Cardiac injury in organophosphate poisoning after acute ingestion

Abstract

Introduction Sparse data and conflicting evidence exist on the prevalence and prognosis of organophosphate (OP)-related cardiac toxicity. We aimed to characterize the cardiac abnormalities of OP after an acute cholinergic crisis in adults without previous cardiovascular conditions. Patients and Methods We did a prospective observational study in a tertiary-care hospital of north India (Postgraduate Institute of Medical Education and Research, Chandigarh) in 74 patients aged ≥ 13 years admitted with acute OP poisoning after self-ingestion. A systemic evaluation, including clinical characteristics, electrocardiography, and echocardiography, was performed to estimate the prevalence and prognosis of cardiac injury. A rate-corrected QT interval was calculated using Bazett’s method, and >440 milliseconds was used to define prolongation. Results Chlorpyrifos was the most commonly ingested OP (n = 29). The patients had a similar occurrence of hypotension (n = 10) and hypertension (n = 9) at admission, and electrocardiography demonstrated sinus tachycardia in 38 (51.3%) and sinus bradycardia in one case. During the hospital stay, 3 out of 74 patients had a prolonged rate-corrected QT interval (457, 468, and 461 milliseconds), and one patient developed supraventricular tachycardia. Eight (10.8%) patients developed the intermediate syndrome, and six (8.1%) died. None of the hemodynamic or electrocardiographic abnormalities was associated with in-hospital mortality or intermediate syndrome development on univariant analysis. Baseline echocardiography at hospital discharge was performed in 27 patients (admitted during 2018) and normal in all except mild tricuspid regurgitation in one. At a 6-month follow-up, 23 cases were available for cardiovascular screening (including echocardiography) and had a normal evaluation. Conclusion Cardiac toxicity is uncommon after acute OP self-ingestion and lacks prognostic significance.

Role of Paraoxonase-1 Enzyme in Prediction of Severity and Outcome of Acute Organophosphorus Poisoning: A Prospective Study

“…Zayed et al (2015) showed that bradycardia and hypotension were the main profound cardiovascular disorders in the symptomatic group. The results of Pannu et al (2021) showed that the most prevalent respiratory symptom, shortness of breath, was present in 75.7% of cases. The study of Elmoneim et al (2019) showed that 60% of patients in the present study presented with hypotension, 82% had tachycardia and 50% of patients presented with tachypnea.…”

Changing spectrum of acute poisoning in North India

“…[ 11 ] Despite a global fall in incidence and mortality, pesticide poisoning with organophosphate or aluminum phosphide is a significant problem in agriculture-dependent economies of South East Asia, China, and Africa. [ 1 2 3 4 5 29 30 31 32 33 ] Apart from advancements in critical care, the specific management of these toxidrome remains almost the same for many decades. Many novel treatments have been evaluated to improve outcomes; however, they remain controversial or necessitate further research to confirm their efficacy.…”

“…Although the annual global manufacturing of herbicides outweighs insecticides several-fold, human herbicide poisoning is uncommon and considered less critical than insecticide poisoning, especially in LMIC. [ 1 2 3 4 5 37 ] Indian data on herbicide poisoning are limited and primarily based on case reports. [ 5 6 7 8 9 10 11 38 39 40 ] However, a never-before incidence of about 6% of herbicide ingestion (with paraquat being the most prevalent) was detected in our study.…”

“…In cholinesterase inhibitor poisoning, atropinization was performed according to the doubling-dose method, followed by an atropine infusion for maintenance. [ 3 ] Flumazenil was indicated only in pure benzodiazepine overdose in a nonhabituated user for reversal of conscious sedation. [ 21 ] The opiate antagonist naloxone was given in suspected or confirmed opioid overdose.…”

“…[ 1 2 ] Because low-middle-income countries (LMIC), especially in the Asia-Pacific region, predominantly have agriculture-based economies, easy accessibility of pesticides results in a high incidence of poisoning. [ 3 4 5 ] In India, organophosphate and aluminum phosphide are the most common pesticides that cause acute poisoning. [ 5 6 7 8 9 10 11 ] Household products such as disinfectants or cleaners remain the continuous source of intentional or unintentional exposures.…”