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Organophosphate acute INTOXICATION

Organophosphate (OP) compounds are a diverse group of chemicals used in both


domestic and industrial settings as insecticides (malathion, parathion)

Exposure to organophosphates (OPs) is also possible via intentional or


unintentional
Skin contamination
Ingestion
Inhalation

Mechanism of action: inhibition of acetylcholinesterase (AChE is an enzyme that


degrades the neurotransmitter acetylcholine (ACh)).
Once AChE has been inactivated, ACh accumulates throughout the nervous
system, resulting in overstimulation of muscarinic and nicotinic receptors:
ENDOGENOUS INTOXICATION WITH ACh
Clinics:
Muscarinic effects
Cardiovascular - Bradycardia, hypotension
Respiratory - Rhinorrhea, bronchorrhea, bronchospasm, cough,
severe respiratory distress
Gastrointestinal - Hypersalivation, nausea and vomiting, abdominal
pain, diarrhea, fecal incontinence
Genitourinary - Incontinence
Ocular - Blurred vision, miosis
Glands - Increased lacrimation, diaphoresis
Nicotinic signs
muscle fasciculations
cramping
weakness
diaphragmatic failure.
CNS effects
headaches, dizziness, paralysis, tremor, anxiety, seizures, coma
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Organophosphate (OP) toxicity is a anamnestic and clinical diagnosis.


Confirmation of organophosphate poisoning is based on the measurement of
cholinesterase activity in red blood cells.
NON SPECIFIC TREATMENT
Adequate oxygenation
Intubation may be necessary in cases of respiratory distress due to
laryngospasm, bronchospasm, bronchorrhea
Continuous cardiac monitoring and pulse oximetry should be established
Remove all clothing and gently cleanse patients suspected of
organophosphate exposure with soap and water because
organophosphates are hydrolyzed readily in aqueous solutions with a high
pH. Consider clothing as hazardous waste and discard accordingly!!!!
SPECIFIC TREATMENT
1) Competitive antagonists at the muscarinic cholinergic receptors in
both the central and the peripheral nervous system.
i. Atropine IV/IM, 1 ampoule=1mg, 1-2 mg in mild intoxication till
100mg in very severe intoxications
ii. The endpoint for atropinization is dried pulmonary secretions,
tachycardia and mydriasis. The main concern with OP toxicity is
respiratory failure from excessive airway secretions.
2) Reactivators of Ach esterase activity
i. Pralidoxime (Contration): 25-50mg/Kg in 30 minutes, iv
ii. Obidoxin (Toxogonin): 1 ampoule =250 mg, 1 -2 ampoules
i.v. or i.m., can be repeated after 6 hours
iii. Nucleophilic agent that reactivates the phosphorylated AChE by
binding to the OP molecule.
iv. Used as an antidote to reverse muscle paralysis resulting from OP
AChE pesticide poisoning
v. Current recommendation is administration within 48 h of OP
poisoning
vi. Because of risks of respiratory compromise or recurrent symptoms,
hospitalizing all symptomatic patients for at least 24 hours in a high
acuity setting is recommended.
3) AchE lyophilised enzyme
4) Fresh plasma that contains the enzyme
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