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Organophosphate Poisoning

Organic Phosphate Poisoning


Presentation

  • […] of presentation, or at weaning.[ncbi.nlm.nih.gov]
  • Initial glucose level at presentation, outcome and general clinical data were recorded.[ncbi.nlm.nih.gov]
  • Seven patients (41.2%) in the methomyl group presented with cardiac arrest, while none presented with cardiac arrest in the Class I organophosphate group (p 0.001).[ncbi.nlm.nih.gov]
  • He was diagnosed as a case of OPC poisoning and was treated with atropine and pralidoxime prior to presentation to our centre.[ncbi.nlm.nih.gov]
  • After a well-resolved cholinergic crisis, the patient developed clinical presentation of IMS within the first 72 h from deliberate malathion ingestion.[ncbi.nlm.nih.gov]
Weakness
  • Thus, IMS can be regarded as a spectrum disorder affecting the neuromuscular junction (NMJ) with two main forms: a forme fruste variety associated with mild weakness and the classical IMS with weakness of 3/5 or less than 3/5 on the Medical Research Council[ncbi.nlm.nih.gov]
  • She developed bulbar palsy, proximal muscle and respiratory weakness 3 day after the ingestion. Ventilation support was needed for 13 days before weaning was successful.[ncbi.nlm.nih.gov]
  • The signs of IMS were weakness of proximal limb muscles and muscles innervated by motor cranial nerves, followed by the weakness of respiratory muscles and serious respiratory insufficiency.[ncbi.nlm.nih.gov]
  • The patient required ventilatory support for 3 months during which time there was slow improvement in the diaphragmatic weakness, which by 6 months had resolved completely.[ncbi.nlm.nih.gov]
  • After surviving the initial critical period in the intensive care unit, he developed rapidly progressive distal weakness and sensory disturbance. Electrophysiological examinations revealed sensory motor axonal polyneuropathy.[ncbi.nlm.nih.gov]
Fatigue
  • Manifestations of Poisoning Muscarinic CNS -CNS stimulant effect leading to tremors, fatigue, drowsiness, confusion, Eye -Meiosis, blurring of vision, increased lacrimation GIT -Increased salivation, nausea, vomiting, diarrhea, Respiratory system -Respiratory[howmed.net]
  • […] muscle twitching agitation Moderate signs of organophosphate exposure include: very narrowed pupils dizziness disorientation coughing and wheezing sneezing difficulty breathing drooling or excessive phlegm muscle twitching and tremors muscle weakness fatigue[healthline.com]
  • When this occurs symptoms such as muscle weakness fatigue muscle cramps fasciculation paralysis tachycardia hypertension hypoglycemia anxiety headache convulsions ataxia depression of respiration and circulation tremor general weakness potential coma[intensivecarehotline.com]
  • The symptoms of organophosphate poisoning include muscle weakness, fatigue, muscle cramps, fasciculation, and paralysis. Other symptoms include hypertension, and hypoglycemia.[en.wikipedia.org]
  • Others have argued that the psychological and physical demands of the job confronted by day-laborers, including farmworkers, directly promote accidents and injuries through fatigue and distraction ( Kidd et al. 1996 ; Salazar et al. 2004 ; Thu 1998 ;[doi.org]
Gangrene
  • Cerebral infarcts and gangrene requiring a below knee amputation were complications of the poisonings. It is proposed that the ischemic complications are due to paradoxical vasoconstriction by acetylcholine at sites of endothelial injury.[ncbi.nlm.nih.gov]
Respiratory Distress
  • An autopsy confirmed the presence of adult respiratory distress syndrome and acute tubular necrosis.[ncbi.nlm.nih.gov]
  • Within 48 hours, patient developed respiratory distress needing intubation.[ncbi.nlm.nih.gov]
  • A 12-day-old infant girl was admitted with increasing lethargy and respiratory distress.[ncbi.nlm.nih.gov]
  • However, following partial recovery, he developed progressive acute respiratory distress syndrome characterized by irreversible fibrosis and obliteration of the lung parenchyma.[ncbi.nlm.nih.gov]
  • Isolated bilateral vocal cord paralysis (BVCP) should be excluded as a cause, if dysphonia or respiratory distress occurs after extubation in patients with intermediate syndrome. LEMG in such cases can be an important diagnostic adjunct.[ncbi.nlm.nih.gov]
Cough
  • Inhalation Eye contact• Cough • Irritation• Difficulty in breathing • Pain• Bronchitis • Lacrimation• Pneumonia • Miosis • Blurring vision • Photophobia 6. All the clinical features infrom head to Toe 7.[slideshare.net]
  • The patient can have wheezing, chest tightness, and productive cough. The bronchorrhea can be significant with frothy and/or bloody sputum and severe pulmonary oedema. Toxic myocardiopathy has been noted in some severe OP poisonings.[emergencymedicalparamedic.com]
  • […] pupils impaired, blurry vision stinging eyes runny nose watery eyes excess saliva glassy eyes headache nausea muscle weakness muscle twitching agitation Moderate signs of organophosphate exposure include: very narrowed pupils dizziness disorientation coughing[healthline.com]
Rhinorrhea
  • Central nervous system signs and symptoms Miosis (unilateral or bilateral) Headache Restlessness Convulsions Loss of consciousness Coma Respiratory signs and symptoms Rhinorrhea (perfuse watery runny nose) Bronchorrhea (excessive bronchial secretions)[emergency.cdc.gov]
  • Sweating and rhinorrhea also frequently are present. Weakness, fasciculations, incoordination, and GI distress all are markers of a worsening poisoned condition. Pulmonary oedema may be a late manifestation of OP poisoning.[emergencymedicalparamedic.com]
  • ., sweating, salivation, lacrimation, rhinorrhea, bronchorrhea); symptoms of a worsening state include muscle fasciculations, weakness, tremor, vomiting, abdominal cramps, and diarrhea.[clinicaladvisor.com]
Vomiting
  • On the same day the patient also developed severe upper abdominal pain along with nausea and vomiting.[ncbi.nlm.nih.gov]
  • A 42-year-old pregnant woman (26 weeks of gestation, G(4)P(0 3)) presented at the emergency department with a two-hour history of dizziness, blurred vision and repeated vomiting.[ncbi.nlm.nih.gov]
  • Decontamination should always be considered early, and the possibility of an ingested poison being vomited and causing a chemical spill should not be overlooked.[ncbi.nlm.nih.gov]
  • Signs and symptoms most frequently noted in patients with organophosphate or carbamate poisoning were perspiration, vomiting, and bronchorrhea. Abdominal pain was reported by 65.3% of the patients.[ncbi.nlm.nih.gov]
  • ., and Ashish Bhalla, M.D. 2 Citing Articles A 15-year-old boy who lived with his family on a farm presented to the emergency department with a 1-day history of vomiting, diarrhea, and altered sensorium.[nejm.org]
Diarrhea
  • Atropine sulphate was administered intravenously in repeated doses to all children with bradycardia, diarrhea, salivation, and miosis.[journals.lww.com]
  • ., and Ashish Bhalla, M.D. 2 Citing Articles A 15-year-old boy who lived with his family on a farm presented to the emergency department with a 1-day history of vomiting, diarrhea, and altered sensorium.[nejm.org]
  • Organophosphate poisoning Pathology Type Toxin Cause(s) Exposure to pesticides Symptoms Excessive salivation, excessive tear production, uncontrolled or excessive urination, diarrhea, nausea, vommiting.[house.wikia.com]
  • Excess acetylcholine produces a predictable cholinergic syndrome consisting of copious respiratory and oral secretions, diarrhea and vomiting, sweating, altered mental status, autonomic instability, and generalized weakness that can progress to paralysis[emergency.cdc.gov]
Nausea
  • On the same day the patient also developed severe upper abdominal pain along with nausea and vomiting.[ncbi.nlm.nih.gov]
  • Organophosphate poisoning Pathology Type Toxin Cause(s) Exposure to pesticides Symptoms Excessive salivation, excessive tear production, uncontrolled or excessive urination, diarrhea, nausea, vommiting.[house.wikia.com]
  • Gastrointestinal symptoms such as nausea, vomiting, and fecal and urinary incontinence, cardiac symptoms such as hypotension, bradycardia, and tearing, drooling, and miosis Children younger than what age are at the greatest risk for accidental poisonings[quizlet.com]
  • Manifestations of Poisoning Muscarinic CNS -CNS stimulant effect leading to tremors, fatigue, drowsiness, confusion, Eye -Meiosis, blurring of vision, increased lacrimation GIT -Increased salivation, nausea, vomiting, diarrhea, Respiratory system -Respiratory[howmed.net]
  • Bradycardia (decreased heart rate) – late (decreased heart rate) Hypotension (low blood pressure) – late (low blood pressure) Arrhythmias Dysrhythmias (prolonged QT on EKG, ventricular tachycardia) Gastrointestinal signs and symptoms Abdominal pain Nausea[emergency.cdc.gov]
Abdominal Pain
  • Abdominal pain was reported by 65.3% of the patients. Abdominal ultrasonography was performed in 22 patients who complained of abdominal pain as a leading symptom. Among these, 63.6% were found to have abdominal free fluid.[ncbi.nlm.nih.gov]
  • We report here the case of a 73-year-old man who had repeated abdominal pain during and after the treatment of acute OP. Hyperamylasemia and a 7-cm pseudocyst in the pancreatic tail were noted on investigations.[ncbi.nlm.nih.gov]
  • On the same day the patient also developed severe upper abdominal pain along with nausea and vomiting.[ncbi.nlm.nih.gov]
  • […] blood pressure) Bradycardia (decreased heart rate) – late (decreased heart rate) Hypotension (low blood pressure) – late (low blood pressure) Arrhythmias Dysrhythmias (prolonged QT on EKG, ventricular tachycardia) Gastrointestinal signs and symptoms Abdominal[emergency.cdc.gov]
Upper Abdominal Pain
  • On the same day the patient also developed severe upper abdominal pain along with nausea and vomiting.[ncbi.nlm.nih.gov]
Hypersalivation
  • She had vomiting, excessive retching, diarrhoea, miosis, hypersalivation and bilateral crepitation on chest during admission. After immediate resuscitation, atropinization was done and it required total of 36 milligram.[ncbi.nlm.nih.gov]
  • The most frequent clinical signs were meiosis, change in mental status, hypersalivation, agitation and fasciculations (Table 2 ).[ccforum.biomedcentral.com]
  • Signs and symptoms include lacrimation, hypersalivation, bronchial hypersecretion and bronchoconstriction, urination and defecation, skeletal muscle fasciculation and twitching, ataxia, respiratory failure, convulsions, hypothermia and death.[web.archive.org]
Hypotension
  • RESULTS: The incidence of hypotension in patients with prolonged QTc intervals was higher than that in the patients with normal QTc intervals (P   0.019).[ncbi.nlm.nih.gov]
  • A 19-year-old man with an alleged history of suicidal ingestion of a pesticide presented with drowsiness and was found to have constricted pupils, hypotension and bradycardia.[ncbi.nlm.nih.gov]
  • We report severe organophosphate poisoning complicated by hypotension and ischemic sequelae in two patients with pre-existing vascular disease.[ncbi.nlm.nih.gov]
  • On initial assessment, he was drowsy and had tachypnea and hypotension. Auscultation of the lungs revealed diffuse crepitations. His pupils were reactive, equal in size, and mildly constricted (4 mm in diameter).[nejm.org]
  • Gastrointestinal symptoms such as nausea, vomiting, and fecal and urinary incontinence, cardiac symptoms such as hypotension, bradycardia, and tearing, drooling, and miosis Children younger than what age are at the greatest risk for accidental poisonings[quizlet.com]
Tachycardia
  • On Holter monitoring, episodic tachycardia and ST-T changes were observed in four, QT prolongation in three, and episodic bradycardia in two.[ncbi.nlm.nih.gov]
  • The most common electrocardiographic abnormalities observed in organophosphate poisoning are sinus tachycardia, QT interval prolongation, and, very rarely, ventricular arrhythmias.[ncbi.nlm.nih.gov]
  • Sinus tachycardia was noted initially by ECG and Q-T interval prolongation with pleomorphic ventricular tachyarrhythmia ('Torsade de pointes') occurred on the third day of admission. 3.[ncbi.nlm.nih.gov]
  • Cardiac arrhythmias are often observed in the acute phase of toxicity; late onset polymorphic ventricular tachycardia preceded by prolonged QT interval on the EKG is also known to occur.[ncbi.nlm.nih.gov]
  • Tachycardia and mydriasis must not be used to limit or to stop subsequent doses of atropine. The main concern with OP toxicity is respiratory failure from excessive airway secretions.[openanesthesia.org]
Hypertension
  • Each OP poisoning patient was frequency-matched to 4 control patients based on age, sex, index year, and comorbidities of diabetes, hypertension, hyperlipidemia, chronic obstructive pulmonary disease, coronary artery disease, and stroke (N 35,696).[ncbi.nlm.nih.gov]
  • […] respiratory rate/depth) – early (increased respiratory rate/depth) Bradypnea (decreased respiratory rate) – late (decreased respiratory rate) Cardiovascular signs resulting from blood loss Tachycardia (increased heart rate) – early (increased heart rate) Hypertension[emergency.cdc.gov]
  • Bradycardia is the usual cardiac sign, but there can be tachycardia and hypertension from nicotinic, sympathetic stimulation.[emergencymedicalparamedic.com]
  • A wide range of other symptoms may also be noted, including incontinence, defecation, tachycardia, bradycardia, hypertension, cramping of skeletal muscles, bronchospasm, and pulmonary edema.[clinicaladvisor.com]
Vascular Disease
  • We report severe organophosphate poisoning complicated by hypotension and ischemic sequelae in two patients with pre-existing vascular disease.[ncbi.nlm.nih.gov]
Miosis
  • Human poisoning due to amitraz may be misdiagnosed as organophosphate/carbamate (OPC) toxicity, since amitraz poisoning shares several clinical features (miosis, bradycardia and hypotension) encountered with OPC poisoning.[ncbi.nlm.nih.gov]
  • Clinical features of organophosphate poisoning are defecation, urination, miosis, bronchorrhea, emesis, lacrimation and salivation. Spontaneous abortion reported some when in pregnant patients.[ncbi.nlm.nih.gov]
  • After a deliberate ingestion of malathion, a 55-year-old male suffering from miosis, somnolence, bradycardia, muscular fasciculations, rales on auscultation, respiratory insufficiency, as well as from an inhibition of red blood cell acetylcholinesterase[ncbi.nlm.nih.gov]
  • On admission, she was unconscious and demonstrated convulsions, depressed respiratory movements, miosis and profuse salivation. Plasma cholinesterase concentration (842 IU.L-1) was very low and OPP was diagnosed.[ncbi.nlm.nih.gov]
  • She had vomiting, excessive retching, diarrhoea, miosis, hypersalivation and bilateral crepitation on chest during admission. After immediate resuscitation, atropinization was done and it required total of 36 milligram.[ncbi.nlm.nih.gov]
Lacrimation
  • Clinical features of organophosphate poisoning are defecation, urination, miosis, bronchorrhea, emesis, lacrimation and salivation. Spontaneous abortion reported some when in pregnant patients.[ncbi.nlm.nih.gov]
  • The typical toxidrome in organophosphate (OP) poisoning comprises of the Salivation, Lacrimation, Urination, Defecation, Gastric cramps, Emesis (SLUDGE) symptoms. However, several other manifestations are described.[ncbi.nlm.nih.gov]
  • SLUDGE stands for: salivation, lacrimation, urination, defication, GIT disturbances, and emesis.[emergencymedicalparamedic.com]
  • Inhalation Eye contact• Cough • Irritation• Difficulty in breathing • Pain• Bronchitis • Lacrimation• Pneumonia • Miosis • Blurring vision • Photophobia 6. All the clinical features infrom head to Toe 7.[slideshare.net]
  • , salivation SLUDGE: salivation, lacrimation, urination, defaecation, emesis INVESTIGATIONS butyrylcholinesterase or acetylcholinesterase activity MANAGEMENT Resuscitation aspiration/bronchospasm/seizures may necessitate airway protection and mechanical[lifeinthefastlane.com]
Blurred Vision
  • A 42-year-old pregnant woman (26 weeks of gestation, G(4)P(0 3)) presented at the emergency department with a two-hour history of dizziness, blurred vision and repeated vomiting.[ncbi.nlm.nih.gov]
  • Signs and Symptoms Muscarinic signs (SLUDGE) salivation, lacrimation, urination, diaphoresis, gastrointestinal upset, emesis and progressing to bronchospasm, bronchorrhea, blurred vision, bradycardia or tachycardia, hypotension, confusion, and shock.[openanesthesia.org]
  • Signs of specific muscarinic stimulation include those which are indicative of parasympathetic stimulation such as: miosis, blurred vision, increased secretions, decreased heart rate, bronchoconstriction, nausea, vomiting, abdominal cramps, incontinence[emergencymedicalparamedic.com]
  • Signs and symptoms of cholinesterase inhibition from exposure to CMs or OPs include the following: In mild cases (within 4 - 24 hours of contact): tiredness, weakness, dizziness, nausea and blurred vision; In moderate cases (within 4 - 24 hours of contact[pmep.cce.cornell.edu]
Muscle Cramp
  • When this occurs symptoms such as muscle weakness fatigue muscle cramps fasciculation paralysis tachycardia hypertension hypoglycemia anxiety headache convulsions ataxia depression of respiration and circulation tremor general weakness potential coma[intensivecarehotline.com]
  • The symptoms of organophosphate poisoning include muscle weakness, fatigue, muscle cramps, fasciculation, and paralysis. Other symptoms include hypertension, and hypoglycemia.[en.wikipedia.org]
Muscle Twitch
  • […] include: very narrowed pupils dizziness disorientation coughing and wheezing sneezing difficulty breathing drooling or excessive phlegm muscle twitching and tremors muscle weakness fatigue severe vomiting and diarrhea involuntary urination and defecation[healthline.com]
  • twitching• Bradycardia• Cardiac arrhythmia• Diarrhoea• Vomiting• Salaivation• Tenesmus• Miosis• Lacrimation• Blurred vision 4.[slideshare.net]
Emotional Lability
  • Two patients with organophosphate poisoning are described, both exhibiting marked choreiform dyskinesias and one experiencing severe depression and emotional lability. Both responded well to the appropriate treatment.[ncbi.nlm.nih.gov]
Incontinence
  • Faecal incontinence is a debilitating condition. Sacral neuromodulation may have a role in the treatment of faecal incontinence.[ncbi.nlm.nih.gov]
  • Gastrointestinal symptoms such as nausea, vomiting, and fecal and urinary incontinence, cardiac symptoms such as hypotension, bradycardia, and tearing, drooling, and miosis Children younger than what age are at the greatest risk for accidental poisonings[quizlet.com]
  • […] late (decreased heart rate) Hypotension (low blood pressure) – late (low blood pressure) Arrhythmias Dysrhythmias (prolonged QT on EKG, ventricular tachycardia) Gastrointestinal signs and symptoms Abdominal pain Nausea & and vomiting Diarrhea Urinary incontinence[emergency.cdc.gov]
  • Signs of specific muscarinic stimulation include those which are indicative of parasympathetic stimulation such as: miosis, blurred vision, increased secretions, decreased heart rate, bronchoconstriction, nausea, vomiting, abdominal cramps, incontinence[emergencymedicalparamedic.com]
  • A wide range of other symptoms may also be noted, including incontinence, defecation, tachycardia, bradycardia, hypertension, cramping of skeletal muscles, bronchospasm, and pulmonary edema.[clinicaladvisor.com]
Seizure
  • Abstract After cutaneous application of the organophosphate insecticide Diazinon for pubic lice, our patient had symptoms of cholinergic excess, lost consciousness, and had a seizure.[ncbi.nlm.nih.gov]
  • […] miosis, bronchorhea, bradycardia, emesis, lacrimation, salivation SLUDGE: salivation, lacrimation, urination, defaecation, emesis INVESTIGATIONS butyrylcholinesterase or acetylcholinesterase activity MANAGEMENT Resuscitation aspiration/bronchospasm/seizures[lifeinthefastlane.com]
  • Benzodiazepines are used for seizures. Prophylactic diazepam may help prevent neurocognitive sequelae after moderate to severe organophosphate poisoning.[msdmanuals.com]
  • Miosis (73%), excessive salivation (70%), muscle weakness (68%), and lethargy (54%) were the most common abnormal signs; 49% and 22% of patients had tachycardia and seizures, respectively, and 38% of children had respiratory insufficiency that required[pediatrics.aappublications.org]
Confusion
  • Nicotinic and muscarinic Ach receptors in theAch receptors in the CNS sympathetic system• Confusion • Excessive sweating• Agitation Other effects• Respiratory failure• Ataxia • hyperglycaemia• convulsion • Acute pancreatitis 5.[slideshare.net]
  • Diagnosis is usually based on a history of exposure, with characteristic signs of cholinergic excess, but can be difficult when the patient is inadvertently exposed or is unconscious or confused.[bestpractice.bmj.com]
  • Confusion, anxiety, restlessness and toxic psychosis can occur and there have been reports of memory loss and depression. The benefits and limitations of atropine as a treatment strategy in organophosphate poisoning.[emergencymedicalparamedic.com]
  • Manifestations of Poisoning Muscarinic CNS -CNS stimulant effect leading to tremors, fatigue, drowsiness, confusion, Eye -Meiosis, blurring of vision, increased lacrimation GIT -Increased salivation, nausea, vomiting, diarrhea, Respiratory system -Respiratory[howmed.net]
  • Abou-Donia's latter point is particularly important, as some of the fume events investigated saw one pilot react badly to the neurotoxins while the other was apparently unaffected, which led to confusion.[flightglobal.com]
Tremor
  • The presence of rigidity, tremors, dystonia and chorea were assessed daily till discharge using modifications of the Unified Parkinson's Disease rating scale and the Tremor rating scale.[ncbi.nlm.nih.gov]
  • Extrapyramidal symptoms occurred between 5 and 15 d and were characterized by dystonia of arms and legs, resting tremor, cogwheel rigidity, and hypereflexia.[ncbi.nlm.nih.gov]
  • Manifestations of Poisoning Muscarinic CNS -CNS stimulant effect leading to tremors, fatigue, drowsiness, confusion, Eye -Meiosis, blurring of vision, increased lacrimation GIT -Increased salivation, nausea, vomiting, diarrhea, Respiratory system -Respiratory[howmed.net]
  • […] nausea muscle weakness muscle twitching agitation Moderate signs of organophosphate exposure include: very narrowed pupils dizziness disorientation coughing and wheezing sneezing difficulty breathing drooling or excessive phlegm muscle twitching and tremors[healthline.com]
Headache
  • Sometimes the farmer just has a bit of a headache, feels unusually tired or finds he can't think clearly. This may just last a few hours to a few days and the sufferer recovers completely.[drmyhill.co.uk]
  • The symptoms included headaches, loss of memory and numbness in his limbs. He was grounded on full pay in September 2011, and consultation with a neurologist in Amsterdam followed.[flightglobal.com]
  • Central nervous system signs and symptoms Miosis (unilateral or bilateral) Headache Restlessness Convulsions Loss of consciousness Coma Respiratory signs and symptoms Rhinorrhea (perfuse watery runny nose) Bronchorrhea (excessive bronchial secretions)[emergency.cdc.gov]
  • Dizziness, headache and the SLUDGE syndrome of salivation, lacrimation, urination, defecation, GI upset and emesis are some of the common early symptoms reported. Sweating and rhinorrhea also frequently are present.[emergencymedicalparamedic.com]
  • Mild organophosphate exposure may cause: narrowed, pinpointed pupils impaired, blurry vision stinging eyes runny nose watery eyes excess saliva glassy eyes headache nausea muscle weakness muscle twitching agitation Moderate signs of organophosphate exposure[healthline.com]
Lethargy
  • A 12-day-old infant girl was admitted with increasing lethargy and respiratory distress.[ncbi.nlm.nih.gov]
  • Miosis (73%), excessive salivation (70%), muscle weakness (68%), and lethargy (54%) were the most common abnormal signs; 49% and 22% of patients had tachycardia and seizures, respectively, and 38% of children had respiratory insufficiency that required[pediatrics.aappublications.org]
  • CNS toxicity is common, sometimes with seizures and excitability and often with lethargy and coma. Pancreatitis is possible, and organophosphates may cause arrhythmias such as heart block and QTc interval prolongation.[msdmanuals.com]
  • ., lethargy, coma) are more commonly observed, along with flaccid muscle weakness, miosis, and excessive salivation. Conversely, bradycardia, muscular fasciculations, lacrimation, and sweating are less common than in adult patients.[clinicaladvisor.com]

Workup

Neurophysiologic Abnormalities
  • There is also a need to study the effect of oximes on the neurophysiological abnormalities.[ncbi.nlm.nih.gov]
Narrow QRS Complex
  • We report a case of organophosphate poisoning associated with atrial fibrillation, right bundle branch block, QT interval prolongation, and intermittent narrow QRS complexes that were most likely due to automaticity from the region of the left posterior[ncbi.nlm.nih.gov]
Pancreatic Necrosis
  • We report two cases of severe acute pancreatitis complicated by pancreatic necrosis and retroperitoneal sepsis in which the diagnosis was obscured by the systemic effects of organophosphate toxicity.[ncbi.nlm.nih.gov]

Treatment

  • The patient accepted treatment with pralidoxime (PAM), atropine, and supporting therapy. It was observed that even after 22 h after treatment, 960 mg of atropine was not enough for the patient to be atropinized.[ncbi.nlm.nih.gov]
  • Despite improvements to intensive care management and specific pharmacological treatments (atropine, oxime, diazepam), the mortality associated with organophosphate (OP) poisoning has not substantially decreased.[ncbi.nlm.nih.gov]
  • The aim of the study was to assess the impact of plasmapheresis treatment in the management of three pediatric patients with organophosphate poisoning who did not respond to standard treatment.[ncbi.nlm.nih.gov]
  • Initial treatment was for pneumonia but deterioration despite appropriate treatment prompted review of her diagnosis and consideration of organophosphate poisoning. There was a brisk response to atropine.[ncbi.nlm.nih.gov]
  • We report two cases of survival after "in-the field" antidote treatment of very severe organophosphate poisonings.[ncbi.nlm.nih.gov]

Prognosis

  • Awareness of this complication should prompt earlier investigation because early diagnosis coupled with timely therapeutic measures may improve patient prognosis.[ncbi.nlm.nih.gov]
  • Clinician awareness is key to successful management of this poisoning, which carries a good prognosis. 2015 BMJ Publishing Group Ltd.[ncbi.nlm.nih.gov]
  • However, ECG findings, such as prolonged QTc interval, are not effective in determination of short-term prognosis and show no relationship with PSS.[ncbi.nlm.nih.gov]
  • Early diagnosis of complications and timely therapeutic measures can improve prognosis.[ncbi.nlm.nih.gov]
  • Previous reports indicate that in contrast to normal heart rate-corrected QT intervals (QTc), QTc prolongation might be indicative of a poor prognosis for patients exposed to organophosphates.[ncbi.nlm.nih.gov]

Etiology

  • Acute kidney injury as a direct complication of organophosphate poisoning has rarely been described and its etiology is unclear.[ncbi.nlm.nih.gov]
  • No etiological factor for acute pancreatitis was evident. We diagnosed complication of organophosphate-induced acute pancreatitis.[ncbi.nlm.nih.gov]
  • Intermediate syndrome (IMS) was described a few decades ago, however, there is still a controversy regard ing its exact etiology, risk factors, diagnostic parameters and required therapy.[ncbi.nlm.nih.gov]
  • The exact etiology, incidence, and risk factors associated with IMS are not well understood, but IMS is recognized as a disorder of neuromuscular junctions. IMS occurs when a person has a prolonged and severe inhibition of AChE.[en.wikipedia.org]
  • The lack of diagnostic support for infection coupled with the expanded exposure history allowed identification of the underlying etiology of acute pesticide poisoning.[depts.washington.edu]

Epidemiology

  • Describes everything you need to know about Organophosphates and Carbamates Extensively covers pesticides, nerve agents, therapeutic drugs, and flame retardants Describes epidemiology of the world's major disasters involving Organophosphates and Carbamates[books.google.de]
  • Seite 69 - Epidemiology is defined as the study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to control of health problems. ‎[books.google.de]
  • International Epidemiological Association, 29, 510 – 515. Goldstein, G., Beers, S.R., Morrow, L.A., Shemanski, W.J., & Steinhauer, S.R. ( 1996 ). A preliminary neuropsychological study of Persian Gulf War veterans.[doi.org]
  • Part 2: An Epidemiological Perspective".[web.archive.org]
  • Most people who are exposed to pesticides are exposed to more than one simultaneously, Eskenazi says, "so it's really hard to say that a single agent is the 'cause' of an observed health problem in human epidemiologic studies."[web.archive.org]
Sex distribution
Age distribution

Pathophysiology

  • The pathophysiological basis for the clinical manifestations of OP poisoning is inactivation of the enzyme, acetylcholinesterase at the peripheral nicotinic and muscarinic and central nervous system (CNS) nerve terminals and junctions.[ncbi.nlm.nih.gov]
  • BACKGROUND: Respiratory failure in acute organophosphate (OP) poisoning can occur early and also relatively late in the clinical course, and the pathophysiology of respiratory failure at these different phases may have important clinical implications.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: Reviewing the anatomical and the functional structure of the NMJ and neuromuscular transmission helps to provide an understanding of the pathophysiological nature of the neuromuscular transmission failure observed in IMS.[ncbi.nlm.nih.gov]
  • Because of this, paramedics must thoroughly understand the pathophysiology and signs and symptoms of organophosphate poisoning. Organophosphates are found in pesticides, herbicides and nerve gas.[emergencymedicalparamedic.com]
  • Specifically, they aim to define the pathophysiology of IMS, which was initially described in 1987 as an illness occurring after the resolution of acute cholinergic crises and associated with proximal muscle weakness [ 2 ].[journals.plos.org]

Prevention

  • Continuous pralidoxime methylsulphate infusion with atro pine did not prevent the development of IMS, most likely due to the delayed treatment and insufficient oxime dose but also because of chemical structure and lipophilicity of ingested OPI.[ncbi.nlm.nih.gov]
  • Future studies are encouraged to evaluate whether long-term effects exist and the best guideline to prevent the continuously impaired renal function.[ncbi.nlm.nih.gov]
  • Positive finding of the hypothesis will open possibility of using incretin based treatment modalities to treat or prevent acute OP induced disruption of glucose homeostasis. Copyright 2016 Elsevier Ltd. All rights reserved.[ncbi.nlm.nih.gov]
  • In severe cases, doctors often prescribe benzodiazepines to prevent or stop seizures.[healthline.com]
  • The interventions did not affect ventilatory requirements (14/19 vs. 15/20 vs. 14/19) or prevent delayed intubation.[ncbi.nlm.nih.gov]

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