Intensive care management of organophosphate insecticide poisoning

Abstract

Introduction Organophosphate (OP) insecticides inhibit both cholinesterase and pseudo-cholinesterase activities. The inhibition of acetylcholinesterase causes accumulation of acetylcholine at synapses, and overstimulation of neurotransmission occurs as a result of this accumulation. The mortality rate of OP poisoning is high. Early diagnosis and appropriate treatment is often life saving. Treatment of OP poisoning consists of intravenous atropine and oximes. The clinical course of OP poisoning may be quite severe and may need intensive care management. We report our experience with the intensive care management of serious OP insecticide poisonings. Methods A retrospective study was performed on the patients with OP poisoning followed at our medical intensive care unit. Forty-seven patients were included. Diagnosis was performed from the history taken either from the patient or from the patient's relatives about the agent involved in the exposure. Diagnosis could not be confirmed with serum and red blood cell anticholinesterase levels because these are not performed at our institution. Intravenous atropine and pralidoxime was administered as soon as possible. Pralidoxime could not be given to 16 patients: 2 patients did not receive pralidoxime because they were late admissions and 14 did not receive pralidoxime because the Ministry of Health office was out of stock. Other measures for the treatment were gastric lavage and administration of activated charcoal via nasogastric tube, and cleansing the patient's body with soap and water. The patients were intubated and mechanically ventilated if the patients had respiratory failure, a depressed level of consciousness, which causes an inability to protect the airway, and hemodynamic instability. Mechanical ventilation was performed as synchronized intermittent mandatory ventilation + pressure support mode, either as volume or pressure control. Positive end expiratory pressure was titrated to keep SaO 2 above 94% with 40% FIO 2 . Weaning was performed using either T-tube trials or pressure support weaning. The chi-square test was used for statistical analysis. Data are presented as mean ± standard deviation. Results There were 25 female and 22 male patients. Thirty-two (68%) were suicide attempts and 15 (32%) were accidental exposure. The gastrointestinal route was the main route in 44 (93.6%) patients. The mortality rates for the patients who did and did not receive pralidoxime were 32 and 18.7%, respectively, and were not statistically different. The most frequent signs were meiosis, change in mental status, hypersalivation and fasciculations. Ten patients (21.2%) required mechanical ventilation. The mortality rate for the patients who required mechanical ventilation was 50%, but the rate was 21.6% for the patients who were not mechanically ventilated. Intermediate syndrome was observed in 9 (19.1%) patients. Complications were observed in ...

Rapid simultaneous determination for organophosphorus pesticides in human serum by LC–MS

“…In contrast, early diagnosis and appropriate treatment are often lifesaving although the clinical course of organophosphate poisoning might be quite severe and necessitate intensive care management [10]. Thus, in such poisoning cases, rapid toxicological screening is necessary for correct diagnosis.…”

Cholinesterase Reactivators: The Fate and Effects in the Organism Poisoned with Organophosphates/Nerve Agents

“…Thus, oximes are able to penetrate the BBB depending on its dose administered in vivo. The depression of central respiratory control centers in the pontomedullar area is considered as a primary event leading to death [54][55][56]. When the sufficient AChE reactivation is present in this area, good therapeutic effect was observed: survival of intoxicated animals correlated with the AChE activity in pontomedullar area [9,38].…”

“…However, the activity determined in the whole brain homogenate can be considered as a "mean" of the AChE activities in different brain structures. In this connection, special importance can be focused to pontomedullar area where the respiration is regulated [54] by cholinergic neurons [55][56][57]. Though in the whole brain homogenate a reactivation was not observed [52,53], selective AChE reactivation was demonstrated in different brain parts, in particular pontomedullar area containing i.a.…”

Cholinergic properties of new 7-methoxytacrine-donepezil derivatives

“…After organophosphate intoxication, the overstimulation of the muscle type of nAChR that occurs at the motor end-plate in respiratory and other muscles (Sungur et al 2001) is followed by fasciculation and weakness, eventually resulting in asphyxiation. Thus, the hypothesis of using a nAChR antagonist was developed.…”