Abstract
Misuse of organophosphate insecticides, even in case of domestic application, can be life threatening. We report the case of siblings admitted with respiratory distress, pinpoint pupils and slurred speech. The symptoms appear after spraying the skin by insecticides. Plasma pseudocholinesterase level appeared to be very low, consistent with acute intoxication with organophosphate insecticide.Management of organophosphate poisoning consists of airway management, administration of oxygen and fluid, as well as atropine in increasing doses and pralidoxime. Decontamination of the patient's skin and the removal of the patient's clothes are mandatory in order to avoid recontamination of the patient as well as the surrounding healthcare personnel.Plasma pseudocholinesterase analysis is a cheap and an easy indicator for organophosphate insecticides intoxications and could be used for diagnosis and treatment monitoring.
Highlights
Organophosphate insecticides are widely used in rural areas
We report a case of siblings who, upon being sprayed with an organophosphate solution, developed severe Organophosphate intoxication (OI) associated with central nervous system (CNS) depression
They are rapidly absorbed by all routes of exposure, including dermal, respiratory and gastrointestinal, and irreversibly inhibit the enzyme acetylcholinesterase at cholinergic synapses, resulting in excess cholinergic stimulation at the neuromuscular junction, the sympathetic and parasympathetic nervous systems, and the CNS [3]
Summary
Organophosphate insecticides are widely used in rural areas. Intentional ingestion of organophosphates is associated with a high mortality rate [1]. Case report A 7-year-old previously healthy boy was brought into the emergency department with vomiting and reduced consciousness by his mother He had been in good health until he was found, 30 min prior to admission, unresponsive in the bathroom. The boy’s 10-year-old sister, with the exact same unpleasant odour, altered sensorium, vomiting and respiratory distress, was brought to the emergency department by the father She was afebrile and had a heart rate of 133 beats/min; the respiration was shallow at a rate of 31 breaths/min with bilateral wheezing and bronchial secretions. The frequency of atropine administration was reduced and stopped when symptoms such as bradycardia, hypersecretion and bronchospams disappeared Both patients improved considerably, the boy showed fasciculations for an additional day. Further evaluation of the siblings 2 weeks later showed normal clinical findings, and the PCE values were within the normal range
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