Management of organophosphorus poisoning and the role of magnesium sulfate: A scoping review of literature

Nekoukar, Zahra; Talabaki, Homa; Zakariaei, Zakaria; Mesri, Mahdi; Azadeh, Hossein

doi:.0..

Clin Exp Emerg Med > Accepted Articles

Review Article

doi: https://doi.org/10.15441/ceem.23.179 [Accepted]

Management of organophosphorus poisoning and the role of magnesium sulfate: A scoping review of literature

Zahra Nekoukar¹, Homa Talabaki², Zakaria Zakariaei³

, Mahdi Mesri⁴, Hossein Azadeh⁵

¹Department of Clinical Pharmacy, Faculty of Pharmacy, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
²Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
³Toxicology and Forensic Medicine Division, Mazandaran Registry Center for Opioids Poisoning, Orthopedic Research Center, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
⁴Medical Ethics Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
⁵Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, Mazandaran University of Medical Sciences, Sari, Iran

Correspondence Zakaria Zakariaei Email: ali.zakariaei@yahoo.com

Received: December 22, 2023. Revised: February 17, 2024. Accepted: March 28, 2024. Published online: April 5, 2024.

ABSTRACT

Organophosphorus agents are easily absorbed via respiratory, gastrointestinal, and dermal routes, and inhibit the acetylcholine transferase enzyme (AChE), which is responsible for the majority of toxicity caused by organophosphates in the body. A comprehensive search was conducted across three prominent databases, namely Google Scholar, PubMed, and Science Direct, to identify relevant articles published. The search focused on the keywords "MgSO4" or "magnesium sulfate" in conjunction with "organophosphate" or "organophosphate poisoning." Inhibition of AChE results in the accumulation of acetylcholine (ACh) in synapses and stimulation of cholinergic receptors. Considering that several studies have shown the use of magnesium sulfate (MgSO4) in inhibiting the release of ACh in the central and peripheral sympathetic and parasympathetic synapses, this study was conducted to review the role of MgSO4 in the treatment of OP. The intravenous administration of MgSO4 exhibits favorable tolerability and clinical efficacy in alleviating cardiac toxicity associated with OP exposure.

Keywords: Organophosphate poisoning, Cholinergic receptors, Acetylcholine transferase, Magnesium sulfate