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.

Lethality of suicidal organophosphorous poisoning in Karachi in 2010

The study was aimed to evaluate the cases of suicide using organophosphorous compounds as intoxicant with the objective to bring up possible preventive measures based upon modifiable factors associated with lethality. Cross-sectional analytical Study. This retrospective study was based upon 66 patients of poisoning treated at intensive care unit of Ward No.5, JPMC Karachi during a period of one year from January 2010 to December 2010. Out of total 66 cases of poisoning 38 were of organophosphorous compounds [OPC] poisoning, 20 males and 18 females. Most of the cases [63%] of OPC poisoning were in age range of 20-40 years, 33 [86.84%] were of suicidal poisoning while 5 [13.16%] had accidental poisoning and 57% reported to treatment facility within 6 hours. All the cases of OPC poisoning had severe symptoms with fatal out come. Suicidal ratio was quite high. The period between the ingestion of poison and initiation of treatment plays vital role. In order to reduce fatality rate urgent intervention is required by government by improving the treatment facilities at local level hospitals i.e. primary health care centres and banning of highly toxic organophosphorous compounds. Additional measures which can help include improving the public awareness regarding recognition of toxic symptoms and importance of prompt referral to an appropriate facility

Intoxicação por exposição à rapadura em três municípios do Rio Grande do Norte, Brasil: uma investigação de epidemiologia de campo / Intoxication due to exposure to contaminated molasses

O estudo objetivou descrever dois surtos de intoxicação por exposição à rapadura, ocorridos em três municípios do estado do Rio Grande do Norte, entre janeiro e fevereiro de 2008. Foi conduzida uma investigação epidemiológica com a realização de estudo de caso. Outras investigações, laboratorial e ambiental, complementaram o quadro de informações sobre os surtos. Foram oito casos prováveis por exposição à rapadura, dos quais cinco por consumo do produto (um evoluiu para óbito) e três por proximidade física. As manifestações clínicas foram compatíveis com intoxicação por organofosforados. Outros sintomas apresentados podem estar relacionados com a presença de SO2, como rouquidão, lacrimejamento, dor nos olhos e ulceração corneana. A acetilcolinesterase eritrocitária resultou alterada para um dos pacientes que consumiu rapadura. Ocorreram dois surtos de intoxicação exógena: um por circunstância acidental e o outro, em decorrência do primeiro, por intoxicação ocupacional, cujo alimento implicado foi a rapadura contaminada com metamidofós e sulfito (SO2). A quantidade de metamidofós presente na rapadura consumida por dois casos foi 3.000 vezes maior que a ingestão diária aceitável para essa substância em humanos. Recomendam-se a adoção de medidas de saúde pública com a finalidade de minimizar a incidência de casos de intoxicação exógena e problemas decorrentes e prevenir surtos ocasionados por substâncias químicas, como as investigadas neste estudo.

Diagnóstico de intoxicação por organofosforados baseado em quadro clínico / Organophosphate intoxication diagnosis based on clinical present

Os organofosforados são compostos agrotóxicos, de ampla comercialização no Brasil, que inibem a enzima acetilcolinesterase, levando a sintomas muscarínicos e nicotínicos, além de possíveis manifestações do sistema nervoso central (SNC). Na rotina de atendimento em Toxicologia, preconiza-se a identificação do agente para tomada de medidas específicas. Contudo, em casos de intoxicações por organofosforados, a peculiaridade do quadro clínico pode ser suficiente para o diagnóstico correto.Apresentamos revisão bibliográfica e relato de caso como ilustração do quadro clínico e levantamento dos casos atendidos no Ceatox-79 (Centro de Atendimento Toxicológico de Marília/SP) no ano de 2007.No caso atendido foi possível realizar o diagnóstico com base no quadro clínico da paciente, que se iniciou com sinais inespecíficos e evoluiu com a apresentação de sinais nicotínicos, possibilitando a conduta adequada. As intoxicações por agrotóxicos, principalmente por anticolinesterásicos, como os organofosforados, apresentam alta incidência. Apesar disso, ainda é escassa a quantidade de referências bibliográficas sobre o assunto, que também não é enfatizado em níveis acadêmico e profissional.

Trends of poisoning in Faridkot region of Punjab- A retrospective study of one year.

Since immemorial times, poisonous substances have been reported to be adversely affecting human life, both in terms of morbidity and mortality. Evolution in fields like agriculture, industry etc has made wide and easy availability of various poisonous substances. The present study is a retrospective study of one year which is related to poisoning cases that were admitted in the emergency department of G.G. S. Medical College, Faridkot from 1st January 1996 to 31st December 1996. The analysis of the data revealed that out of 78 patients admitted in the hospital, 31 patients died. The maxi-mum incidence was seen in the age group of 21-30 years with males outnumbering the females. The commonest poison used was organophosphorus group of compounds.

Epidemiology of acute poisoning in children due to household substances. Mortality and morbidity in Hazara division

Acute Poisoning in children due to house hold substances is a global problem, however mortality and morbidity is nowadays very less in developed countries due to precautionary measures and better treatment facilities while situation in developing countries like Pakistan is alarming one. The present study was conducted to know about the death and injuries due to household poisoning in children in Hazara Division. The purpose of study was also too seek measures to reduce the risk factor. This prospective study was carried out in the Paedriatic unit of Ayub Hospital Complex and Department of Forensic Medicine and Toxicology, Ayub Medical College, Abbottabad from July to 2008 to September 2009. A total number of 6 leases of acute poisoning of children were brought to emergency department of Ayub Hospital Complex. 45 cases were admitted in Paedriatic unit while 16 were treated in emergency department were sent back to home. There were 37 male children [60.65%] and 24 [39.34%] female. The maximum number of cases were between age group 1-5 years 43 [70.49%]. 99% percent cases in our this study were of accidental nature only one case was homicidal nature while suicidal was none. Insecticide / rodenticide were the commonist agent ingested, followed by pharmacutical products. Kerosene oil was the third commonist agent ingested in our studies. Mortality rate was 3.27%. Organo-phosphorus compound [insecticide], rodentcide and kerosene oil [petroleum products] and pharmaceutical products are common source of household accidental poison globally. In developed countries there frequencies is decreasing rapidly due to health education and precautionary measures adopted mandatorily by manufacturers but in developing countries like Pakistan the situation is same as 50 years back. The risk factor can be reduced by adopting preventive measures at national level through health education of masses and parents and making products safety measures mandatory for manufacturers, moreover parents must be educated about the harms of some Herbal agents containing Opiates and on safe storage of medicines and house hold poisonous agents

Intoxicação por organofosforados: aspectos farmacológicos, clínicos e terapêuticos / Poisoning for organofosforados: farmacológicos, clinical and therapeutical aspects

O uso abusivo e indiscriminado dos agratóxicos representa um grave problema de saúde pública. São responsáveis por um grande número de intoxicações ocupacionais ou acidentais, destacando-se entre eles os organofosforados. Tais substâncias agem inibindo a enzima acetilcolinesterase, levando a um aumento da acetilcolina nas fendas sinápticas e consequentemente o surgimento de quadros clínicos agudos e crônicos, que muitas vezes comprometem a saúde das pessoas de forma irreversível. Dessa forma será feita uma revisão do mecanismo de ação dos organofosforados, dos quadros clínicos das intoxicações por tais substâncias e das medidas terapêuticas a serem seguidas diante de tais situações. Com isso, objetivamos gerar esclarecimentos e conhecimento para uma atuação mais rápida e efetiva dos profissionais de saúde envolvidos com pacientes vítimas dessas intoxicações.

Factors for Determining Survival in Acute Organophosphate Poisoning

BACKGROUND/AIMS: Organophosphate poisoning has a high mortality rate. Recently, differences among organophosphorus insecticides in human self-poisoning were reported. This study investigated the prognostic risk factors and the mortality of different organophosphates following acute organophosphate poisoning. METHODS: This retrospective study included 68 patients with acute organophosphate poisoning. We investigated patient survival according to initial parameters, including the initial Acute Physiology and Chronic Health Evaluation (APACHE) II score, serum cholinesterase level, and hemoperfusion and evaluated the mortality according to organophosphate types. RESULTS: Thirteen of the 68 patients died. The agents responsible for mortality were different. The APACHE II score was a significant predictor of mortality (odds ratio [OR], 1.194; p<0.01; 95% confidence interval [CI], 1.089 to 1.309) and respiratory failure (OR, 1.273; p<0.01; 95% CI, 1.122 to 1.444). The mortality was 0% for dichlorvos, malathion, chlorpyrifos and profenofos. However, other organophosphates showed different mortality (16.7% for O-ethyl-O-4-nitrophenyl phenylphosphonothioate, 25% for phenthoate, 37.5% for phosphamidon, 50% for methidathion). The usefulness of hemoperfusion appears to be limited. CONCLUSIONS: The initial APACHE II score is a useful prognostic indicator, and different organophosphates have different mortality.

Organophosphorus poisoning.

Acute poisoning by organophosphorus (OP) compounds is a major global clinical problem, with thousands of deaths occurring every year. Most of these pesticide poisoning and subsequent deaths occur in developing countries following a deliberate self ingestion of the poison. Metacid (Methyl parathion) and Nuvan (Dichlorovos) are commonly ingested OP pesticides; Dimethoate, Profenofos, and Chlorpyrifos are other less frequently ingested compounds in Nepal. The toxicity of these OP pesticides is due to the irreversible inhibition of acetylcholinesterase (AChE) enzyme leading to accumulation of acetylcholine and subsequent over-activation of cholinergic receptors in various parts of the body. Acutely, these patients present with cholinergic crisis; intermediate syndrome and delayed polyneuropathy are other sequel of this form of poisoning. The diagnosis depends on the history of exposure to these pesticides, characteristic manifestations of toxicity and improvements of the signs and symptoms after administration of atropine. The supportive treatment of OP poisoning includes the same basic principles of management of any acutely poisoned patient i.e., rapid initial management of airways, breathing, and circulation. Gastric lavage and activated charcoal are routinely used decontamination procedures, but their value has not been conclusively proven in this poisoning. Atropine is the mainstay of therapy, and can reverse the life threatening features of this acute poisoning. However, there are no clear cut guidelines on the dose and duration of atropine therapy in OP poisoning. Cholinesterase reactivators, by regenerating AChE, can reverse both the nicotinic and muscarinic effects; however, this benefit has not been translated well in clinical trials. All these facts highlight that there are many unanswered questions and controversies in the management of OP poisoning and there is an urgent need for research on this aspect of this common and deadly poisoning.

Neurological manifestations in organophosphorous toxicity.

Organophosphorous compounds are one of the efficient methods available for pest control. Because of its easy availability, the various preparations of organophosphorpus compounds cause significant morbidity and mortality to the human lives. In addition to producing pesticide related illness and death, Organophosphorous compounds produces different neurological manifestations as a sequelae to its toxicity. Four such neurological syndromes are discussed with their salient clinical features.

Patterns of acute poisoning and its outcome reported at civil hospital Karachi

To determine frequently used agents in acute poisoning, mode of poisoning, influencing factors, time interval between intoxication and hospital arrival outcome. The study was conducted in the department of Medicine, Civil Hospital Karachi in year 2006. It was a Descriptive and observational study. All cases of acute poisoning admitted in medical unit IV were included in this study. In all the cases a previously prepared Performa was filled, the Performa included patient's demographic patterns, agent used for poisoning, various influencing and precipitating factors of acute poisoning, route of poisoning, time interval between intake and arrival in hospital, past history of such episode, psychiatric history and outcome. Total of 118 cases of acute poisoning admitted during the study period. Sixty two [52.85%] were female and fifty six [47.15%] were males. Oral route was used in all cases. Mode of poisoning was suicidal [61.02%], deliberately self harm [22.03%], accidental [11%] and homicidal [5.08%]. Common reasons for poisoning in males were financial constraints [48%] and unemployment [40%]. Common reason for poisoning in females was family conflictions [68%]. Fifteen patients [12.54%] had previously attempted the poisoning as well. Previously known psychiatric illness was found in five [4.24%] of patients. Most of the patients [102] reached within eight hours, only six arrived within two hours. Eleven patients [9%] expired in which six were females and five were males. Organophosphorus compounds were found to be the commonest incriminating agent in poisoning. Family conflictions and financial constraints were the main reasons behind poisoning. Most of the patients are reaching late in hospital, Majority of the deaths are occurring immediately after arrival and within two days. Reattempt of poisoning was found in significant number of patients which were although preventable. Mortality in cases of poisoning is still high

Pesticide poisoning.

Acute poisoning with pesticides is a global public health problem and accounts for as many as 300,000 deaths worldwide every year. The majority of deaths occur due to exposure to organophosphates, organochlorines and aluminium phosphide. Organophosphate compounds inhibit acetylcholinesterase resulting in acute toxicity. Intermediate syndrome can develop in a number of patients and may lead to respiratory paralysis and death. Management consists of proper oxygenation, atropine in escalating doses and pralidoxime in high doses. It is Important to decontaminate the skin while taking precautions to avoid secondary contamination of health personnel. Organochlorine pesticides are toxic to the central nervous system and sensitize the myocardium to catecholamines. Treatment involves supportive care and avoiding exogenous sympathomimetic agents. Ingestion of paraquat causes severe inflammation of the throat, corrosive injury to the gastrointestinal tract, renal tubular necrosis, hepatic necrosis and pulmonary fibrosis. Administration of oxygen should be avoided as it produces more fibrosis. Use of immunosuppressive agents have improved outcome in patients with paraquat poisoning. Rodenticides include thallium, superwarfarins, barium carbonate and phosphides (aluminium and zinc phosphide). Alopecia is an atypical feature of thallium toxicity. Most exposures to superwarfarins are harmless but prolonged bleeding may occur. Barium carbonate Ingestion can cause severe hypokalaemia and respiratory muscle paralysis. Aluminium phosphide is a highly toxic agent with mortality ranging from 37% to 100%. It inhibits mitochondrial cytochrome c oxidase and leads to pulmonary and cardiac toxicity. Treatment is supportive with some studies suggesting a beneficial effect of magnesium sulphate. Pyrethroids and insect repellants (e.g. diethyltoluamide) are relatively harmless but can cause toxic effects to pulmonary and central nervous systems. Ethylene dibromide-a highly toxic, fumigant pesticide-produces oral ulcerations, followed by liver and renal toxicity, and is almost uniformly fatal. Physicians working in remote and rural areas need to be educated about early diagnosis and proper management using supportive care and antidotes, wherever available.

Organophosphate induced delayed neuropathy.

A 19 year young male who consumed organophosphorous compound and required assisted mechanical ventilation for two weeks, later on developed delayed neuropathy is described.

Magnetic resonance imaging changes in a case of extra-pyramidal syndrome after acute organophosphate poisoning.

Distal symmetrical polyneuropathy and neuromuscular weakness is common neurological problem in recovery phase of acute organophosphate (OP) poisoning. Various types of extra pyramidal syndromes are uncommon sequel after OP poisoning. These are reported to be reversible within few weeks and characteristically associated with normal magnetic resonance imaging (MRI). In this report we are presenting a case with extra pyramidal syndrome after acute OP poisoning with few interesting MRI changes in striatum.

Larva currens in a case of organophosphorous poisoning.

A 20-year-old healthy farmer consumed organophosphorous poison. On third day he developed diarrhoea and on fourth day linear serpiginous ulcers appeared on both buttocks. Clinically lesions were considered as decubitus ulcers. By stool examination and other laboratory investigations it was diagnosed as cutaneous larva currens due to Strongyloides stercoralis in a case of organophosphorus poisoning. Patient responded very well to a course of albendazole.

Poisoning : pattern and profile of admitted cases in a hospital in central Nepal.

An analysis of all poisoning cases admitted in medical and pediatric wards of Patan Hospital for one year (1st Jan to 31st Dec 2004) was carried out. A total of 154 cases were admitted which was 0.8% of total hospital admissions. Females outnumbered males and almost two-thirds patients were young adults (15-34 years). Seasonal variation in poisoning was observed with more cases in the summer months. Organophosphorus compounds (42%), drugs (25%), and zinc phosphide (6.5%) were common poisonings in total and in adult populations, whereas kerosene was the most frequent poisoning in pediatric age group. Paracetamol, benzodiazepines, and tricyclic antidepressants were the most frequently used drugs. The circumstances of poisoning were intentional (75%) and accidental (20%); most of the childhood poisonings were accidental in nature. The mean hospital stay for all type of poisoning was 7.5 days; whereas it was 10.2 days for organophosphorus, 2.5 days for paracetamol, and 1.5 days each for zinc phosphide and kerosene ingestion. Intensive care unit (ICU) service was required in 17% of patients; and almost 25% developed complications. Aspiration pneumonia and respiratory failure were the most frequently observed complications. Ninety four percent of admitted patients recovered completely; leaving a mortality rate of 5%.

Current trend of poisoning--a hospital profile.

A one-year study was carried out among the poisoning cases admitted in the emergency wing of Guru Nanak Dev Hospital attached to Government Medical College, Amritsar during the period from 10-5-1997 to 9-5-1998. Out of 10,664 admitt emergencies, 3.19% were poisoning cases. Male to female ratio was nearly 3:1. Majority (45.59%) of the victims were in the age group of 21-30 years, 69.12% were married and 51.47% belonged to urban area. At the time of admission 61.47% cases were conscious, 26.17% were partially conscious and 12.36% were unconscious. Majority (76.47%) of the victims committed suicide, in 20.88% cases manner of death was accident and homicide was reported in 1.76% cases. Commones poison was aluminium phosphide (38.23%) followed by organophosphorus compounds (17.64%). The study observed increasing trend of suicide by aluminium phosphide and organophosphorus compounds, whereas other poisons for committing suicide were less commonly used.

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%.