Use of Acetylcholinesterase Inhibitors in Envenomations by N
Dr. Atul Chowdhury
Use of Acetylcholinesterase Inhibitors in Envenomations by Neurotoxic Snakes

1. Patients with clear, objective evidence of neurotoxicity (e.g., ptosis or inability to maintain upward gaze) should receive a test dose of edrophonium (if available) or neostigmine.
a. Pretreat with atropine: 0.6 mg IV (children, 0.02 mg/kg with a minimum of 0.1 mg)
b. Treat with: Edrophonium: 10 mg IV (children, 0.25 mg/kg) or Neostigmine: 0.02 mg/kg IV or IM (children, 0.04 mg/kg)

2. If objective improvement is evident after 30 min, treat with:
a. Neostigmine: 0.5 mg IV, IM, or SC (children, 0.01 mg/kg) every hour as needed
b. Atropine: 0.6 mg as IV continuous infusion over 8 h (children, 0.02 mg/kg over 8 h)

3. Closely monitor the airway and perform endotracheal intubation as needed.

Reference:Harrison’s Principle of Internal Medicine 20th edition....

Dr.Atul Chowdhury
MD General Medicine
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