Role of intravenous lipid emulsion therapy and packed red blood cell transfusion as adjuvant treatment in the management of a child with severe organophosphate poisoning (chlorpyrifos)

Abstract

A previously well 3-year-old child presented with rapidly deteriorating clinical status minutes after ingestion of an orange-coloured liquid housed in a soda bottle (HomeTrek—chlorpyrifos). She had miotic pupils, copious oral secretions, crackles on lung auscultation, hyperactive bowel sounds, impending signs of respiratory failure and declining sensorium. A diagnosis of severe organophosphate (OP) toxicity was made. Despite resuscitation and atropine administration, she deteriorated and exhibited atropine toxicity. She was given 20% intravenous lipid emulsion therapy and red blood cell (RBC) transfusion as adjunctive therapy with favourable outcome. She was discharged after 11 days and her RBC cholinesterase levels were 45% and 17% below normal, taken on day 10 and day 35 postingestion, respectively. She showed no signs of intermediate syndrome and delayed polyneuropathy. This case highlights the need for timely recognition of severe OP poisoning, and the role of lipid emulsion therapy and packed RBC transfusion as adjunctive treatment.

Comment on lipid emulsion for xenobiotic overdose

“…Email: mullinsm@wustl.edu T A B L E 1 Octanol-water coefficients (log P) for the organophosphates identified in Pannu et al 5 and in Chhabria et al 6 from the US National Library of Medicine (https://pubchem.ncbi.nlm.nih.gov/ last accessed 31 January 2023).…”

“…3,4 A recent case report described successful lipid emulsion treatment of poisoning by chlorpyrifos (log P = 4.96). 5 A pilot study of intravenous lipid emulsion in organophosphate poisoning in India indicated that lipid emulsion may be a safe therapeutic intervention in organophosphate poisoning, but the study lacked the power needed to evaluate for efficacy. 6 The same research group recently published an open-label, randomized control trial of lipid emulsion for organophosphate poisoning.…”