Page 164 - 2026 SMOG

PRALIDOXIME CHLORIDE (2-PAM CHLORIDE)
Dose/Administration
PEDIATRIC
ADULT
(Always reference Broselow Tape)
• Organophosphate/Nerve Agent Poisoning • Organophosphate/Nerve Agent Poisoning
• Auto-injector • IM
˚ 600mg per dose; max: 3 doses (1800mg) ˚ ≤40kg
• ATNAA Auto-injector (provides a single IM ■ Mild symptoms: 15mg/kg prn q15min
dose of Atropine (2.1mg) and Pralidoxime (max TOTAL dose: 45mg/kg)
Chloride (600mg): ■ Severe symptoms: 15mg/kg, repeat
˚ For ≥2 mild symptoms, inject 1 ATNAA twice in rapid succession for a total
dose of 45mg/kg delivered
(single dose). If severe symptoms
develop, inject 2 additional doses in ˚ >40kg
rapid succession ■ Mild symptoms: 600mg prn q15min
˚ For severe symptoms, inject 3 ATNAAs Severe symptoms: 600mg, repeat twice
(max TOTAL dose: 1800mg)
in rapid succession
• IV/IO ■ in rapid succession for a total dose of
˚ After max dose ATNAA 1800mg delivered
■ 500mg over 5min • Auto-injector
PLUS ˚ ≥41kg only: 600mg per dose; max:
10mg/kg/hr infusion until clinical 3 doses
improvement is stable • IV
Note: Pralidoxime (2-PAM) Adult and ˚ ≤16 y/o:
Pediatric Drip Protocol [given after 1800mg ■ Loading Dose: 20–50mg/kg
IM Injection (3 ATNAAs) if symptoms persist] (max dose: 2g)
1. Reconstitute 1g 2-PAM with 20mL of sterile ■ Continuous Infusion: 10–20mg/kg/hr
water (max dose: 500mg/hr)
2. Add 10mL reconstituted 2-Pam (500mg) to ■ Intermittent Dosing: 20–50mg/kg
100mL Bag of NS and infuse over 5min (max dose: 2g; may repeat after 1hr if
3. Prepare continuous infusion by mixing 1g muscle weakness is not relieved)
(20mL reconstituted) into 100mL bag of NS, ˚ >16 y/o:
which will provide a 10mg/mL solution. Can ■ Loading Dose: 30mg/kg
also prepare 10g in 1L NS for a 10mg/mL (max dose: 2g)
solution ■ Continuous Infusion: 8–10mg/kg/hr
4. Begin continuous infusion (max dose: 650mg/hr)
■ Intermittent Dosing: 1–2g administered
1hr after the loading dose if muscle
weakness has not been relieved

156 • MEDICATIONS