Table 1.

Atropine recommendations in textbooks, handbooks, and online databases of clinical toxicology

Source	Edition/Year	Recommended regimen to attain atropinisation (IV unless stated otherwise)	Markers of atropinisation	Max dose of atropine first 24h
Aggarwal 24	1st / 1997	2-4mg, repeated every 5-15 min	Dry secretions	NG
Bryson18	3rd / 1996	2-4mg, repeat or increase until atropinisation	Drying of secretions, skin and mouth, mydriasis, flushed skin, and tachycardia	1g
Casarett 23	7th / 2003	5mg, repeated every 20-30 min	No sweating or salivation, flushed skin, mydriasis.	Up to 50mg
Dreisbach 30	13th / 2001	2mg IM, repeat every 3-8 min	Control of “signs of parasympathetic toxicity”	NG
Dart 1 40*	1st / 2000	2-4mg, repeated every 5-10 min (or doubling the dose)	Control of pulmonary secretions	“massive amounts”
Dart 2 15*	3rd / 2003	2-4 mg, repeated every 2-5 mins, with increasing incremental doses (eg 4-8 mgs)	Control of pulmonary secretions, with clear lungs and adequate oxygenation	NG
Fernando 49	2nd / 1998	2-10mg, then 2mg repeated every 10-15 min	Counteract muscarinic effects on pulse, secretions, pupil	>100mg
Flanagan 19	1st / 2001	2mg, every 5-10 min	Dry mouth, pulse of 70-80bpm, reduction of bronchial secretions	1-2g
Ford17	1st / 2001	1-2mg; repeated every 5 min doubling the dose	Drying of the tracheobronchial tree and ability to oxygenate the patient	100s of mg
Goldfrank20	7th / 2002	1-5mg, repeated every 2-3 min	Dry skin and mucous membranes, decreased or absent bowel sounds, tachycardia, reduced secretions, no bronchospasm and usually mydriasis	1g
Gossel 32	3rd / 1994	2-4mg, repeated every 10-15 min	Diminish bradycardia, salivation, and bronchial secretions; produce signs of atropinisation (mydriasis, tachycardia and dry mouth)	50mg
Haddad16	3rd / 1998	1-2mg, then 2mg repeated every 15-30 min	Flushing, drying of airway secretions, dilated pupils, increased heart rate.	NG
Henry 29	1st / 1997	2-4mg, repeated every 10 min	Dry mouth, plus pulse >100, pupils dilated	“large amounts”
Hypertox 45	3.7 / 2003	1-2mg, repeated every 5-10 min	No secretions	NG
Jones34	1st / 2001	2mg, repeated every 10 min	Flushed red skin, tachycardia, dilated pupils, dry mouth	30mg or more
Krieger 38	2nd / 2001	2-5mg, repeated every 10-20 min	Flushed skin, dry mouth, dilated pupils, bronchodilation, raised heart rate	3.5g
Lall 22	1st / 1998	2-5mg, repeated every 5-10 min	Control of parasympathetic manifestations, or clearing of rales and drying of pulmonary secretions	NG
Leikin 27	3rd / 2001	2-5mg, repeated every 5-10 min	Dry pulmonary secretions	>100mg
Poisindex 46	2003	2-5mg, repeated every 10-30 min	Clear lungs, no secretions.	NG
Olson 14	3rd / 1999	1-5mg, repeated every 5-10 min	Clear chest, dry secretions, reversal of significant bradycardia	Several grams
PAPA 50	2nd / 1999	1-3mg, repeated every 5-10 min	Dry flushed skin, pupillary size at least 4mm, heart rate >120/min	NG
Proudfoot 25	2nd / 1993	2mg, repeated every 10-30 min	Flushed dry skin, tachycardia, dilated pupils, dry mouth.	NG
Proudfoot 31	2nd / 1996	2mg, repeated to control peripheral muscarinic signs	Control of bronchospasm and bronchorrhoea	100mg or more
Reigart 26	5th / 1999	If GCS normal: 2-4mg, repeated every 15 min. If GCS reduced: ~4-8mg, repeated every 5-15 min	Control of pulmonary secretions	300mg
Seyffart 10	4th / 1996	1-2mg, repeated or increased in increments every	Abolition of excess bronchial	NG
		15-60 min	secretion, dry mouth and skin, flushing
Toxbase 47	2002	2mg, repeated every 10-30 min	Reversal of bronchospasm and bronchorrhoea	“very large doses”
Toxinz 48	2003	1-5mg, repeated every 5-30 min	Clear lungs, no secretions.	>200mg
WHO PIM 43	1986	1-2mg, then same or increased dose every 15-30 min	Full atropinisation (signs include dilated pupils, dry mouth, skin flushing)	“several hundred mgs”
WHO EHC 42	1999	2mg, then same or increased dose every 15-30 min	Full atropinisation (signs include dilated pupils, dry mouth, skin flushing)	“several hundred mgs”
WHO OP Antidotes 9	2002	2mg, then same or increased dose every 15-30 min	Reduction in secretions, especially bronchial secretions	NG
WHO Treat- ment guide44	1999	1-2 mg, repeated every 5-10 min	Drying of respiratory secretions	100mg
Viccellio 37	2nd / 1998	1-2mg, then 2mg repeated every 5-10 min. Larger increments of atropine may be used.	Control of bronchial secretions and bronchospasm	1g

^*These texts had two and three different recommendations, respectively, for atropinisation. The recommendations given for OP poisonings are presented here.