recent advances in treatment of acute organophosphorous nerve agents poisoning

organophosphorous (op) chemical warfare nerve agents mainly sarin and tabun were used during the iran-iraq war with high mortalities. in addition to atropine and oximes, the followings have recently been used successfully for the treatment of op poisoning. 1. sodium bicarbonate: infusion of high doses of sodium bicarbonate (5 meq/kg in 60 min. followed by 5-6 meq/kg/day to obtain arterial blood ph of 7.45 to 7.55) revealed positive effects in patients with acute op poisoning in mashhad. 2. magnesium sulfate: intravenous magnesium sulfate in a dose of 4 g only on the first day after admission was also effective in acute human op poisoning. 3. antioxidants: the toxicity of op compounds is mediated by generation of nitric oxide and other free radicals. these toxic molecules can be counteracted by antioxidants such as vitamins c and e, spin traps, melatonin and low molecule weight thiols. the latter compounds can also increase the synthesis of glutathione, which can both ameliorate the op-induced oxidative stress and enhance op detoxification. it is concluded sodium bicarbonate, magnesium sulfate and the antioxidants should be added to the standard treatment of op poisonings.