Management of OPC and Carbamate Poisoning in Intensive Care Unit of Enam Medical College & Hospital, Savar, Dhaka

Abstract

Background:Bangladesh is an agriculture-dependent country. Organophosphorus insecticides are widely used for the better outcome of cultivation. It is used for suicidal purpose due to its easy availability all over the country. Worldwide, acute pesticide poisoning is causing major health problems with high mortality in developing countries. Objective: The objective of our study was to establish that early management of acute poisoning with organophosphorus and carbamate in ICU along with ventilatory support in severe respiratory distress reduces the mortality rate. Total 84 patients with acute poisoning cases were selected. The diagnosis was confirmed by the history of ingestion of insecticides, observing clinical signs and symptoms and presence of foul smelling of poisonous agent. Management included supportive care, intubation, artificial ventilation in selective cases, administration of antidotes as loading and maintenance dose for atropinization with atropine and pralidoxime, antibiotics, anti-ulcerant, anticonvulsant, inotropic support (in severe hypotension) along with other symptomatic treatment. After stabilization, decontamination was started with removal of contaminated clothes, thorough wash with soap and water, irrigation of eyes with water and normal saline. Gastric lavage was given within 2 to 3 hours of ingestion of poison. Results: Acute poisoning was observed more in male (60.71%) than in female (39.29%) and in age group of 21-40 years (60.71%). Suicidal attempt was present in 97.61% cases and causes of suicidal poisoning were familial disharmony (76.19%), financial loss (14.28%) and failure in examination (9.52%). Organophosphate group poison ingestion was in 77.38% cases and carbamate group poison in 21.43% and both agents in 1.19% cases. Ventilatory support was given in 48.80% cases and 78.05% patients were successfully extubated from mechanical ventilator. Mean duration of ventilatory support was 2-14 days. Out of 84 patients, 75 (89.28%) survived and 9 (10.72%) patients expired. Fifty two (61.91%) patients were discharged within 4-6 days, 16 (19.04%) within 2-3 days, and 7 (8.33%) patients were discharged within 7-14 days. Conclusion: Early ICU admission and appropriate management of patients after ingestion of poisonous agent results in reduced morbidity and mortality.

Clinico-demoghraphic profile and outcome of critically ill poisoning patient admitted in the ICU of the largest tertiary care government hospital in Dhaka, Bangladesh

“…The female gender has been more victimized from acute poisoning than that of the male group, and the younger women are affected more in this study.The possible reasons behind this are due to emotional liability, cultural belief, and social circumstances. Some studies have reported female preponderance of deliberated selfpoisoning in Srilanka and Zimbabwe similar to our finding 7,11,21,22,26,27 . Generally, many studies have shown the male domination of acute poisoning in their analysis, which is similar to this observation 9,10,12,13 .…”

“…The most common route of poisoning was ingetion. There are many studies that have reported that organophosphorus compounds occupy the leading cause of acute poisoning 4,5,7,9,14,21,22,26,27 . This is due to easy availability of OPC in our society of agriculture-based country; even WHO has reported previously that use of pesticides is the most popular way of deliberating selfpoisoning worldwide, and it is estimated about one-third of the global suicides is resulting from the pesticides selfpoisoning 15 .…”

“…Easnem et al also showed Ventilator support was given in 48.80% cases and 51.2% cases were managed with oxygen support. Mean duration of ventilatory support was 2-14 days and mortality rate was 2.8%26 Mehrpour et al ,showed their study (41.2%) were intubated, and the mean duration of 8.53 ± 8.99 days, 17.6% died and 23.6% survived…”

Comparative analysis of organophosphorus versus carbamate pesticide poisoning: a case study

“…The IMS is characterised by muscle paralysis primarily affecting proximal, craniofacial, and respiratory muscles and may, in severe cases, end with respiratory arrest ( 20 , 21 ). However, the incidence of IMS in patients with carbamate poisoning is lower than that of organophosphorus poisoning ( 22 ).…”