From the Research
Pralidoxime (PAM) injection should be diluted to a concentration of 20 mg/mL before administration. For intravenous use, dilute the contents of one 1-gram vial in 50 mL of sterile water for injection. For intramuscular use, dilute to a concentration of 300 mg/mL by adding 3 mL of sterile water to a 1-gram vial. Administer the IV dose slowly over at least 15-30 minutes to avoid side effects like tachycardia, laryngospasm, and muscle rigidity. For severe organophosphate poisoning, the recommended adult dose is 1-2 grams IV initially, followed by continuous infusion of 500 mg/hour. Pediatric dosing is 20-50 mg/kg IV initially. Pralidoxime works by reactivating acetylcholinesterase that has been inhibited by organophosphate compounds, breaking the phosphorus-enzyme bond before it becomes permanently bound ("aging") 1.
The solution should be used within 24 hours of reconstitution and any unused portion should be discarded. Always check for particulate matter and discoloration before administration. It is essential to note that the provided evidence does not directly address the dilution of PAM, but based on general medical knowledge and the example provided, the above recommendation is made.
Key points to consider:
- Dilution concentration: 20 mg/mL for IV use and 300 mg/mL for IM use
- Administration rate: slow IV administration over 15-30 minutes
- Dosage: 1-2 grams IV initially for severe organophosphate poisoning, followed by continuous infusion of 500 mg/hour
- Pediatric dosing: 20-50 mg/kg IV initially
- Solution stability: use within 24 hours of reconstitution, discard unused portion.