日本内科学会雑誌
Online ISSN : 1883-2083
Print ISSN : 0021-5384
ISSN-L : 0021-5384
有機燐剤中毒とその拮抗剤
難波 達治谷口 雄一郎岡崎 昌一植松 義則
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1959 年 47 巻 12 号 p. 1542-1548

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As an antidote for alkylphosphate poisoning, oximes have been proved to be the most effective drug available at present. The method of the clinical application of PAM (pyridine-2-aldoxime methiodide), one of oximes, against parathion poisoning was already established by the authors.
The remaining problem of PAM was the way how to apply it to an extremely severe case of parathion poisoning, for example to an attempted suicide case. With the purpose to solve this problem, the authors conducted animal experiments and same clinical studies; and obtained the following results: 1) one or two grams of PAM in the form of aqueous; solution is at first to be injected intravenously, followed by intravenous irrigation; 2) for the i. v. irrigation, the use of 2.5% PAM solution, readily available on the market, given at the rate of 0.5g PAM an hour is most effective, producing no side-effect; 3) the disappearance of muscular fasciculation is the most helpful sign to decide the amount of the irrigation; 4) in the early stage, the inhibited blood cholinesterase recovers very soon, but. later the rate of recovery becomes slow.
Therefore, quite a sufficient amount of PAM may be recommended at the beginning of the treatment; 5) within the limit of our experiences, the concomitant administration of atropine and PAM is in any way not superior to the sole PAM injection and 6) gastric lavage, artificial respiration, oxygne inhalation, and other procedures are to be resorted to in the course of the PAM therapy.
The efficacy of PAM against alkylphosphates, the drugs now obtainable besides ethyland methylparathion, has been examined from the standpoints of both the effects of PAM on the mortality of mice by alkylphosphates and the rate of reactivation of the rabbit. blood cholinesterase inhibited by alkylphosphosphates. PAM is effective on poisonings by EPN, TEPP, pestox-3, malathon, diazinon, and dipterex. The effect of PAM against EPN poisoning has also been ascertained in human cases.
DAM (diacetylmonoxime) and MINA (monoisonitrosoacetone), reportedly to be the most effective oximes, are in fact less effective against the alkylphosphate poisonings such as mentioned above when compared with PAM.

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