Storage characteristicsĮven when stored at up to 45☌ (113☏) 87% of the atropine sulfate reconstituted from bulk power was still undegraded, pathogen-free, and without tropic acid (an expected degradation product) after 8 weeks. Using such an approach, a single pharmacist can reconstitute one hundred 6 mg syringes of atropine within about a half-hour, at a cost of as little as $11 (versus $5,000 for prefilled syringes). To address this problem, protocols have been developed for the reconstitution of high-concentration atropine from bulk powder. Roughly 355 people died in the attack.Because of the high doses required for some cases of organophosphate poisoning, and because of the potential for mass casualty incidents involving insecticides and nerve agents, rapid access to large amounts of atropine may be critical. However, the atropine available to the hospitals in Syria wasn't enough to save everyone, and some patients didn't reach the hospital soon enough. Most cities have an emergency stockpile of the medicine for chemical attacks such as the one in Damascus last week. Atropine can also dry up nasal and tear-duct secretions, and it has been used to speed up slow heartbeats, preventing cardiac arrest. You might have experienced its effects already: It is chiefly used in ophthalmology to dilate the pupil of the eye for examination of the retina.
The good news is that atropine is cheap and generic. Doctors give an initial dose and then administer more until the patient's bronchial secretions stop. It simply depends on how much gas the patient was exposed to. There is no specific dosage of atropine used to treat the symptoms brought on by nerve gas.
"You want to do it within 30 minutes to an hour, if possible."
"The important thing is to get the atropine in as quickly as possible," Khare says. That way, even though the chemical attack causes an overabundance of acetylcholine in a victim's brain, the receptors do not pick up the signals and the person's nervous system has a chance to even itself out. It alleviates the symptoms brought on by nerve gas exposure by blocking the acetylcholine receptors. Smithsonian reports that both the Egyptians and Greeks used atropine, although it wasn't until 1901 that pure atropine was made in a lab. "By blocking this neurotransmitter, patients exhibit signs and symptoms which include constricted pupils, large amounts of salivation/bronchial and lung secretions, involuntary urination, and ultimately convulsions and death due to the inability of the respiratory muscles to work, causing asphyxiation," Khare says.Ītropine is the most common drug used to combat nerve gases. Without the acetylcholinesterase to moderate the signals, the parasympathetic system is flooded with acetylcholine, resulting in overstimulation of the nerve cells. Khare tells PopMech that nerve agents such as sarin disrupt the parasympathetic system by blocking the neurotransmitter acetylcholinesterase, which breaks down acetylcholine, another neurotransmitter that controls several functions within the cardiovascular, gastrointestinal, urinary, and respiratory systems. Play icon The triangle icon that indicates to play The sympathetic controls the "fight or flight" response, while the parasympathetic helps the body relax and digest food and is sometimes referred to as the "rest and digest" system. The autonomic nervous system is then further broken down into the sympathetic and parasympathetic systems. The human nervous system has two branches: the voluntary, which governs primarily muscle movement, and the involuntary, which is called the autonomic. So how does atropine combat the effects of a nerve gas attack? "Atropine, in large quantities, is the antidote to these nerve gases," says Rahul Khare, assistant director of the department of emergency medicine at Northwestern University's Feinberg School of Medicine. To combat the effects of what might be the world's worst chemical weapons attack in 25 years, the hospital staff turned to atropine-at least until they ran out of the drug. The symptoms point to exposure to sarin gas or another drug agent. Doctors in the Syrian capital treated thousands of patients who were experiencing neurotoxic symptoms, including pinpoint pupils, foaming mouths, convulsions, blurry vision, and difficulty breathing. In the hours following the reported chemical weapons attack in the suburbs of Damascus last Wednesday, ailing men, women, and children flocked to the city's hospitals.
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