Organophosphate poisoning and its management
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Transcript of Organophosphate poisoning and its management
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Organophosphate
Poisoning
Sunil Kumar Daha
Janakpur, Nepal
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Organophosphorus compounds• Nerve agents:
• G agents: sarin, tabun, somanV agents: VX,VE
• Insecticides:Dimethyl compounds Diethyl
compounds • Dichlorvos• Fenthion• Malathion• Methamidophos
Diethyl compounds• Chlorpyrifos
• Diazinon
• Parathion-ethyl
• Quinalphos
Intoxication may follow ingestion, inhalation or dermal absorption.
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Mechanism of toxicity
Inhibit acetyl cholinesterase causing accumulation of acetylcholine at central and peripheral cholinergic nerve endings, including neuromuscular junctions
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Clinical features• onset, severity and duration of poisoning depend on the route of
exposure and agent involved
• causes an acute cholinergic phase, which may occasionally be followed by the intermediate syndrome or organophosphate-induced delayed polyneuropathy (OPIDN
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• muscarinic features such as nausea, vomiting, abdominal colic, diarrhoea, sweating, hypersalivation, miosis, bronchospasm, bronchorrhea, bradycardia, urinary incontinence
• Nicotinic features such as muscle fasciculation and flaccid paresis of limb, respiratory, and occasionally, extraocular muscles
• CNS features is characterized by anxiety, slurred speech, mental status changes (e.g., delirium, coma, and seizures), and respiratory depression
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Intermediate syndrome
• Occur in 20% case of OP poisoning
• Development of weakness of muscle rapidly• Spreading from ocular muscle to head and neck, proximal limbs and
muscle of respiration may leads of ventilatory failure
• May appear after 1-4 days after exposure when symptomps/signs of acute cholinergic syndrome are no longer obvious
• May last 2-3 weeks
• no specific treatment but supportive care, including maintenance of airway and ventilation,
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Organophosphate-induced delayed polyneuropathy
•Rare complication
•Occur 2-3 weeks after exposure
• Mixed sensory/motor polyneuropathy
• C/F :muscle cramps followed by• numbness and paraesthesis flaccid paralysis of lower
limbs and subsequently upper limbs
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General management• Maintenance of ABC
◦ Airway should be cleared of secretion◦ High flow O2◦ IV access
• Decontamination of skin◦ To prevent further absorption◦ Contaminated clothing and contact lenses removed◦ Skin washed with soap and water and eye irrigated
• Gastric lavage and activated charcoal if within 1hours
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Antidotes - Atropine
• 2mg IV,repeated every 10-25 minutes until atropinization (as manifested by drying of secretions, tachycardia, flushing,dry mouth, and dilated pupils) occurs
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Pralidoxime
• Dose:1-2 g for adults and 20-40 mg up to 1 g in children ,infused in NS over 5-10 minutes
• reactivates the cholinesterase and counteracts weakness, muscle fasciculations, and respiratory depression
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• Treat seizures with a benzodiazepine and phenytoin; if severe seizures require muscle relaxants
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References
• Davidson's Principles and Practice of Medicine 21 Edition
• Kumar and Clark 7th Edition (2009)
• Emergency Medicine,Tintinalli
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Thank You