Intoxicación por organofosforados / Organophosphorus poisoning

El panorama de las intoxicaciones es muy amplio y abarca un sin número de sustancias potencialmente mortales. Se estiman alrededor de 13 millones de químicos, incluyendo los naturales y los sintéticos, dentro de este último grupo se encuentran los plaguicidas, los cuales surgen como armas químicas probadas en insectos. Son una de las familias de productos químicos más ampliamente utilizadas por el hombre e independientemente de sus beneficios, es evidente que son sustancias deliberadamente tóxicas y carecen de selectividad real. Afectan simultáneamente a la «especie blanco como a otras categorías de seres vivos, particularmente al ser humano Pueden clasificarse en función de algunas de sus características principales, como son la toxicidad aguda, la vida media, la estructura química y su uso o de acuerdo a su estructura química se clasifican en diversas familias. Los reportes de la organización mundial de la salud (OMS) muestran que anualmente a nivel mundial, hay aproximadamente un millón de intoxicaciones accidentales y dos millones de intoxicaciones provocadas (suicidios) con plaguicidas, de las cuales aproximadamente 200.000 terminan en la muerte. En este trabajo abordaremos la intoxicación aguda por organofosforados ya que en la actualidad estos productos tienen una amplia aplicación en la actividad agrícola, provocando la muerte de cientos de personas. La mayor parte de las intoxicaciones ocurren en países en desarrollo y México no es la excepción, motivo por el cual se realiza este trabajo con la finalidad de ofrecer herramientas para un diagnóstico correcto, un tratamiento oportuno con el fin de evitar posibles complicaciones asociadas y preservar la vida del paciente

The panorama of poisoning is very wide and covers a number of potentially mortal substances. About 13 million chemicals are estimated, including the natives and synthetic, within the latter group are pesticides, which arise as chemical weapons in insects. They are one of the most widely used chemical families and regardless of their benefits, it is evident that they are deliberately toxic substances and lack real selectivity. They simultaneously affect the "white species as other categories of living beings, particularly the human being can be classified according to some of its main characteristics, such as acute toxicity, half -life, chemical structure and its use or according to Its chemical structure are classified into various families. The reports of the World Health Organization (WHO) show that worldwide, there are approximately one million accidental poisonings and two million poisoning caused (suicides) with pesticides, of which approximately 200,000 end up in death. In this work we will address acute organophosphate poisoning since these products are currently a wide application in agricultural activity, causing the death of hundreds of people. Most poisoning occur in developing countries and Mexico is no exception, which is why this work is done in order to offer tools for a correct diagnosis, timely treatment in order to avoid possible associated complications and preserve The patient's life

Use of bone marrow for detection of toxic chemicals for the elucidation of poisoning in forensic veterinary medicine / Uso de medula óssea para detecção de produtos químicos tóxicos para a elucidação de intoxicação em patologia veterinária forense

In forensic toxicology, the detection of toxic chemicals from human bone marrow is often used in cases with an extended post mortem interval; however, in veterinary medicine, this practice is not used. Therefore, this study was performed to investigate the suitability of bone marrow for toxicological analysis in dogs and cats. Six animals with suspected poisoning were selected; the carcasses were sent for necropsy, and the organs were collected and preserved in buffered formalin and processed routinely for histological examination. In addition, bone marrow samples from the femur, humerus, and tibia were collected for toxicological analysis by liquid chromatography coupled to mass spectrometry detection (LC-MS). This analysis confirmed the presence of aldicarb, aldicarb sulfone, asulam, carbendazim, chlorpyrifos, dichlorvos, thifensulfuron methyl and trifloxysulfuron-sodium and associated with clinical symptoms and anatomo-histopathological alterations it was recognized the poisonings. It is expected that this study will promote the toxicological investigation of bone marrow and open avenues for the use of this tissue as an option for the detection of toxic chemicals in cases of forensic pathology.(AU)

Na toxicologia forense, a detecção de substâncias químicas tóxicas provenientes da medula óssea humana é frequentemente usada em casos com intervalo post mortem prolongado; no entanto, na medicina veterinária, essa prática não é utilizada. Portanto, este estudo foi realizado para investigar a utilização da medula óssea nas análises toxicológicas em cães e gatos. Seis animais com suspeita de intoxicação foram selecionados; as carcaças foram enviadas para necropsia e os órgãos foram coletados e preservados em formalina tamponada e processados rotineiramente para exame histológico. Amostras de medula óssea de fêmur, úmero e tíbia foram coletadas para análise toxicológica por cromatografia líquida acoplada à espectrometria de massa-massa (LC-MS). A análise por LC-MS confirmou a presença dos agrotóxicos aldicarbe, aldicarbe sulfona, asulam, carbendazim, clorpirifós, diclorvós, tifensulfuron metil e trifloxisulfuron-sódico, e em associação com sinais clínicos e achados anatomo-histopatológicos comprovou-se as intoxicações. Espera-se que este estudo promova a utilização da medula óssea como uma opção na investigação toxicológica para a detecção de produtos químicos tóxicos em casos de patologia forense.(AU)

Intoxicación por organofosforados / Organophospate poisoning

Resumen La intoxicación por organofosforados es de gran importancia en el campo de la medicina, debido a su uso frecuente en la actividad agrícola, las intoxicaciones producidas por estos agentes pueden ser ocupacionales, accidentales, y con mayor frecuencia por ingesta voluntaria. Una de las mayores repercusiones de los organofosforados es la inhibición del acetil colinesterasa, enzima encargada de hidrolizar el acetil colina. Las manifestaciones clínicas de la intoxicación aguda se deben a la estimulación de receptores muscarínicos y nicotínicos, entre ellas broncorrea, salivación, lagrimeo, broncoespasmo, defecación, emesis, miosis, entre otros. El diagnóstico se realiza mediante la historia clínica y examen físico, de manera adicional con la detección de los niveles en sangre eritrocitaria de acetil colinesterasa o de los metabolitos de los organofosforados. El manejo incluye la descontaminación del agente, la revisión del estado respiratorio y el acceso al soporte ventilatorio, posteriormente se procede con el tratamiento farmacológico que incluye el uso de la atropina, pralidoxima y diazepam. El presente artículo constituye una revisión bibliográfica sobre la intoxicación por organofosforados, sus manifestaciones clínicas, diagnóstico y tratamiento.

Abstract Organophosphorus poisoning is of great importance in the field of medicine due to its frequent use in agriculture, the poisoning by exposure to these agents can be occupational, accidental, and frequently due to voluntary intake. Organophosphorus' intake most notable effects are produced by the inhibition of the acetyl cholinesterase, responsible for hydrolyzing acetyl choline. Clinical manifestations of acute intoxication typically include bronchorrhea, salivation, lacrimation, bronchospasm, defecation, emesis, miosis, among others and they occur due to the stimulation of muscarinic and nicotinic receptors. Diagnosis is made through the interrogation and physical examination, in addition to the detection of acetyl cholinesterase levels or the organophosphates' metabolites in blood testing. Management includes decontamination of the agent, review of respiratory status and access to ventilatory support, followed by pharmacological treatment that includes the use of atropine, pralidoxime and diazepam. The present article constitutes a bibliographic review about the organopho sphorus intoxication, its clinical manifestations, diagnosis and treatment.

Diagnóstico diferencial de cetoacidosis hiperglicémica: Intoxicación por plaguicidas. Caso clínico / Differential diagnosis from hyperglycemic ketoacidosis: Pesticide poisoning. Clinical case

La cetoacidosis diabética en niños puede ser una causa de morbilidad grave y mortalidad, especialmente si no se reconoce en el momento del primer diagnóstico. Sin embargo, existen otras patologías que pueden aparentar una alteración metabólica de este tipo y pasarse por alto si no se tiene sospecha clínica. A continuación, se describe un caso clínico que presenta cetoacidosis hiperglicémica debido al contacto con organofosforado, en el cual fue necesario el uso de insulina en infusión continua para el control del trastorno metabólico, sin repercusiones después del alta.

Diabetic ketoacidosis in children causes serious morbidity and mortality, especially if it is not recognized on time in the initial diagnosis. However, there are other diseases that can appear to be a metabolic disorder of this kind and be ignored if it is not suspected. We present a clinical case with hyperglycemic ketoacidosis due to the contact with organophosphate; we had to use a continuous infusion of insulin to control the metabolic disorder without repercussions after the girl came home.

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.

Performance Assessment of the SOFA, APACHE II Scoring System, and SAPS II in Intensive Care Unit Organophosphate Poisoned Patients

This study assessed the ability of the Sequential Organ Failure Assessment (SOFA) and Acute Physiology, Chronic Health Evaluation (APACHE) II scoring systems, as well as the Simplified Acute Physiology Score (SAPS) II method to predict group mortality in intensive care unit (ICU) patients who were poisoned with organophosphate. The medical records of 149 organophosphate poisoned patients admitted to the ICU from September 2006 to December 2012 were retrospectively examined. The SOFA, APACHE II, and SAPS II were calculated based on initial laboratory data in the Emergency Department, and during the first 24 hr of ICU admission. The probability of death was calculated for each patient based on the SOFA score, APACHE II score, and SAPS II equations. The ability to predict group mortality by the SOFA score, APACHE II score, and SAPS II method was assessed using two by two decision matrices and receiver operating characteristic (ROC) curve analysis. A total of 131 patients (mean age, 61 yr) were enrolled. The sensitivities, specificities, and accuracies were 86.2%, 82.4%, and 83.2% for the SOFA score, respectively; 65.5%, 68.6%, and 67.9% for the APACHE II scoring system, respectively; and 86.2%, 77.5%, and 79.4% for the SAPS II, respectively. The areas under the curve in the ROC curve analysis for the SOFA score, APACHE II scoring system, and SAPS II were 0.896, 0.716, and 0.852, respectively. In conclusion, the SOFA, APACHE II, and SAPS II have different capability to discriminate and estimate early in-hospital mortality of organophosphate poisoned patients. The SOFA score is more useful in predicting mortality, and easier and simpler than the APACHE II and SAPS II.

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.

Intermediate syndrome in organophosphorous poisoning.

One hundred and fifty three cases of Organophosphorous poisoning cases presented to Kasturba Hospital, Manipal, India during a 2 year period ( 2001- 2002), out of which 45 cases (29.4%) had features of Intermediate Syndrome. Largest number of victims were in the age group of 21-30 years (37.7%). Males predominated (71.1%). Methyl Parathion was the commonest compound (57.7%). Respiratory muscle weakness was the most common manifestation seen (84.4%). Mortality was 22.3%.