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Corrales et al

Note that 2-PAM has an affinity for the acetylcholine anionic binding site on cholinesterase (right middle panel), which could explain the oxime related worsening of cholinergic side effects when 2-PAM is administered prior to the onset of action of atropine in the setting of organophosphate poisoning, by transiently preventing nerve-agent free cholinesterase from interacting with acetylcholine

The direct reaction estimates the conjugated bilirubin fraction, and with the addition of a promoter (alcohol), the indirect reaction measures the unconjugated fraction

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