Organophosphorus poisoning: the wet opioid toxidrome

Abstract

In The Lancet, David Steindl and colleagues describe the case of a 44-year-old man who was poisoned by a novichok organophosphorus nerve agent. 1 Steindl D Boehmerle W Körner R et al. Novichok nerve agent poisoning. Lancet. 2020; (published online Dec 22.)https://doi.org/10.1016/S0140-6736(20)32644-1 Summary Full Text Full Text PDF Scopus (7) Google Scholar The man was a passenger on a domestic flight in Russia when he became confused, and vomited and collapsed unconscious; 2 h later, he was hospitalised in Omsk, Russia, and treated for respiratory failure and coma. After transfer by air ambulance to Berlin, Germany, features of the cholinergic toxidrome (ie, small or pinpoint pupils, bradycardia, sweating, and hypersalivation) allowed a diagnosis of organophosphorus poisoning to be made. Assessments done by a doctor from the air ambulance crew before transfer to Germany did not indicate that organophosphorus poisoning had yet been diagnosed or antidotes used. However, atropine was later detected in urine. With administration of antidotes and intensive care at Charité-Universitätsmedizin Berlin, the man made a full recovery. Novichok nerve agent poisoningOn Aug 20, 2020, a 44-year-old man who was previously healthy suddenly became confused and began to sweat heavily on a domestic flight in Russia approximately 10 min after departure; he vomited, collapsed, and lost consciousness. After an emergency landing, the man was admitted to the toxicology unit of a local hospital in Omsk, Russia, approximately 2 h after symptom onset. According to the discharge report, the patient presented comatose with hypersalivation and increased diaphoresis and was diagnosed to have respiratory failure, myoclonic status, disturbed carbohydrate metabolism, electrolyte disorders, and metabolic encephalopathy. Full-Text PDF