Impressive but classical electrocardiograph changes after organophosphate poisoning

Robert, Dominique; Thielen, Griet; Brabant, Jan Van

doi:10.1080/15563650701558586

Cited by 5 publications

(2 citation statements)

References 3 publications

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“…A theory has been suggested that there are distinct phases; including a brief period of intensely elevated sympathetic tone that causes severe tachycardia, which is succeeded by a protracted interval of increased parasympathetic activity, which results in sinus bradycardia, atrioventricular block, ST segment and T wave abnormalities and QTc interval broadening. As we know, QTc prolongation results from strong and uneven sympathetic stimulation of myocardial fibres making it the main reason that we observe these ECG changes in acute cases of OP poisoning with autonomic discharge or altered consciousness (Jorens et al, 2008).…”

Section: Discussionmentioning

confidence: 94%

An unusual case of organophosphate poisoning presenting Wellens or Pseudo-Wellens pattern: A diagnostic dilemma

Khan¹,

Parihar²,

Umalkar³

et al. 2023

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Organophosphate compounds such as Malathion, parathion, dimethoate, chlorpyrifos, tabun etc. Block the acetylcholinesterase enzyme, due to which acetylcholine levels increases. Organophosphate poisoning can occur after dermal, respiratory or oral exposure to organophosphate compounds.Respiratory symptoms are presented frequently in cases of organophosphate poisoning. Salivation, rhinorrhea along with bronchorrhea and bronchospasm are the muscarinic effects contributing to hypoxemia and increase in respiratory rate. Nicotinic effect causes muscular fragility and paralysis which may lead to respiratory failure. In wellens syndrome, the ECG reveals biphasic T waves or deep inverted T waves in leads V2-V3, indicating LAD stenosis, whereas Pseudo-Wellens have a Wellens ECG pattern but normal coronary architecture. In this case a 29-year-old male patient was brought from outside hospital with alleged history binge alcohol consumption and was found in unconscious state in his farm 2 days back.

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Section: Discussionmentioning

confidence: 94%

An unusual case of organophosphate poisoning presenting Wellens or Pseudo-Wellens pattern: A diagnostic dilemma

Khan¹,

Parihar²,

Umalkar³

et al. 2023

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“…Dysrhythmias and conduction defects may occur in the early phase of severe poisoning [6]. The electrocardiographic changes may be impressive, even mimicking acute myocardial ischemia [7]. The possibility of late onset malignant ventricular arrhythmias cannot totally ruled out, but most of the patients then exhibited at least a prolonged QT interval.…”

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confidence: 99%

Organ donation following fatal organophosphate poisoning

Mariage

Gallinat

Hantson

2012

Transplant International

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Poisoned donors are often overlooked as organ donors because of the perceived risks of toxins transmission or organ dysfunction [1,2]. We describe a case of successful liver and kidneys donation after fatal organophosphate (OP) poisoning.A 49-year-old man was admitted to the hospital after the suicidal ingestion of an unknown amount of the OP compound parathion (E-605 from Bayer Ò , Leverkusen, Germany), a pesticide that has been officially banned for many years. He had a medical history of chronic ethanol abuse and grade I chronic obstructive pulmonary disease. He had been found in cardiac arrest with no bystander rescue. After cardiac massage (10 min), intubation for mechanical ventilation, and 10 mg of i.v. atropine, there was a rapid return of spontaneous ventilation before arrival at the hospital.The patient was hemodynamically stable, but remained comatose with pinpoint pupils and myoclonus. Laboratory results revealed an ethanol blood concentration of 3.39 g/l, with a marked decrease of serum cholinesterase (386 IU/l, normal values 5860-13 060) consistent with the diagnosis of severe OP poisoning. The patient received a total dose of 27 500 mg of pralidoxime and 410 mg of atropine during the first 6 days. The treatment was pursued for persisting miosis, fasciculation, and decreased serum cholinesterase level (240 IU/l on day 7). The neurological condition never improved. The brain computed tomodensitometry (CT) was normal and the electroencephalogram showed diffuse slowing with theta waves. The patient suffered numerous lung complications, with atelectasis and pneumonia.On day 21, he abruptly developed hypotension and diabetes insipidus. The clinical diagnosis of brain death was confirmed by an isoelectric EEG and by the absence of intracerebral perfusion at brain angio-CT. The cause of brain death was very likely the progression of postanoxic encephalopathy, with a long initial delay between asystole and resuscitation. Organ donation was accepted by the relatives and the kidneys and the liver were recovered. The last laboratory values were: serum creatinine 0.53 mg/dl (nl < 1.69), ASAT 79 IU/l (nl < 30), ALAT 89 IU/l (nl < 35). The electrocardiogram (EKG) showed sinus rhythm with a QTc interval at 459 ms and diffuse repolarization changes.

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Chemical Terrorism

Ballantyne¹

2009

General, Applied and Systems Toxicology

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Terrorism has a very long history. Terrorism has been defined terrorism as deliberately and violently targeting civilians for political purposes. One of the objectives of terrorism may be to generate a disproportionate response and thereby alienate the population against the state. The range of weaponry potentially available to terrorists is wide and variable: weapons used may include guns or explosive devices, radioactive/nuclear sources, biological organisms and toxins (bioterrorism) or xenobiotic chemicals (chemical terrorism). Chemicals that might be used include irritant and/or disorienting materials, nauseating materials, psychogenic materials and severely toxic and lethal agents. The only major chemical terrorist action to date was the two instances of use in Japan of sarin, an organophosphorus ester G‐agents, where there was large‐scale mass casualties. While many other compounds could be used in chemical terrorism (eg cyanide, arsine), the only other mass casualty situation to date involving terrorism was the death of many innocent citizens in an anti‐hostage situation in Moscow; this appears to have caused by the authorities' response, rather than the action of the terrorists.

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Impressive but classical electrocardiograph changes after organophosphate poisoning

Cited by 5 publications

References 3 publications

An unusual case of organophosphate poisoning presenting Wellens or Pseudo-Wellens pattern: A diagnostic dilemma

An unusual case of organophosphate poisoning presenting Wellens or Pseudo-Wellens pattern: A diagnostic dilemma

Organ donation following fatal organophosphate poisoning

Chemical Terrorism

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