The Poison Review

CARBAMATE POISONING: TREATMENT RECOMMENDATIONS IN THE SETTING OF A MASS CASUALTIES EVENT Rosman Y et al. Am J Emerg Med 2009;27:1117-1124.

Abstract

This paper, from the Israel Poison Information Center in Haifa, discusses the controversial issue of the role of oximes (such as 2-PAM) in treating carbamate toxicity.  Unlike organophosphates, carbamates cause reversibleinhibition of anticholinesterase. Therefore, it would make sense that treating patients exposed to carbamates with good support and atropine should be sufficient.  Unfortunately, the sparse animal and human data that exists addressing this issue is not conclusive. The authors make the reasonable suggestion that in a mass casualty incident in which an clinical diagnosis of cholinergic syndrome is made, both atropine and an oxime be administered at least until it is clear whether an oxime or a carbamate is involved.