|
The Cochrane Collaboration
Cochrane Reviews |
| Explore | New + Updated | Other languages |
|
 |
Alkalinisation for organophosphorus pesticide poisoningRoberts DM, Buckley N
Bookmark this:
     more ...
SummaryUse of sodium bicarbonate to treat organophosphorus pesticide poisoningMany people, particularly in developing countries, are poisoned by organophosphorus pesticides (OPs) used in agriculture and for killing insects in the home. Poisoning may be accidental or intentional. Even when the usual antidotes are given 10 to 20% of those poisoned still die. Research in animals has suggested that use of sodium bicarbonate (baking soda) or similar chemicals which make the blood alkaline might save people poisoned by OPs. The review authors looked for studies in which such chemicals were given to OP poisoned patients, to see how effective the treatment is. They sought controlled trials, a type of research study in which one group of patients is given one treatment, while a similar group (the control group) is given a different treatment. The authors found five studies on the topic but only one controlled trial that they could use in the review. The controlled trial had 53 participants. The results of this small trial showed a slight benefit from using sodium bicarbonate in conjunction with standard treatment for OP poisoning. However, this study does not provide enough evidence to recommend routine use of sodium bicarbonate. There are hundreds of different kinds of OPs so treatment may vary based on the type of poisoning as well as the severity of the poisoning. More research needs to be done to determine the best treatment for poisoning with OPs in various situations.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2009 Issue 4, Copyright © 2009 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This version first published online:
January 24. 2005 AbstractBackgroundPoisoning with organophosphorus pesticides (OPs) is an important cause of morbidity and mortality in all parts of the world, particularly developing countries. The case-fatality ratio for pesticide intentional self-poisoning is around 10 to 20% even when the standard antidotes (atropine, oximes and benzodiazepines) are used. Alternative treatments have been trialled in an attempt to improve outcomes from acute OP poisoning, one of which is plasma alkalinisation. Animal and preliminary human research has suggested benefit from plasma alkalinisation with sodium bicarbonate (NaHCO3) as a treatment for acute OP poisoning. ObjectivesTo determine the efficacy of alkalinisation, in particular NaHCO3, for the treatment of acute OP poisoning. Search strategyWe searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Current Awareness in Clinical Toxicology, Info Trac, http://www.google.com.au, and Science Citation Index of studies identified by the previous searches. We also manually reviewed the bibliographies of identified articles and personally contacted experts in the field. The searches were conducted in March 2004. Selection criteriaRandomised controlled trials and controlled clinical trials of symptomatic patients following acute OP poisoning treated with alkalinisation. The quality of studies and eligibility for inclusion was assessed using criteria by Jadad and Schulz. Data collection and analysisStudies were identified and both authors independently extracted data which was recorded on a pre-designed form. Study design, including the method of randomisation, participant characteristics, type of intervention and outcomes were recorded. The Relative Risk (RR) for death and Weighted Mean Difference (WMD) for the total dose of atropine were determined. Main resultsOne small randomised controlled trial with alternating allocation was located. The RR of death in patients receiving NaHCO3 compared to controls was 0.52 (95% CI 0.05 to 5.39) and the WMD for total dose of atropine was -36.1(95% CI -68.43 to -3.77). Four other studies were identified but none satisfied inclusion criteria; two studies were uncontrolled and two were historically controlled. NaHCO3 was used in each study to induce alkalinisation. Marked heterogeneity between subjects and treatments was noted - for example, a different regimen of NaHCO3 was used in each study. Authors' conclusionsClinical studies suggest benefit from plasma alkalinisation with NaHCO3 in OP poisoning, but there is insufficient evidence to support its routine use. Further research is required to determine the method of alkalinisation that will optimise outcomes, and the regimen which will produce the target arterial pH of 7.50 (range 7.45 to 7.55). This should be followed by a well-designed randomised controlled trial to determine efficacy. |