Cases Of Organophosphate Poisoning Research Articles

Mean Cholinesterase Level among Organophosphorus Poisoning Patients Visiting the Emergency Department in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Acute organophosphorus pesticide poisoning is widespread and the most common in many developing countries, including Nepal. Through the inhibition of acetylcholinesterase, organophosphorus poisoning is characterised by the clinical picture of acute cholinergic crisis. Many researchers have shown increased levels of liver enzymes and decreased levels of serum cholinesterase in organophosphorus poisoning, however, very little work has been done in Nepal that studies the correlation between serum cholinesterase and liver enzymes in organophosphorus poisoning. The aim of the study is to find out the mean cholinesterase level among organophosphorus poisoning patients visiting the Emergency Department in a tertiary care centre. This was a descriptive cross-sectional study done among 94 organophosphate poisoning cases visiting the emergency department of a tertiary care centre from August 2021 to August 2022 after obtaining approval from the Institutional Review Committee (Reference number: 04102021/06). Convenience sampling was done. Blood workups were done for cholinesterase and liver function tests. Point estimate and 90% Confidence Interval were calculated. The mean cholinesterase level among organophosphorus poisoning patients was 1978.82±1878.22 (1660.17-2297.47, 90% Confidence Interval). The mean cholinesterase level among organophosphorus poisoning patients was similar when compared to other studies done in similar settings. cholinesterases; liver function tests; organophosphorus poisoning.

Mean Serum Creatine Kinase among Organophosphate Poisoning Cases in a Tertiary Care Centre: A Descriptive Cross-sectional Study

Major cases of poisoning are associated with organophosphates. Cholinergic effects and an intermediate phase seen with organophosphate poisoning may implicate myopathy. Creatine kinase is a marker of muscle tissue damage. This study aimed to find out the mean serum creatine kinase among organophosphate poisoning cases in a tertiary care centre. A descriptive cross-sectional study was carried out among organophosphate poisoning cases in a tertiary care hospital from 13 October 2017 to 30 March 2018. Ethical approval was taken from the Institutional Review Committee [Reference number: 117(6-11-E) 2/074/075]. Blood samples were assayed for serum acetylcholinesterase in the pharmacology laboratory and for serum creatine kinase and lactate dehydrogenase in the biochemistry laboratory. Low serum acetylcholinesterase was taken as the basis for the establishment of organophosphate poisoning. A convenience sampling technique was used. Point estimate and 95% Confidence Interval were calculated. Among 103 organophosphate poisoning cases, the mean serum creatine kinase was 931.35±446.60 IU/l (845.10-1017.60, 95% Confidence Interval). The mean serum creatine kinase level among organophosphate poisoning cases was higher than in other studies done in similar settings. acetylcholinesterase; creatine kinase; organophosphate poisoning; rhabdomyolysis.

Frequency of Organophosphate Poisoning and its Outcome in SKBZ AK CMH Muzaffarabad

Background: Organophosphate toxicity is a worldwide problem as this is equally easily available in rural and urban areas. Furthermore, the complications and outcome of the organophosphate poisoning was also examined. Aim: to determine the frequency of organophosphate poisoning and its outcomes in this region with limited laboratory and ICU facilities. Place and duration of study: SKBZ/AK CMH Muzaffarabad from January 2019 to December 2019. Methodology: This observational, prospective analytical study was planned in Department of Medicine, SKBZ/AK CMH Muzaffarabad. A total of 110 suspected poisoned patients were included having age between 12-60 years. Patients who had taken more than one poison were excluded from the study. The organophosphate poisoning was identified through pupil size, increased secretion and Glasgow Coma Scale. Results: The average age of the patients was 24.38±6.35 years. The male to female ratio was 1:1.69. Majority 77 (70%) of the patients were single and resident in rural areas 59 (53.6%). The incidence rate of organophosphate poisoning was 90 out of 110 (81.81%). There were at least 75% cases of organophosphate poisoning among all poisoned cases with p value 0.03. The survival rate was 93.3% (84 out of 90). The most important factor affecting survival rate was the time lag between ingestion of the poison and initiation of specific therapy with p value 0.022. Conclusion: Organophosphate poisoning has high incidence although has good prognosis and not a very problematic death rate. We also concluded that the survival rate can be improved through reduction in time lag before start the treatment. Keywords: Cause of poisoning, Organophosphate poisoning, Complication of Organophosphate poisoning

Histopathological changes in lungs, liver and kidneys in cases of death due to agricultural poisoning in a tertiary care centre: A cross sectional study

Medico legal deaths due to agricultural poisoning claim a substantial number of lives in Andaman and Nicobar Islands. Respiratory failure is the most common complication of OP poisoning leading to death. Histopathological studies of viscera in organophosphate poisoning cases help the autopsy surgeon in ascertaining out the secondary causes of death. Microscopy of three visceral organs-lungs, liver and kidneys of 40 cases of organophosphate poisoning were studied and the changes were correlated with the duration of survival post consumption. By knowing the exact histopathological changes in these organs, it is easier to attribute death to a failure of one of these organs as a consequence of organophosphate consumption. Knowing the rapidity of involvement of an organ is beneficial to the treating physician as well thereby helping him reduce the morbidity and hence mortality.

Suicidal ingestion of organophosphate compound (Sniper): A case report

Background: Organophosphate insecticide is one of the leading causes of poisoning in many developing Countries.Aim: To describe a typical case of organophosphate poisoning and discuss its management.Case Presentation: An 18 years old female Supermarket sales attendant presented with history of intentional ingestion of organophosphate(OP) compound(Sniper) to commit suicide. She was unconscious, and in severe respiratory distress. Her baseline vital signs were as follows: Pulse rate 52/m, Blood pressure-140/80mmHg, respiratory rate 32/m, and temperature 37.6°C.She had bilateral coarse crepitations and the SpO2 ranged between 40-65%. She was managed with intravenous normal saline, atropine at 1mg stat, then 2mg repeated every 5 minutes up to four times, followed by 8mg added to 500ml of normal saline in continuous infusion for 5 hours.Also, she was intubated and manually ventilated in addition to other supportive care in ICU. She regained consciousness within 24hours and was extubated. However, she developed a sudden acute cardiorespiratory distress and died in the second day of ICU admission.
 Conclusion: Severe organophosphate poisoning may be fatal. Early presentation to the hospital, prompt diagnosis and treatment with appropriate dose regimen of atropine, and other supportive care may improve survival.

Organophosphate Poisoning: Demographics, Severity Scores and Outcomes From National Poisoning Control Centre, Karachi.

IntroductionOrganophosphate ingestion is the commonest cause of self-harm encountered at poison control centers in Pakistan. It usually affects a young populous. Organophosphates are found in various forms and formulations that are easily accessible to the general public. These compounds are extremely potent poisons causing rapid clinical deterioration with minimal ingestion or exposure.Signs and symptoms can range from mild or none to severe such as bradycardia, miosis, fasciculations, seizures and altered level of consciousness. Poisoning severity is measured using the Peradeniya Organophosphorus Poisoning (POP) scale. Mortality rates are relatively low for mild to moderate disease. Severe disease as calculated by the POP carries an exceptionally high mortality rate.The National Poisoning Control Centre (NPCC) at Jinnah Postgraduate Medical Centre, Karachi treats an extraordinary number of poisoning cases on a daily basis. Despite this data pertaining specifically to OP ingestion is nearly absent. There have been no studies analyzing the various aspects of organophosphate poisoning in the last 30 years to the best of our knowledge. Here, we look to rectify this.AimsTo evaluate the demographics, severity scores and outcomes of organophosphate poisoning cases in the last year from the NPCC, Karachi.MethodsThis was a retrospective study. It was held from 1st January 2019 to 31st December 2019. All data was recorded from patients admitted to the NPCC with a proven diagnosis of organophosphate poisoning.ResultsThree thousand and three hundred patients were inducted into this study. Over 3/4th of the patients were teenagers or aged less than 30 years. Almost all referrals were made from within the city. Overall survival rate at 28 days was 89.45%. Most patients presented with mild to moderate disease as calculated by the POP; severe disease had a mortality rate of nearly 50%.ConclusionOrganophosphates make up a significant portion of all cases of poisoning treated at the NPCC. The POP is an excellent tool to evaluate disease severity. Overall survival rates are good but mortality rate is high for severe disease even in young patients.

RETROSPECTIVE STUDY OF ACUTE POISONING IN ELDERLY CASES ADMITTED TO MENOUFIA POISONING CONTROL CENTER (MPCC), MENOUFIA UNIVERSITY HOSPITALS FROM 2012 TO 2014

Introduction: Elderly people are exposed to poisons more than younger patients and they metabolize many drugs differently. Aim of the study: to evaluate poisoning in elderly patients. Subjects and Methods: A retrospective study was done on 255 elderly poisoned cases (≥ 60 years old) admitted to MPCC within the period from January 2012 to December 2014.The cases were evaluated and they were further statistically analyzed. Results: Out of 6556 acutely poisoned cases throughout the period of study, 3.9% elderly cases were included. 83.5% of cases were in the age group 60-<65 years. Males outnumbered females (62.4%). More than half of the cases (57.6%) were from urban areas. Housewives were the commonest (32.9%) followed by farmers (28.2%). Suicidal attempts were more in retired and free laborers groups 60% and 100% respectively, accidental exposures were 79.2% in farmers while 6.7% of manual workers and 4.2% of farmers were exposed to homicide. Organophosphate was the commonest poisoning substance among farmers (87.5%), while retired, drivers and unemployed were commonly intoxicated by drugs (40%, 40% and 50%respectively). Cases with metabolic acidosis were intoxicated by corrosives & organophosphate 33.3% for each one. Low cholinesterase level was found in 39 cases of organophosphate poisoning. Methanol level was elevated in three cases of alcohol poisoning and Toxi-lab was positive in three cases of drug poisoning. ECG was done for 25 cases, 24% of them showed bradycardia and 16% showed tachycardia. Thirty six cases underwent X-ray, 11.2% & 8.3% showed increased broncho-vascular marking and alveolar opacities respectively. Mortality rate constituted 9.4% of cases. Logistic regression analysis cleared that PH was the most predictor affecting the outcome followed by hypoxia. Conclusion and recommendation: PH, hypoxia and coma were the risk factors in the outcome. Proper evaluation and continuous monitoring of elderly poisoned cases are required to decrease the mortality rates among these patients.

Fatal cases associated with eating chapatti contaminated with organophosphate in Tororo District, Eastern Uganda, 2015: case series

BackgroundFew cases of organophosphate poisoning in developing countries have been investigated using clinical and epidemiological methods. On 30 October 2015, 3 students at Mukuju School, Tororo District, Uganda, died soon after eating chapatti (locally-made flat bread) from the same food stand. Ministry of Health investigated to identify the cause and recommend prevention measures.MethodsWe defined a case as onset during 30–31 October 2015 in a resident of Mukuju Town of ≥1 of the following symptoms: excessive saliva, profuse sweating, dizziness, low blood pressure, constricted pupils or loss of consciousness. We reviewed medical/police records and interviewed survivors, healthcare workers, and police officers. We collected samples of implicated food for toxicological analysis. Autopsies were performed on decedents to identify the cause of death.ResultsWe identified 7 cases with 3 deaths (case-fatality ratio = 43%). Clinical manifestations included acute onset of confusion (100%), constricted pupils (43%), excessive saliva (43%), and low blood pressure (43%). All 7 cases had onset from 16:00–18:00 h on 30 October, with a point-source exposure pattern. Of the 7 cases, 86% (6/7) were men; the mean age was 24 (range: 20–32) years. The 3 decedents each ate a whole chapatti while the other 4 cases ate half or less. Autopsy findings of the 3 decedents indicated organophosphate poisoning. Toxicological analysis found high levels of malathion in leftover foods (266 mg/L in dough and 258 mg/L in chapatti) and malaoxon (a highly toxic malathion derivative) in decedents’ postmortem specimens (mean levels of 19 mg/L in the blood and 22 mg/L in the gastric contents). There was a delay of 4 h before the patients received appropriate treatment. Police investigations revealed that flour used to make the chapatti was intentionally contaminated with an organophosphate pesticide.ConclusionThis fatal outbreak of organophosphate poisoning was associated with consumption of roadside-vended chapatti made of flour contaminated with pesticide. Clinicians should be aware of symptoms of organophosphate poisoning and prepared to treat it quickly. Street vendors should carefully consider the source of their ingredients. An in-depth surveillance review of such poisonings in Uganda would guide policymakers in reducing access by criminals and accidental exposures for the public.

Epidemiology of Organophosphate Poisoning in the Tshwane District of South Africa.

Background:Organophosphate poisoning is a major public health problem in South Africa. Individuals get exposed to organophosphate in both the domestic and industrial spheres.Method:A cross-sectional study was conducted using retrospective, secondary data of organophosphate poisoning cases over a 3-year period, reported at the Tshwane District surveillance office. Data were analysed using Microsoft Excel, and Epi Info version 7 was used for descriptive statistics.Results:A total of 207 cases were reported with ages ranging from 10 months to 59 years. Most of the cases were men (58.9%). Intentional poisoning accounted for 51% of cases. Unintentional poisoning accounted for 21.7% of cases, and 26.5% of cases had unknown circumstances of poisoning. A significant number (50.2%) of intentional poisonings were suicide related. Nonsuicidal cases accounted for 47.4% of cases, and deliberate unlawful poisoning accounted for 2.4% of cases. The mortality rate for the whole group was 3.4%.Conclusions:Improvement in data collection on organophosphate poisoning is essential to properly measure the burden of the problem. More effective regulatory controls for pesticide use are needed in South Africa.

Structures of paraoxon-inhibited human acetylcholinesterase reveal perturbations of the acyl loop and the dimer interface.

Irreversible inhibition of the essential nervous system enzyme acetylcholinesterase by organophosphate nerve agents and pesticides may quickly lead to death. Oxime reactivators currently used as antidotes are generally less effective against pesticide exposure than nerve agent exposure, and pesticide exposure constitutes the majority of cases of organophosphate poisoning in the world. The current lack of published structural data specific to human acetylcholinesterase organophosphate-inhibited and oxime-bound states hinders development of effective medical treatments. We have solved structures of human acetylcholinesterase in different states in complex with the organophosphate insecticide, paraoxon, and oximes. Reaction with paraoxon results in a highly perturbed acyl loop that causes a narrowing of the gorge in the peripheral site that may impede entry of reactivators. This appears characteristic of acetylcholinesterase inhibition by organophosphate insecticides but not nerve agents. Additional changes seen at the dimer interface are novel and provide further examples of the disruptive effect of paraoxon. Ternary structures of paraoxon-inhibited human acetylcholinesterase in complex with the oximes HI6 and 2-PAM reveals relatively poor positioning for reactivation. This study provides a structural foundation for improved reactivator design for the treatment of organophosphate intoxication. Proteins 2016; 84:1246-1256. © 2016 Wiley Periodicals, Inc.

Accidental organophosphate poisoning in a child in Uyo, Nigeria: a public health alert

&lt;p class="abstract"&gt;&lt;span lang="EN-US"&gt;Organophosphates are often constituents of pesticides and insecticides. Some of these products are sold by unregistered vendors on the streets and in market places in sub-Saharan Africa. When purchased, and improperly stored, children may easily have access to, and inadvertently consume them. The clinical features of organophosphate poisoning include diarrhoea, diaphoresis, urination, miosis, bronchorrhoea, bronchospasm, bradycardia, emesis, lacrimation and salivation. Atropine administration is an important cornerstone of the management of this condition, with a good outcome in this instance. A case of organophosphate poisoning is herein reported to illustrate the effect of the predisposing factors to accidental childhood poisoning. It is hoped that this will help make an urgent case to raise public awareness on the prevention of accidental childhood poisoning, as well as the enforcement of regulations on the production, labeling, distribution and sale of these organophosphate compounds.&lt;/span&gt;&lt;/p&gt;

Clinical profile of organophosphate poisoning at a tertiary-care center

Background: Nowadays, organophosphate (OP) compounds are widely used in agricultural field as an insecticide. Toxicity with these compounds is owing to inhibition of acetylcholinesterase enzyme. Patients are presented with muscarinic and nicotinic side effects. Red blood cells and plasma acetylcholinesterase enzyme (AChE) levels are helpful in diagnosis of the patients. It may cause life-threatening acute and chronic complications. All poisoned patients are required intensive care and treatment with injections atropine and PAM. Objective: To study the clinical aspect of OP poisoning in detail with hospital stay, clinical course, complication, and recovery and mortality in OP poisoning. Materials and Methods: This study was done at PDU Medical College, Rajkot, Gujarat, India, comprising 50 cases of OP poisoning. After taking written consent, personal history of the patients was taken. Then, a detailed history regarding poison and clinical symptoms was taken. Then, general and systematic examinations of patients were carried out, and blood samples were sent for investigations. We followed up the patients till discharge or expired. Result: In our study, maximum incidence of OP poisoning was in between 20 and 40 years age group (60%), and male to female ratio was 2:1. Clinical signs such as bradycardia and tachycardia were present in 20% cases. Miosis was present in 70% cases, and it is more dangerous. Low serum AchE level was found in 68% cases, with mortality in 44.62% among them. Type-I paralysis (52%) and acute respiratory failure (32%) were found as life-threatening complications. In our study, 64% patients survived. Conclusion: Detailed history and thorough clinical examination of patients are helpful in diagnosing the patients of OP poisoning. Life-threatening complications occurred in these patients. Early detection and immediate treatment in intensive care units with injections atropine and PAM can increase the chances of survival rate of patients.

Correlation Between Poison Severity Asessment And Outcome In Organophosphate Poisoning In Tertiary Care Hospital.

To compare poison severity score with incidence of intermediate syndrome, ventilation and outcome in organophosphate poisoning. A retrospective study was conducted in a tertiary care teaching hospital of South India. Data was collected retrospectively from medical record section from 2012 to 2013 in a suitable designed case record form. Data was analysed by using SPSS 20.0 with chi-square and one way anova. Total of 199 cases of organophosphate poisoning was documented out of which 135 (67.8%) were males and 64 (32.2%) were females. The average age in this group of patients was found to be 34.22 + 14.26. The average pre-hospitalization period was 1.58 + 2.07 days. Among them majority of the cases were suicidal (94.5%). Patients with a poison severity score of grade 1,5. 8% had intermediate syndrome. In grade 2 only 33.3% had intermediate syndrome and the most was seen in grade 3 where 60% had intermediate syndrome. Patients with a poison severity score of grade 1 only 10.6% were on ventilation, in grade 2 only 56.7% were on ventilation and in grade 3,93.8% were on ventilation. Patients with a poison severity score of grade 1 had a recovery rate of 92.3%. Patients with a poison severity score of grade 2 had a recovery rate of 66.6% and patients with grade 3 had a recovery rate of 64.6%. As the severity in poison severity score increases other parameters like ventilation, intermediate syndrome and mortality also increases. There is a strong correlation between the poison severity score and outcome of the patient.

Pre-Interventional Cardiac and ECG Changes in Acute Organophosphate Poisoning Cases Admitted to a Tertiary Hospital in India

Background : Cardiac complications are the less common fatal effect of acute organophosphate poisoning. This study was undertaken to analyze the pre-interventional cardiac and Electrocardiographic (ECG) changes in acute organophosphate poisoning cases. Materials and Methods: Clinical records of acute organophosphate poisoning patients of age less than 50 years admitted to KLE’s Dr. Prabhakar Kore Hospital, Belgaum, Karnataka, from 01-01-2010 to 31-12-2010 were analyzed. Cases of organophosphate poisonings referred from other hospitals, poisoning with multiple agents, patients with history of previous cardiac diseases and coexisting medical conditions were excluded from the study. Poisoning Severity Score was calculated as per International Programme on Chemical Safety and patients were grouped into 3 grades. Results: In this study, 50 cases of acute organophosphate poisoning (male - 32; female - 18) were analyzed. Sinus tachycardia was present in 45 patients (90%), hypertension in 13 (26%) and hypotension in 12 (24%). Prolonged corrected QT interval was observed in 14 patients (28%), elevated ST segment in 2 (4%), inverted T wave in 13 (26%) and conduction defects in 1 (2%). Among 14 patients with prolonged corrected QT interval, 12 were in grade III and 2 in grade II severity; and, among 13 patients who had inverted T wave, 2 were in grade I, 4 in grade II and 7 in grade III severity. Acidosis, as assessed by blood pH and HCO 3 , was observed in 22 patients (44%). Conclusion: Fatal cardiac complications do occur in acute organophosphate poisoning, which are overlooked at times as the most common complications expected are respiratory complications. Higher incidence of ECG changes in Grade III cases suggests that if the cardiac complications develop, the patient should be immediately transferred to an intensive cardiac care unit.

Organophosphate poisoning presenting as bradycardia

Organophosphate poisoning is very common in India. Its presentations are very vivid. Here we present a case of organophosphate poisoning in a young male with only bradycardia as sole manifestation of poisoning.

Is there a role for progesterone in the management of acute organophosphate poisoning during pregnancy?

Organophosphates are commonly used pesticides and cause about onemillion unintentional and 2million suicidal exposures with up to 300,000 fatalities every year around the world. Toxicity of organophosphates is due to inhibition cholinesterase activity and prolonging the effects of acetylcholine in the receptor site. Clinical features of organophosphate poisoning are defecation, urination, miosis, bronchorrhea, emesis, lacrimation and salivation. Spontaneous abortion reported somewhen in pregnant patients. Intravenous administration of benzodiazepines, atropine and pralidoxime is the formal treatment of this toxicity. Atropine and pralidoxime have been assigned to pregnancy class C by the FDA and should be recommended for use in pregnant women clinically suffer organophosphate poisoning. Benzodiazepines have been assigned to pregnancy class D and should be avoided during pregnancy. Clinical experiments suggest transplacental transfer of organophosphates is possible, and fetal sensitivity is probable, but a single acute overdose most likely don’t make any physical deformities, therefore termination of pregnancy is not imperative. Nonetheless, no definite strategy focused on maintaining pregnancy. Here we propose an idea that in any female case of acute organophosphate poisoning in childbearing range of age, maternal serum Beta-HCG should be tested for pregnancy and prophylactic progesterone should be used in pregnant cases of organophosphate poisoning.

Amitraz Poisoning in a Patient from Rural Africa

Amitraz is a pharmacologically active chemical compound widely used in Africa as an ectoparasiticide and agricultural pesticide. This article reports a 25 year old female from rural Kenya who presented to emergency department with fourteen hours history of unconsciousness and mydriasis after having ingested an unknown poison. She was erroneously treated as a case of organophosphate poisoning but later managed supportively with intravenous fluids, airway management and monitoring of urine output. The importance of considering chemicals other than organophosphates in patients with poisoning as well as the supportive management of patients with amitraz intoxication is highlighted. Public education on potential hazards of amitraz poisoning is of vital importance for community health.

Pattern of Organophosphorous Poisoning: A Retrospective Community Based Study

Pesticide poisoning is very common in Nepal. Hospital based studies from various parts of Nepal have shown that poisoning with organophosphorus compounds is the most common type of poisoning. Current study is undertaken to see the pattern of organophosphorus poisoning and to identify the common risk factors among the cases. If the risk factors are modifiable, attempts in addressing the risk factors and decreasing the likelihood of poisoning will certainly be fruitful in reducing the morbidity and mortality associated with organophosphorus poisoning. To assess the risk factors of organophosphorus poisoning which is major public health problem in Nepal. A community based retrospective study of 75 cases of organophosphate poisoning who were brought to the emergency department of Dhulikhel hospital over the period of 3 years. Basic information was collected from hospital records and home visits were made to study the risk factors. Data were collected through interviews of the study population and their family members using a pre-designed questionnaire. In this study 75 cases and their families were interviewed of which there were 59% males and 42% females (M/F ratio of 1:1.4). The majority (40%) of the poisoning cases were in the age group 25-34 years. Lower literacy level showed positive association with the incidence of poisoning. Occupation wise vast majority (80%) of the cases were engaged in agricultural work. Suicidal attempts by ingesting organophosphate compounds were high in farmers and females. In this study, majority of the poisoning were attempts of intentional self harm. Agriculture workers and females are high risk groups and may be associated with the fact that they have easy access to the poison. Interventions directed towards health education, counseling, and enforcement of laws restricting the availability and use of harmful pesticides may help in reducing such events in future.

Case Report: An Unusual Heart Rhythm Associated with Organophosphate Poisoning

Organophosphate pesticides have emerged as a common cause of poisoning, particularly in developing countries. The most common electrocardiographic abnormalities observed in organophosphate poisoning are sinus tachycardia, QT interval prolongation, and, very rarely, ventricular arrhythmias. We report a case of organophosphate poisoning associated with atrial fibrillation, right bundle branch block, QT interval prolongation, and intermittent narrow QRS complexes that were most likely due to automaticity from the region of the left posterior fascicle.

Prolonged Intermediate Syndrome Due to Organophosphate Poisoning

Organophosphate poisoning can present as acute cholinergic syndrome, Intermediate syndrome and delayed neuropathy. Intermediate syndrome secondary to organophosphate poisoning is a serious health problem leading to increased morbidity and mortality. The incidence of problem varies and range from 8%-84% of organophosphate poisoning cases. The factors account for this difference is nature of organophosphate compound, severity of poisoning and inadequate Oxime therapy. The recognition of this syndrome is important as organophosphate poisoning is common in our country. We presented this case of organophosphate poisoning leading to prolonged intermediate syndrome. The muscle weakness associated with this syndrome generally resolves in 5-18 days but in our case this lasted for 23 days. After a prolonged Intensive Care Unit (ICU) stay patient was discharged home with no residual symptoms. The case highlights anticipation and recognition of this problem after cholinergic crisis is over.