Clinical Management of Organophosphorus Nerve Agents’ Poisonings

  • Mohammad Moshiri
  • Anahita Alizadeh
  • Mahdi Balali-Mood


Organophosphorus nerve agents (NAs) are known as the deadliest chemical warfare agents. The NAs have four classes G, V, and GV agents and Novichok family. They are highly lipophylic. NAs irreversibly inactivate acetylcholine esterase (AChE) and lead to accumulate toxic levels of acetylcholine. Respiratory system is the main organ that is affected by NAs and respiration may be arrested due to central and peripheral dysfunctions. NA exposure is detected through four methods: (I) measurement of AChE activity, (II) evaluation of hydrolysis products in plasma and urine, (III) fluoride reactivation of phosphylated binding sites, and (IV) determination of NAs and metabolites by mass spectrometric methods. The NA treatment should be started as soon as possible by removing victims from the field and administrating atropine and oximes by auto-injectors. Although atropine and different types of oximes are the main antidotes, there are also some adjuvant treatments for NA intoxication including magnesium sulfate, sodium bicarbonate, gacyclidine, benactyzine, tezampanel, hemoperfusion, antioxidants, and bioscavengers. We also review treatments of victims from high-risk groups, such as pregnant women, children, and elderly.


Organophosphorus compounds Acetylcholinesterase Chemical warfare agents Nerve agents Oximes Atropine Gacyclidine Benactyzine Magnesium sulfate Sodium bicarbonate Tabun Sarin Soman VX G agents V agents GA GB GF Novichok agent 


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Copyright information

© Springer-Verlag London 2014

Authors and Affiliations

  • Mohammad Moshiri
    • 1
  • Anahita Alizadeh
    • 2
    • 3
  • Mahdi Balali-Mood
    • 4
  1. 1.Department of Pharmacodynamics and Toxicology, School of PharmacyMashhad University of Medical SciencesMashhadIran
  2. 2.Medical Toxicology Research Center, School of MedicineMashhad University of Medical SciencesMashhadIran
  3. 3.University Department of Clinical Toxicology, Imam Reza Hospital, Faculty of MedicineMashhad University of Medical SciencesMashhadIslamic Republic of Iran
  4. 4.Medical Toxicology Research Centre and University Department of Clinical Toxicology, Imam Reza Hospital, Faculty of MedicineMashhad University of Medical SciencesMashhadIslamic Republic of Iran

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