticide poisoning (AOPP) involves the adminis-tration of intravenous (IV) atropine and pralidoxime to counteracetylcholinesterase (AChE) inhibition at the synapse, symptomatictreatment, and supportive therapy. However, clinical trials havedemonstrated the ineffectiveness of the standard therapy, with a highmortality of 43.94% [2] in Southeast Asia and India. Differentorganophosphates have different mortality [3]. The major causes ofmortality for insecticide poisonings were the toxic effect of organo-phosphate, coma, and respiratory failure [4,5].The standard therapy for poisoning with organophosphoruspesticides requires IV atropine and oximes [6]. The role of oximes ascholinesterase agents for the treatment of organophosphorus pesti-cide poisoning has been further studied. However, oximes may not beuseful for several theoretical and practical reasons, particularly for thelate presentation of patients with dimethyl organophosphoruspoisoning and in those with a large excess of organophosphoruspoisoning that simply reinhibits reactivated enzymes [7]. Therefore, itis important to explore and quantify the safest and most effectivemethod of administering oximes to patients with AOPP [8-10].Treatment with atropine, which inhibits the effects of acetylcholineat muscarinic receptors, is well established [11,12]. However, studieshave suggested that oximes fail to benefit patients or decreasemortality [13,14]. Therefore, many physicians prefer using onlyatropine to improve symptoms. Unfortunately, using a large dose ofatropine has many adverse effects including increased mortality fromatropine overdose.This study aimed to determine the efficacy of 2 therapies inpatients with severe AOPP and evaluated atropine adverse effects, thelength of intensive care unit (ICU) stay, complications, and mortality.