ORGANOPHOSPHATE POISONING

BY: ABID HUSSAIN

H.O (MU 1)
 INTRODUCTION
• OP Compounds Are Widely Used As
Pesticides,Insecticides And Chemical Warfare
Agents
• OP Compounds Have Been Used More Than 50
Years And Are Still Used In Developing Countries
• It Is Believed That B/W 750,000 And 300,0000
OP Poisoning Occur Globally Every Year
• Many Studies Estimate That OP Pesticides Cause
300,000 Fetalties Annually In Developing
Countries
 TYPES OF OP COMPOUNDS
• NERVE AGENTS
• G Agents = Soman,Tabun,Sarin
• V AGENTS
• INSECTICIDES
• Aldicarb,Carbofuran
• DIMETHYL COMPOUNDS
• Malathion
• Fenthion
• Dichlorvos
• DI ETHYL COPMOUNDS
• Parathion
• Chlorpyrefos
• Diazinon
 PATHOPHYSIOLOGY
• OP Compounds Inhibits The Enzyme
Especially Choline Esterase Which Leads To
Occumulation Of Acetylcholine In The
Cholinergic Synpasis Such As,muscarinic And
Nicotinic Receptors,which Results In Acute
Cholinergic Phase Followed By Ocassionally
In Intermediate Syndrome And
Organophophate Induced Delayed Poly
Neuropathy
 CLINICAL FEATURES
• ACUTE CHOLINERGIC SYNDROME
• Usually starts within few minutes of exposure
• It may present with muscarinic and nicotinic feature
A. MUCARINIC FEATURES IN PSS
i. BRONCHOSPASM & BROCHORROHEA
ii. LACRIMATION & MIASIS
iii. SALIVATION
iv. URINATION
v. DIARRHEA & VOMMITING
vi. HYPOTENSION & BRADYCARDIA
B. NICOTINIC FEATURES IN THE SS
i. TACHYCARDIA,HYPERTENSION
ii. MYDRIASIS
iii. SWEATING
 CONTINUE….
• NICOTINIC FEATURES IN THE NMJ
i. MUSCLE WEAKNESS
ii. PARALYSIS
iii. FASCICULATIONS

• NICTONIC & MUSCARINIC FEATURES IN THE CNS

i. CONFUSION
ii. AGITATIONS
iii. COMA
iv. RESPIRATORY FAILURE
 GRADING OF CLINICAL SEVERITY OF OPP
MILD MODERATE SEVERE FATAL
Rhinorrhea Abdominal Pain Convulsions Coma
Sweating Vomitting Pulmonary Edema Convulsions
Salivation Diarrhea Respiratory Failure Hypersecretions &
Apnea within few
minutes after
exposure
Lacrimation Fasciculations Urinary
Incontinance
Anxiety ALOC Feacal Incontinance
 DIAGNOSIS OF OPP
• Diagnosis Is Made On The……
1. Characteristic clinical sign
2. Ideally be confirmed to measure the activity of the
butaryl choline esterase in plasma and acetyl choline
esterase in red blood cell
 EMERGENCY AND SUPPORTIVE MEASURE

A. If the agent was recently ingested consider

the gut de-contamination by performing
I. Gaustric lavage
B. If there is external contamination then
 Remove the clothes and contact lenses
 Wash the skin with soap and water
 MANAGEMENT
• Check airway breathing and circulation
• Place the patient in the left lateral position as
it reduce the risk of stomach contents,makes
airway potent and delays the spontaneous
absorption of the drug
 SPECIFIC TREATMENT
• ATROPINE
Start with 2 mg iv bolus,repeated every 10-25 min untill secretions
stopped
After 5 minutes of administration check the following parameters
 Sbp more than 90 mmHg
 Pulse rate > 80 beats/min
 Lung fields = Clear
 Pupils = Dilated
 Sweating = Stops
If above parameters are not corrected double the dose of
atropine every 5 minutes untill the above parameters to be
corrected
 CONTINUE….
• Once The Patient Is Stable Start An Infusion Of
Atropine Giving Every Hour About 10-20% Of
The Total Intial Dose Nedeeded To Stable The
Patient
• Stop The Atropine Infusion If The Features Of
The Toxicity Appears Such As..
Urinary Retention
Agitation
Hyperthermia
Tacchycardia
Absent Bowel Sounds
• PRALIDOXINE (CONTRATHIONE)
 Give 30 Mg/Kg IV As Loading Dose Over 10-20
Minutes Followed By The Continues 8-10 Mg/Kg/Hr
 Maximum Dose Of 12gm In 24 Hr
 COMPLICATIONS & THEIR MANAGEMENT
• INTERMEDIATE SYNDROME
o Generally develops quite rapidly in a 1 and 4 days after
exposure
o About 20% of the patients develop the weakness that spreads
from ocular muscles to those of head and neck,proximal limbs
and respiratory muscle resulting in the respiratory failure
o It may last 2-3 weeks
o There is no specific treatment but supportive care including
maintainance of airway and ventilations
 CONTINUE….
• OP INDUCED DELAYED POLY NEUROPATHY
 It is rare complication that usually occurs 2-3 weeks
after acute exposure
 It is mixed sensory and motor poly neuropathy
 The early clinical features are the Muscle cramps
followed by the numbness and parasthesia proceeding
to the flaccid paralysis of the lower limb first followed
by the upper limbs
 There is no specific treatment physiotherapy may limit
the deformity
 Recovery is often incomplete and may be limited to
hands and feet
Thanks..