Abstract
In Reply.— In addition to our initial report of possible Malathion nephrotoxicity, Wedin et al now report a case of poisoning with the organophosphate dimpylate, in which the renal manifestations were decreased urine output and crystalluria. The initial low urine output was probably related to volume depletion as opposed to any direct nephrotoxic effect from dimpylate. The crystalluria is described as amorphous, and there is no mention of urine and serum chemistries or urine pH in the case report. Formation of crystals requires a supersaturated urinary solution with respect to a certain solute. There are no reports of organophosphates directly increasing the urinary excretion of calcium, uric acid, oxalate, or cystine to account for the crystalluria. The nicotinic manifestations of organophosphate poisoning do include muscular twitching and weakness, but frank rhabdomyolysis that might secondarily result in a large release of uric acid and uricosuria has not been reported. Calcium crystal
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