Abstract
The present case reports the first ever case of homicidal poisoning due to injection of an organophosphate insecticide with successful resuscitation and reporting. Case: A 7-month-old baby presented to the emergency department with a history of insect bite since 5 hours by his relatives with a main complaint of irritability, disturbed conscious level, irregular respiration and wheezy chest. The injection site has appeared as oval area of redness and swelling at right elbow region that were noticed by the pediatric emergency department physician, with a medical history of resistance to medications for suspected insect bite (antihistaminic and corticosteroids in pediatric dosage) from referral hospital. By toxicological consultation, we revealed disturbed conscious level (GCS 10), pinpoint pupils and increase all body secretions, salivation, bronchorrhea and incontinence in urine and stools. The clinical toxicology consultant suspected a case of acute anticholine esterase toxicity and recommended a plasma pseudocholinesterase level that appeared to be very low, consistent with acute intoxication with organophosphate insecticide. The management of organophosphate poisoning was started, as airway management, administration of oxygen and fluids, as well as atropine in increasing doses and pralidoxime. Our case report emphasizes the necessity of a detailed history taken and careful smart medical examination for the possibility of homicide in such cases. Although injection sites may be the expected results of insect bite, medical treatment, dermal lesions also may be associated with injections of toxic substances.
Highlights
Organophosphate (OP) poisoning is common in developing countries, especially in Egypt
Organophosphate insecticides are widely used in rural areas
OP poisoning by parenteral route has been described by very few authors [2,3,4]
Summary
Organophosphate (OP) poisoning is common in developing countries, especially in Egypt. We report a case of a 7 month male baby who, upon being injected “homicidal attempt” with an organophosphate insecticides solution, developed severe OI associated with Central Nervous System (CNS) depression. The physical examination of the baby by the clinical toxicologist showed, pinpoint pupils (less than 1 mm in diameter), siallorrhea, disturbed conscious level (his Glasgow Coma Scale (GCS) score was 10) Upon presentation, his vital signs included a rectal temperature of 36.1°C; heart rate, 132 beats/min; respiratory rate, 46 breaths/min; blood pressure, 85/45 mmHg; and haemoglobin saturation, 94%. The baby’s PCE was 412 IU/L (laboratory reference range: 1900-3800 IU/L) These clinical and laboratory findings confirmed our diagnosis of organophosphate intoxication. His PCE level was 1150 IU/L on the 6th day (Figure 1)
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