Atropinisation
Definition
The clinical end point of titrated atropine therapy in cholinergic poisoning: drying of pulmonary secretions, clearing of crepitations, heart rate above 80, systolic BP above 80 mmHg. Pupil size is not the end point.
- Context
- Titrated atropine therapy in cholinergic poisoning
- Heart rate target
- Above 80 beats per minute
- Systolic BP target
- Above 80 mmHg
- Lung sign
- Drying of secretions, crepitations clear
- Not the end point
- Pupil size
Common questions
Why is pupil size explicitly excluded as an atropinisation end point?+
Pupil dilation is a common effect of atropine but is not a reliable dosing guide because pupillary response varies between patients and can lag behind the clinically important effects on airway secretions and cardiovascular status.
What is the forensic or clinical significance of confirming atropinisation?+
It marks the point where the anticholinesterase toxicity, typically from organophosphate exposure, has been adequately countered, guiding the clinician on when to stop escalating atropine doses and switch attention to complications such as respiratory failure or the need for an oxime.
Related terms
- Antidote
- A substance that counteracts a poison by competitive receptor block, enzymatic reactivation, chelation, immune binding or substrate replacement. Antidotes are class-specific, not...
- DUMBBELS
- Mnemonic for the muscarinic side of the cholinergic toxidrome: Diarrhoea, Urination, Miosis, Bronchospasm and Bronchorrhoea, Bradycardia, Emesis, Lacrimation, Salivation.
- Oxime Reactivation
- Restoration of acetylcholinesterase function by pralidoxime (2-PAM) or obidoxime through cleavage of the organophosphate-enzyme bond, effective only before the enzyme is irreversibly...
- Specific Antidote
- An agent that acts on the poison's mechanism, not just on its symptoms. Naloxone for opioids, NAC for paracetamol, methylene blue for...
- Toxidrome
- A reproducible cluster of clinical findings (vital signs, pupil size, skin, bowel and bladder, mental status) that identifies a class of poison...