Management of exogenous intoxication by carbamates and organophosphates at an emergency unit / Manejo de intoxicação exógena por carbamatos e organofosforados em uma unidade de emergência

Summary Objectives: to evaluate and indicate the procedure to be followed in the health unit, both for diagnosis and the treatment of acute exogenous intoxications by carbamates or organophosphates. Methods: a descriptive study based on retrospective analysis of the clinical history of patients diagnosed with intoxication by carbamates or organophosphates admitted at the emergency unit of the Hospital de Urgências de Sergipe Governador João Alves (HUSE) between January and December of 2012. Some criteria were evaluated, such as: intoxicating agent; patient's age and gender; place of event, cause, circumstances and severity of the intoxication; as well as signs and symptoms of the muscarinic, nicotinic and neurological effects. Results: seventy patients (average age: 25±19.97) formed the study's population. It was observed that 77.14% of them suffered carbamate intoxication. However, organophosphate intoxications were more severe, with 68.75% of patients presenting moderate to severe forms. Suicide attempt was the leading cause of poisoning, with 62 cases (88.57% of total). Atropine administration was an effective therapeutic approach for treating signs and symptoms, which included sialorrhea (p=0.0006), nausea (p=0. 0029) and emesis (p lt0.0001). The use of activated charcoal was shown effective, both in combating the signs and symptoms presented by both patient groups (p <0.0001). Conclusion: it is concluded that the use of atropine and activated charcoal is highly effective to treat the signs and symptoms developed by patients presenting acute exogenous intoxication by carbamates or organophosphates.

Resumo Objetivo: avaliar e indicar os procedimentos a serem seguidos na unidade de saúde tanto para o diagnóstico como para o tratamento de intoxicações agudas exógenas por carbamatos ou organofosforados. Métodos: estudo descritivo baseado na análise retrospectiva da história clínica de pacientes diagnosticados com intoxicação por carbamatos ou organofosforados admitidos em uma unidade de emergência, entre janeiro e dezembro de 2012. Foram avaliados alguns critérios, como: agente intoxicador; idade do paciente e gênero; causa de envolvimento, circunstâncias e gravidade da intoxicação; sinais e sintomas dos efeitos neurológicos muscarínicos e nicotínicos. Resultados: setenta pacientes (idade média: 25±19,97 anos) formaram a população de estudo. Foi observado que 77,14% deles sofreram intoxicação por carbamatos. Os casos mais graves foram intoxicados por organofosforados, com 68,75% dos pacientes apresentando formas moderadas a graves. Tentativa de suicídio foi a causa principal de envenenamento, com 62 casos (88,57% do total). A administração de atropina foi uma medida terapêutica efetiva para tratamento de sinais e sintomas, como sialorreia (p=0,0006), náusea (p=0,0029) e êmese (p<0,0001). O uso do carvão ativado mostrou efetividade para o combate dos sinais e sintomas apresentados por pacientes em geral (p<0,0001). Conclusão: o uso de atropina e de carvão ativado é uma medida terapêutica altamente efetiva para combater os sinais e sintomas apresentados por pacientes vítimas de intoxicação aguda exógena por carbamatos ou organofosforados.

Study of Acetyl Cholinesterase, Butyryl Cholinestrase and β - Glucuronidase in Organophosphorus Poisoning.

Organophosphorus poisoning is common problem throughout the world. It occurs due to accidental exposure; suicidal and homicidal attempt. Many deaths occur within hours of ingestion of organophosphorus compounds like pesticides. For its prevention, speedy diagnosis and prompt treatment is required; which requires sensitive marker/s. The aim of this study was to find such marker/s. In this regard, activities of Acetylcholinesterase, Butyrylcholinesterase and β-glucuronidase were estimated in 80 samples including 40 controls and 40 organophosphorus poisoning cases (mild = 07, moderate = 19 and severe = 14). Results indicated that activities of Acetylcholinesterase and Butyrylcholinestrase decrease in mild, moderate and severe Organophosphorus poisoning in proportionate manner whereas, β-glucuronidase activity increases as severity of Organophosphorus poisoning progresses. Thus, all the three enzymes showed alterations in their activities however, the degree of change in activity was maximum in case of Acetylcholinesterase. Thus, Acetylcholinesterase activity is the most sensitive marker amongst three enzymes in Organophosphorus poisoning.

Laboratory Abnormalities in Patients with Organophosphorous Poisoning.

Organophosphorous (OP) poisoning is an ever increasing and troublesome situation in the developing countries and is a major health care challenge in the 21st century. Hundred patients who attempted suicide with organophosphates, admitted to the emergency services were included in the study. They were graded (grade 0,1,2,3) according to clinical findings and examined for parameters like RBS, serum urea, serum creatinine, liver function tests, serum amylase, serum cholinesterase and LDH . The APACHE (II) of the cases were determined and correlated with severity of the clinical manifestations. A significant decline in serum cholinesterase (ChE) with increasing grades of intoxication(p <0.05) was observed along with raised levels of random blood sugar, serum urea, creatinine, hepatic enzymes and amylase. APACHE(II) score, showed a significant rise with severity of the degree of intoxication (p<0.001) and a negative correlation with serum cholinesterase. The findings of this study highlighted usefulness of biochemical and clinical indices in the management of organophosphorous poisoning thereby recognizing the complications early and facilitating early management.

The pattern of poisoning in khammam.

This study was undertaken to study the patterns of poisoning cases admitted at Mamata General Hospital Khammam, Andhra Pradesh from June 2005 to June 2010. The poisoning was common mode of suicide and one of the common causes of death in developing countries, particularly in agricultural workers. The emphasis was given on age, sex, socioeconomic status, etc. type and mode of poisoning. Organophosphate compounds were the most commonly 74.10% abused substance. The common motive of poisoning was suicidal 93.43% in both male 85.85% and female 14.14% with male to female ratio 6.07: 1%. Peak incidence was observed in the age group 21-30 years 50.59% and majority were from Hindu community 90.83% as compared to other community. The overall mortality of poisoning is 17.33%. Majority 366 (72.90%) were consumed the approximate amount of poison is 400-500 ml and maximum number of deaths 74 985.05%) are associated with highly toxic amount of 400-500ml of poison consumed. The study observed increasing trend of suicide by organophosphate compounds and rat poison ,whereas other poisons for committing suicide are less commonly used and here with–reflecting the pattern of poisoning in Khammam.

A study of serum cholinesterase levels in organo phosphorous poisoning cases.

The study period is 11 months that is from 01-01-2007 to 28-11-2007, 35 cases of organ phosphorus poisoning were admitted at Mamata General Hospital, khammam, Andhra Pradesh, India. The cases were studied on various epidemiological parameters and Proforma prepared for detailed data. In our study the majority of victims were males, married, Hindu, Literate, from rural area, medium socioeconomic group and common age of victims is 21 to 30 years. The common mode of poisoning is suicidal, one is accidental poison in child and one is occupational as contact poison while spraying .No homicidal poison was reported in our study. Majority victims have consumed poison in day time, commonly abused poison is monochrotophos, and approximate amount of poison consumed by majority of the victims is 250 ml to 500 ml and majority were admitted within 3 to 6 hours of consumption of poison. The common motive of poisoning was suicidal in both male [24 cases] and female [10 cases], especially young victims from rural domicile with agricultural occupation. The majority of victims consumed poison in summer followed by winter season. The probable reason is rain dependent agricultural occupation, unemployment, joint family and medium socioeconomic status of population of this area.

An epidemiological study of organophosphorus poisoning at manipal teaching hospital, Pokhara, Nepal.

Organophosphorus compounds are chemical compounds containing carbon-phosphorus bonds (apart from phosphate and phosphite esters), primarily used in pest control and are often persistent organic pollutants. Acute poisoning by organophosphorus (OP) compounds is a major global clinical problem, with thousands of deaths occurring every year in Nepal. Most of these pesticide poisoning and subsequent deaths occur due to deliberate self ingestion of the poison. Sixty five patients with severe organophosphorus poisoning were admitted to the emergency ward of Manipal Teaching Hospital, Pokhara, Nepal from January 2008 to December 2008. History of ingestion, clinical signs & symptoms and survival time in case of death was also recorded to diagnose the OP poisoning. The mean age of patients was about 27 years. Most of the admitted cases were of suicidal in nature and women are the main victim. Suicidal deaths due to ingestion of organophosphorus compound are very common in Nepal especially in women. The reason may be the increasing stress in the family and economic constraints. Further study should be needed by government and NGO to evaluate it.

Sociodemographic profile of poisoning cases.

Acute poisoning is an important medical emergency and one of the causes of death. A thorough knowledge of the profile of the victim is essential for management and prevention of poisoning. The present paper evaluates pattern of poisoning cases including deaths over a period of two years from 1999 to 2001 in Berhampur, Orissa. 53.3% of the cases were male with male to female ratio 1.14:1. Peak incidence was observed in the age group 21-30 years(124 cases). More than four-fifth of the cases belonged to medium socioeconomic status and 58.1% cases were from rural areas. Majority of the victims were literate and married outnumbered the unmarried cases. Occurrence of poisoning was more common in day time and during Summer season. Organophosphate compounds was the most commonly (22.9%) abused substance. Based on these findings preventive measures like restriction of sale and strengthening the legislature on availability of poison, promoting poison information center etc have been put forward.