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If pralidoxime is administered before adequate atropinization , it may temporarily worsen life-threatening muscarinic effects, including: Bronchoconstriction Increased respiratory secretions , which can lead to airway obstruction Therefore, clinical guidelines recommend administering atropine before pralidoxime , and this sequence is reflected in autoinjector design (Aman et al., 2021
I strongly recommend that everyone, especially women of childbearing age, get an MTHFR mutation test
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