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Benefits of magnesium sulfate in the management of acute human poisoning by organophosphorus insecticides

Poison Control Center, Loghman-Hakim Hospital, School of Medicine, Shaheed-Beheshti University of Medical Sciences, Tehran, Iran

Shahin Shadnia

Poison Control Center, Loghman-Hakim Hospital, School of Medicine, Shaheed-Beheshti University of Medical Sciences; Department of Toxicology and Pharmacology, School of Pharmacy, and Laboratory of Toxicology, Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran

Ali Rezaie

Mahboobeh Abdi

Department of Toxicology and Pharmacology, School of Pharmacy, and Laboratory of Toxicology, Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran

Mohammad Abdollahi

Department of Toxicology and Phannacology, School of Pharmacy, and Laboratory of Toxicology, Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, PO Box 14155-6451, Tehran, Iran; mohammad.abdollahi{at}utoronto.ca

Organophosphorus chemicals (OPs) are the pesticides most often involved in serious human poisoning. Treatment of intoxication with OPs conventionally involves atropine for reduction of muscarinic signs and oximes that increase the rate of hydrolysis of the phosphorylated enzyme acetylcholinesterase (AChE). Although atropine and oximes (pralidoxime or obidoxime) are traditionally used in the management of such poisoning, their efficacy remains a major issue of debate; thus, the goal of this prospective clinical trial was to elaborate the value of magnesium sulfate (MgSO₄) in the management and outcome of OP insecticide poisoning.

This unicenter, randomized, single-blind trial study was conducted on patients who were acutely poisoned with OPs and admitted to the Poisoning Center of Loghman-Hakim Hospital in Tehran, Iran. In a systematic sampling, every fourth eligible patient was chosen to undergo MgSO₄ treatment. Magnesium sulfate was administered at dose of 4 g/day i.v. continued for only the first 24 hours after admission.

The mean daily oxime requirement and the mean daily atropine requirement were not statistically significant between two treated groups. The mortality rate and hospitalization days of patients who received MgSO₄ treatment were significantly lower than those who had not received MgSO₄ (P < 0.01).

It is concluded that administration of MgSO₄, in a dose of 4 g/day concurrent to conventional therapy, in OP acute human poisoning is beneficial by reducing the hospitalization days and rate of mortality.

Key Words: human • magnesium • organophosphorus • pesticide • poisoning

Human & Experimental Toxicology, Vol. 23, No. 12, 565-569 (2004)
DOI: 10.1191/0960327104ht489oa


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