Epidemiology of Acute Organophosphate Poisoning in Hospital Emergency Patients

Dharmani, Chandrabhan; Jaga, Kushik

doi:10.1515/reveh.2005.20.3.215

Cited by 52 publications

(43 citation statements)

References 38 publications

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“…Carbon monoxide (CO) and organophosphate (OP) poisoning are amongst the most common causes of morbidity and mortality (1,2). Following exposure to CO or OP agents, morphologic changes are seen in some regions of the brain within a few hours (3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

“…Following exposure to CO or OP agents, morphologic changes are seen in some regions of the brain within a few hours (3)(4)(5). The neurotoxicity has been documented in accidental human poisoning, epidemiological studies, and animal models, and involves neuronal degeneration and subsequent neurological, neurobehavioral, and neuropsychological consequences in both poisonings (2)(3)(4)(5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

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Comparison of SPECT findings and neuropsychological sequelae in carbon monoxide and organophosphate poisoning

Özyurt

Kaya

Kahveci

et al. 2008

Clinical Toxicology

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Abnormal regional cerebral blood flow in patients with acute carbon monoxide (CO) and organophosphate (OP) poisoning was examined using (99m)Tc-hexamethylpropylene amine oxime (HMPAO) brain single photon emission computed tomography (SPECT) in fourteen patients. We evaluated the predictive significance of acute phase brain SPECT findings for long-term neuropsychological sequelae. Changes were found in the frontal, temporal, parietal lobes within the first week after both types of poisoning. The distribution of the hypoperfused cerebral areas as demonstrated by (99m)Tc-HMPAO imaging was similar in the two groups during the acute phase. Neuropsychological sequelae developed in five patients poisoned with OP and six with CO. Patients who had SPECT findings heterogeneously or in the temporal or frontal lobes displayed disorientation. Those with fronto-parietal and frontal lobe changes displayed mental confusion. Parkinsonism also was observed in patients with parieto-occipital, parietal and frontal lobe lesions. The distribution of these lesions appears to predict the long term sequelae of these poisonings, though additional studies with larger numbers of patients are needed to confirm the role of SPECT imaging in both OP and CO poisonings.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of SPECT findings and neuropsychological sequelae in carbon monoxide and organophosphate poisoning

Özyurt

Kaya

Kahveci

et al. 2008

Clinical Toxicology

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“…Trends in pesticide poisonings specifically attributable to organophosphates (accidental and intentional) and evidence of environmental contamination with organophosphates in developing countries especially across Asia and Africa are consistent with an increase in their use (18,19). Despite the apparent relative increase in organophosphate use in the developing compared to the developed world, there appears to be a general global shift away from the use of organophosphate pesticides as indicated mostly by sales information from Costa Rica, New Zealand, and the United States (15).…”

Section: Production and Usementioning

confidence: 86%

“…The burden of organophosphate poisoning appears to be great in developing countries (18). In a systematic and comprehensive review of the global burden of pesticide suicides during the 1990-2007 period, pesticide self-poisoning accounted for at least a third of suicides worldwide (which totaled an estimated 233,997 and 325,970) (19); most of these occurred in the developing world; and organophosphates were among the most commonly ingested pesticides (19).…”

Section: Acute Toxicity: Cholinergic Syndromementioning

confidence: 99%

Organophosphorus Pesticides

Storm¹

2012

Patty's Toxicology

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Most organophosphorus compounds today fall into two general groups: the so‐called nerve agents, that are very acutely toxic and organophosphorus pesticides that are less toxic. Nerve agents were generally the first toxic organophosphorus developed, and were the original basis for organophosphorus pesticides. Interest about nerve agents has increased lately given concerns about their potential use in terrorist acts. Organophosphate nerve agents and pesticides are a highly diverse group of chemicals. They are all characterized by their ability to inhibit the enzyme acetylcholinesterase (AChE) that deactivates the neurotransmitter acetylcholine (ACh). At present, the widest use of organophosphorus compounds is as pesticides, although they have also been used as therapeutic agents, gasoline additives, hydraulic fluids, cotton defoliants, fire retardants, plastic components, growth regulators, and industrial intermediates to a much smaller extent. Compounds in this class are numerous and have been categorized in many ways according to the nature of the substituents. Gallo and Lawryk (1991) [2], for example, categorized them into four main groups I–IV based on the characteristics of the leaving group (X). Group I compounds, phosphorylcholines, have a leaving group that contains a quaternary nitrogen and are among the most potent organophosphates (e.g., Shradan). Group II compounds, fluorophosphates, have a fluoride leaving group and are also generally highly toxic (e.g., diisopropyl fluorophosphate). Group III compounds have leaving groups that contain cyanide or a halogen other than fluoride and are generally less potent than group I or II (e.g., Parathion). Group IV contains most of the organophosphates used as insecticides today. These compounds have alkoxy, alkylthio, aryloxy, arylthio, or heterocyclic leaving groups and a wide variety of other substituents. Another classification scheme is based on the nature of the atoms that immediately surround the central phosphorus atom and results in 14 different categories. According to this scheme, phosphates are the prototype for the entire class and are those compounds where all four atoms that surround the phosphorus atom are oxygen (e.g., dichlorvos, mevinphos). Sulfur‐containing organophosphate compounds (phosphorothioates, phosphorothiolates, phosphorodithioates, and phosphorodithiolates) are far more numerous than phosphates and include well‐recognized organophosphate insecticides such as parathion, diazinon, chlorpyrifos, etc. Other groups contain nitrogen (phosphoramides and phosphorodiamides), nitrogen and sulfur (phosphoramidothionates and phosphoramidothiolates), carbon (phosphonates and phosphinates), or carbon and sulfur (phosphonothionates, phosphonothionothiolates, and phosphinothionates). All aspects of organophosphate chemistry, toxicity, analysis, and exposure potential have been previously and comprehensively reviewed. In addition, information regarding the toxicity of organophosphorus pesticides in particular has expanded greatly in recent years as a result of toxicity data supplied by registrants to the U.S. EPA's Office of Pesticides to support reregistration. These data have been made publicly available by the U.S. EPA on its Internet Web site ( www.epa.gov/pesticides ). The following discussion draws heavily from recent reviews and also includes summaries of relevant toxicity data submitted to, and made available by, the U.S. EPA.

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“…Although some patients rapidly become symptomatic, the onset and severity of symptoms depend on the specific compound, amount, route of exposure, and rate of metabolic degradation. Worldwide studies report mortality rates from 3% to 25% (3,6).…”

Section: Introductionmentioning

confidence: 99%