atropine_toxicity_dosing: Atropine Dosing for Cholinesterase Inhibitor Toxicity

In cliot: Clinical Indices and Outcomes Tools

Atropine Dosing for Cholinesterase Inhibitor Toxicity

Description

Calculates the recommended atropine dosing for patients with organophosphate or carbamate toxicity (cholinesterase inhibitor poisoning). The protocol utilizes a "doubling dose" strategy: if bronchial secretions remain copious after the initial dose, the subsequent dose is doubled every 5-10 minutes until secretions are dried (atropinization). Once controlled, a maintenance infusion is calculated.

Usage

atropine_toxicity_dosing(last_dose_mg, secretions_controlled,
                         total_cumulative_dose_mg = NULL)

Arguments

last_dose_mg	Numeric. The amount of atropine (in mg) administered in the most recent bolus.
secretions_controlled	Numeric (0 or 1). Assessment of therapeutic endpoint (clear breath sounds, dry axillae, no bronchorrhea). (1 = Yes, 0 = No).
total_cumulative_dose_mg	Numeric (Optional). The total sum of all bolus doses administered to achieve control. Required to calculate the maintenance infusion rate (typically 10-20% of the total loading dose per hour).

Value

A list containing:

Status	Current clinical status (Controlled vs. Uncontrolled).
Recommendation	Clinical action plan (Double dose or Start infusion).
Next_Bolus_Dose_mg	The recommended quantity for the next IV push if uncontrolled.
Maintenance_Infusion_Rate	The recommended hourly infusion rate if controlled.

References

Eddleston M, Buckley NA, Eyer P, Dawson AH. Management of acute organophosphorus pesticide poisoning. Lancet. 2008;371(9612):597-607. doi:10.1016/S0140-6736(07)61202-1

Examples

# Example 1: Uncontrolled after 2mg
# Secretions still present (0)
atropine_toxicity_dosing(2, 0)

# Example 2: Uncontrolled after 4mg
# Secretions still present (0) -> Recommends 8mg
atropine_toxicity_dosing(4, 0)

# Example 3: Controlled
# Secretions dry (1). Total dose given was 20mg.
# Recommends infusion at 2-4 mg/hr
atropine_toxicity_dosing(8, 1, total_cumulative_dose_mg = 20)

cliot documentation built on Dec. 1, 2025, 1:06 a.m.