OP/nerve agents are still considered as important chemicals acting on living organisms and are widely used. They are characterized according to their action as compounds influencing cholinergic nerve transmission via inhibition of AChE. Modeling of this action and extrapolation of experimental data from animals to humans is more possible for highly toxic agents than for the OP. The symptoms of intoxication comprise nicotinic, muscarinic, and central symptoms; for some OP/nerve agents, a delayed neurotoxicity is observed. Cholinesterases (AChE and BuChE) are characterized as the main enzymes involved in the toxic effect of these compounds, including molecular forms. The activity of both enzymes (and molecular forms) is influenced by inhibitors (reversible, irreversible, and allosteric) and other factors, such as pathological states. There are different methods for cholinesterase determination; however, the most frequent is the method based on the hydrolysis of thiocholine esters and subsequent detection of free SH-group of the released thiocholine. The diagnosis of OP/nerve agent poisoning is based on anamnesis, the clinical status of the intoxicated organism, and on cholinesterase determination in the blood. For nerve agent intoxication, AChE in the red blood cell is more diagnostically important than BuChE activity in the plasma. This enzyme is a good diagnostic marker for intoxication with OP pesticides. Some other biochemical examinations are recommended, especially arterial blood gas, blood pH, minerals, and some other specialized parameters usually not available in all clinical laboratories. These special examinations are important for prognosis of the intoxication, for effective treatment, and for retrospective analysis of the agent used for exposure. Some principles of prophylaxis against OP/nerve agent poisoning comprising the administration of reversible cholinesterase inhibitors such as pyridostigmine (alone or in combination with other drugs), scavengers such as preparations of cholinesterases, some therapeutic drugs, and possible combinations are given. Basic principles of the treatment of nerve agent OP poisoning are described. They are based on the administration of anticholinergics (mostly atropine but some other anticholinergics can be recommended) as a symptomatic treatment, cholinesterase reactivators as a causal treatment (different types but without a universal reactivator against all OP/nerve agents) as the first aid and medical treatment, and anticonvulsants, preferably diazepam though some other effective benzodiazepines are available. New drugs for the treatment are under experimental study based on new approaches to the mechanism of action. Future trends in the complex research of these compounds, which is important not only for the treatment of intoxication but also for the quantitative and qualitative increase of our knowledge of toxicology, neurochemistry, neuropharmacology, clinical biochemistry, and analytical chemistry in general, are characterized.

Jirí Bajgar

Advances in clinical chemistry

临床化学卷的进展包含学术界和临床实验室科学领域领先专家的材料。这些评论涵盖了广泛的临床化学学科，包括临床生物标志物探索、尖端微阵列技术、蛋白质组学和基因组学。它是临床化学、分子诊断学、病理学和临床实验室科学从业人员不可或缺的资源和实用指南。

Advances in Clinical Chemistry is a significant journal in the field of clinical chemistry, featuring contributions from leading experts in academia and clinical laboratory sciences. The reviews cover a wide range of topics in clinical chemistry, including the exploration of clinical biomarkers, cutting-edge microarray technologies, proteomics, and genomics. This journal serves as an indispensable resource and practical guide for professionals in clinical chemistry, molecular diagnostics, pathology, and clinical laboratory sciences.

《Advances in Clinical Chemistry》是临床化学领域的重要期刊，涵盖了学术界和临床实验室科学领域的领先专家撰写的研究材料。这些评论涉及广泛的临床化学主题，包括临床生物标志物的探索、前沿的微阵列技术、蛋白质组学和基因组学。该期刊是临床化学、分子诊断学、病理学和临床实验室科学从业人员不可或缺的资源和实用指南。

Advances in Clinical Chemistry

Adv Clin Chem

Organophosphates/nerve agent poisoning: mechanism of action, diagnosis, prophylaxis, and treatment.

The diagnosis of OP/nerve agent poisoning is based on anamnesis, the clinical status of the intoxicated organism, and on cholinesterase determination in the blood, where AChE in the red blood cell is more diagnostically important than BuChE activity in the plasma.

Category	Quartile
医学	2
医学, 医学实验技术	1

Organophosphates/nerve agent poisoning: mechanism of action, diagnosis, prophylaxis, and treatment.

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