II. Indications

  1. Nerve Agent Exposure
  2. Organophosphate Exposure
  3. Not indicated for pure carbamate Poisoning

III. Pharmacokinetics

  1. Binds Nerve Agent and breaks agent-enzyme bond
  2. Less effective after Nerve Agent aging occurs
    1. Soman (GD) ages in 2 minutes
    2. Other Nerve Agents age over 24-48 hours

IV. Dosing: Emergency Department

  1. Initial IV bolus
    1. Adult: 1-2 grams IV over 10 minutes
    2. Child age < 12 years: 20-50 mg/kg IV over 30 minutes
  2. Maintenance Protocol 1 (bolus)
    1. Repeat dosing above in 1-2 hours
    2. May re-administer q10-12 hours prn symptoms
  3. Maintenance Protocol 2 (Continuous infusion)
    1. Continuous IV 10-20 mg/kg/hr up to 500 mg per hour
    2. Discontinue at 24 hours

V. Dosing: Military (MARK I Kit)

  1. MARK I Kit Autoinjector contains 2-PAMCl 600 mg
  2. Atropine usually administered prior to 2-PAMCl

VI. Precautions

  1. Do NOT administer more than 3
  2. Cardiac Arrest risk

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