Toxic megacolon as a rare complication following atropine therapy due to organophosphate poisoning: A case report

Mostafazadeh, Babak; Farzaneh, Esmaeil; Paeezi, Maryam; Nikkhah, Farahnaz

doi:10.1177/0025817217703520

Cited by 5 publications

(5 citation statements)

References 4 publications

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“…In summary, these are the recommended indications to delay EN [11][12][13] . In addition, fearing of ileus caused by atropine might be one of the reasons of previously reported cases 6,8,9,21) . Moses et al 10) reported that atropinization precludes early EN because of atropine' s effect on gut motility, indicating possible mucosal injuries due to organophosphate and carbamate can be another reason not to start EN during atropinization 1,2) .…”

Section: Discussionmentioning

confidence: 98%

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Assessment and Methods of Nutritional Support during Atropinization in Organophosphate and Carbamate Poisoning Cases

Park¹,

Min²,

Choi³

et al. 2020

JKSCT

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Purpose: Atropine is an antidote used to relieve muscarinic symptoms in patients with organophosphate and carbamate poisoning. Nutritional support via the enteral nutrition (EN) route might be associated with improved clinical outcomes in critically ill patients. This study examined the administration of nutritional support in patients undergoing atropinization, including methods of supply, outcomes, and complications. Methods: A retrospective observational study was conducted in a tertiary care teaching hospital from 2010 to 2018. Forty-five patients, who were administered with atropine and on mechanical ventilation (MV) due to organophosphate or carbamate poisoning, were enrolled. Results: Nutritional support was initiated on the third day of hospitalization. Thirty-three patients (73.3%) were initially supported using parenteral nutrition (PN). During atropinization, 32 patients (71.1%) received nutritional support via EN (9) or PN (23). There was no obvious reason for not starting EN during atropinization (61.1%). Pneumonia was observed in both patient groups on EN and PN (p=0.049). Patients without nutritional support had a shorter MV duration (p=0.034) than patients with nutritional support. The methods of nutritional support during atropinization did not show differences in the number of hospital days (p=0.711), MV duration (p=0.933), duration of ICU stay (p=0.850), or recovery at discharge (p=0.197). Conclusion: Most patients undergoing atropinization were administered PN without obvious reasons to preclude EN. Nutritional support was not correlated with the treatment outcomes or pneumonia. From these results, it might be possible to choose EN in patients undergoing atropinization, but further studies will be necessary.

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Section: Discussionmentioning

confidence: 98%

“…A previous study reported that atropine delayed gastric emptying resulting in delayed mouth-to-ileum transit 6) . However, cases of ileus are rarely reported in commonly used dosages 8,9,21) . In addition, ileus might not be a critical complication of atropine.…”

Section: Discussionmentioning

confidence: 99%

Assessment and Methods of Nutritional Support during Atropinization in Organophosphate and Carbamate Poisoning Cases

Park¹,

Min²,

Choi³

et al. 2020

JKSCT

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“…Toxic megacolon developed form atropine intoxication: though incidence of atropine-associated toxic megacolon is very rare, however still few cases have reported such complication. These case reports suggested an involvement of atropine in the manifestation of toxic megacolon, (Mostafazadeh et al, 2017;Scharer et al, 1964;Mann et al, 1977). In the fi rst two cases, toxic megacolon developed after the administration of anticholinergic agent and was reversed after the discontinuation of the anticholinergic agent.…”

Section: Discussionmentioning

confidence: 99%

“…Although the pathophysiological bases of atropine involvement in toxic megacolon remain unclear, some theories suggest that anticholinergic agents, such as atropine, lead to gastrointestinal peristalsis inactivity and delay intestinal transit time which in turn may have caused toxic megacolon. (Mostafazadeh et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

Clinical uses and toxicity of Atropa belladonna; an evidence based comprehensive retrospective review (2003-2017)

Almubayedh¹,

Albannay²,

Alelq³

et al. 2018

Biosci. Biotech. Res. Comm

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Atropa belladonna (AB), commonly known as deadly nightshade is a poisonous plant which contains several alkaloids such as atropine and scopolamine etc. Any deliberate as well as unintentional ingestion of AB fruits, roots or leaves may result toxicity. Aim of the study: This study aims to present the clinical uses of atropine alongwith the adverse effects and toxicity associated with the use of atropine in the form of conventional or as herbal medication. A retrospective (2003-2017) literature was searched in various databases such as web of science, PubMed, google scholar, Scopus, E-Resource Portal of Imam Abdulrahman bin Faisal University etc. using the keywords i.e. AB, clinical uses of AB, adverse effects and cases reported with AB. Ten (10) cases met the eligibility criteria where the toxicity was mostly associated with the use of AB fruit, tablets and AB contaminated drinks. Major symptoms observed in these cases were related to Anticholinergic syndrome (ACS); tachycardia, dilated pupils, confusion, fl ushed dry skin, hallucinations and seizures in some cases alongwith a toxic megacolon. Furthermore, the treatment protocol used widely for ACS consisted of; gastric lavage and the use of Physostigmine as an antidote (antagonizes the central as well as peripheral toxicity of atropine). AB fruit revealed a vital role as anticholinergic drug, mydriatic agent and as an antidote for OP poisoning, however, its use deprived of medical supervision or in a large quantity, it may cause severe toxicity.

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“…, an acute gastric lesion shown in Figure 1 . Gastroscopy showed that there were many bulges in the mucosa of the stomach cavity, purulent secretions at the top, and obvious congestion in the surrounding mucosa (Figure 1B ), and edema in part of the descending duodenum (Figure 1C ); (2) Atropine, which was administered against poisoning, inhibited intestinal peristalsis and promoted the absorption of intestinal edema and toxins, further leading to an increased abdominal pressure (maximum: 27 cm H 2 O) and weakened bowel sounds[ 8 ]; (3) Severe poisoning caused serious hemodynamic changes and hypoxia. The concentration of lactic acid was 13.0 mmol/L, and therefore, a high dose of norepinephrine was administered to maintain blood pressure.…”

Section: Discussionmentioning

confidence: 99%

Duodenal perforation after organophosphorus poisoning: A case report

Lu¹,

Hu²,

Zhang³

et al. 2021

WJCC

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BACKGROUND Organophosphorus poisoning (OP) is one of the common critical conditions in emergency departments in China, which is usually caused by suicide by taking oral drugs. Patients with severe OP have disturbance of consciousness, respiratory failure, toxic shock, gastrointestinal dysfunction, and so on. As far as we know, the perforation of the duodenum caused by OP has not been reported yet. CASE SUMMARY A 33-year-old male patient suffered from acute severe OP, associated with abdominal pain. Multiple computed tomography scans of the upper abdomen showed no evidence of intestinal perforation. However, retrograde digital subtraction angiography, performed via an abdominal drainage tube, revealed duodenal perforation. After conservative treatment, the symptoms eased and the patient was discharged from hospital. CONCLUSION Clinicians should pay close attention to gastrointestinal dysfunction and abdominal signs in patients with severe OP. If clinical manifestation and vital signs cannot be explained by common complications, stress duodenal ulcer or perforation should be highly suspected.

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Toxic megacolon as a rare complication following atropine therapy due to organophosphate poisoning: A case report

Cited by 5 publications

References 4 publications

Assessment and Methods of Nutritional Support during Atropinization in Organophosphate and Carbamate Poisoning Cases

Assessment and Methods of Nutritional Support during Atropinization in Organophosphate and Carbamate Poisoning Cases

Clinical uses and toxicity of Atropa belladonna; an evidence based comprehensive retrospective review (2003-2017)

Duodenal perforation after organophosphorus poisoning: A case report

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