Q: What is the hazard of using sub-optimal dose of Atropine
in Bradycardia?
Answer:
Minimum dose of Atropine in Bradycardia is 0.5 mg (0.4mg to be
precise). Doses less than 0.5 mg (0.2 mg in peds) may further decrease the rate. Though this pradoxical bradycardia has been questioned in some literature papers.
Various explanations have been proposed for
that including stimulation of the vagus nerve causing bradycardia at low doses,
as Atropine may crosses blood brain barrier. Another explanation given is at low
doses, atropine may have affinity for presynaptic autoreceptors thus blocking
the negative feedback loop of acetycholine and increasing presynaptic output of
acetylcholine into the synaptic junction. This will activate m2 receptors on the
heart and lead to bradycardia. At higher doses the muscarinic blocking effects
of Atropine causes tachycardia.
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