Alkalinisation for organophosphorus pesticide poisoning

Evidence Summaries

Level of Evidence = D
Plasma alkalinisation with NaHCO3 in acute poisoning with organophosphorus pesticides might possibly improve outcomes although the evidence is insufficient to support its routine use.

A Cochrane review 1 on the efficacy of alkalinisation for the treatment of acute organophosphorus pesticides (OP) poisoning included 2 studies with a total of 158 subjects. In the higher dose study, (NaHCO3 5 mEq/kg intravenously over one hour, followed by an infusion of 5–6 mEq/kg over 23 hours. The infusion was repeated every day until recovery/death) the RR of death in patients receiving NaHCO3 compared to controls was 0.52 (95% CI 0.05 to 5.39) and the WMD for total dose of atropine was -36.1 (95% CI –68.43 to –3.77). No clinical benefits from lower dose NaHCO3 were noted.

Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment), by inconsistency (heterogeneity in interventions), and by imprecise results (few patients and wide confidence intervals).


1. Roberts D, Buckley NA. Alkalinisation for organophosphorus pesticide poisoning. Cochrane Database Syst Rev 2005 Jan 25;(1):CD004897 .  [PMID:15674967]

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