Acute organophosphate insecticide poisoning

To describe the clinical course, diagnosis, out come of acute organophosphate [OP] insecticide poisoning. Descriptive study. At National Poisoning Control Centre [NPCC], Medical unit 1, Jinnah Post Graduate Medical Centre, Karachi, from 1st January 2000 to 31st December 2007. A total of 6539 pts were admitted to the ICU of NPCC, out of which 2708 [41%] were of organophosphate poisoning. Lab investigations done included blood complete picture, urea, creatinine, ABG's and serum cholinesterase levels. Data was retrieved from the files on a structured performa. Variables of the study include gender, mode of exposure, clinical course, management and complications. There were 1391[51%] were males and 1317 [48%] females. 713 [26%] had accidental exposure, while 1995 [73%] attempted suicide. The majority of patients exhibited the classic clinical features of parasympathetic over activity. 1608 patients received atropine, while pralidoxime alone was given to only 399 patients and atropine along with pralidoxime was given to 701 patients. Complications encountered during their treatment and stay in the hospital included aspiration pneumonia observed in 310 patients, hyperglycemia in 982 patients. 102 patients had respiratory failure and thus required mechanical ventilation with mean ventilation duration of 2.3 +/- 1.5 days. 500 patients had urinary tract infection and 789 patients developed cellulitis or phlebitis. A total of 147 patients died making a mortality rate of 0.05%. The widespread use of organophosphates as a household and agricultural pesticide, in the absence of adequate regulations and education in their use is probably the most important reason for OP poisoning in an agricultural country like Pakistan. Despite severe toxicity in most of our cases, there were very few fatalities. This reflects the necessity of early diagnosis, treatment and the implementation of advanced supportive care in ICU