Review of severe organophosphate poisonings over a period of 11 years (1996-2006)

Barco JC, Omar C, Puiguriguer Ferrando J, Coll I, Barceló B, Castanyer T

Objective: To review all the organophosphate poisonings (OP) over a 11-year period

which required at least seven days of admission at our hospital.

Methods: Descriptive retrospective study of patients with OP attended at the hospital

from 1996 to 2006. The variables age, sex, type of poisonous compound,

destination at admission, length of stay, environment (rural or urban), cause of

poisoning, clinical symptoms, therapeutic measures, acetylcholinesterase measurement,

and history of psychiatric disorders were assessed.

Results: Eight patients were included, mean age 49 years (range: 26-65), 50% female.

Poisonous compound were pure OP (50%), OP plus herbicide (25%) and OP

plus carbamate (25%). Mean hospital stay was 40,5 days. Mean stay in the ICU in

6 patients who required intensive care was 23 days. Five (63.5%) patients were

from rural origin and 3 (27.5%) were urban cases. Five cases (62.5%) were suicide

attempts, 2 (25%) were accidents and the reason was not clear in one case. 100%

presented with cholinergic syndrome, 2 cases (25%) mild muscarinic syndrome

and 6 cases (75%) muscarinic, nicotinic and central symptoms. Four cases (50%)

presented intermediate syndrome and 4 cases relapse of cholinergic symptoms. Severe

hypothermia was present in 2 cases. Respiratory insufficiency was seen in 6

patients, which required orotracheal intubation. Gastrointestinal decontamination

was performed in 6 cases. Two patients received activated charcoal without lavage.

Atropine was used in 5 cases (62.5%) and pralidoxime in 4. Hemoperfusion with

activated carbon and hemofiltration was used in one case. Serum cholinesterase

activity was measured in 6 cases.

Conclusion: Severe organophosphate poisonings has multiple symptoms. If general

measures adopted are not enough and/or treatment is withdrawn early they can

increase significantly.

Barceló B, Barco JC, Castanyer T, Coll I, Omar C, Puiguriguer Ferrando J