Toxin:: [[Cholinergic syndrome]] not to be confused with pyridoxine (remember pra**L**idoxime with cho**L**inergic) The initial dose is 1 gram pralidoxime iodide in 100 mls of normal saline IV over 15 minutes. Then Commence a pralidoxime infusion at 250 mg per hour. Notes: - Cases should be discussed with a clinical toxicologist. - Pralidoxime reactivates acetylcholinesterase that has been inhibited by binding to organophosphate or carbamate pesticides. It is only effective if given **before irreversible binding** or “ageing” of the complex takes place. - Re-establishment of enzymatic function rapidly reverses the nicotinic and muscarinic effects of organophosphates poisoning. - [[atropine]] is usually administered before pralidoxime and its effects are synergistic - note that atropine does NOT work at nicotinic receptors