Intensive care management of organophosphorus poisoning patients: an experience from tertiary care centre

Authors

  • Syed Nazima Nazima Department of Anesthesiology and Critical Care, Government Medical College, Srinagar, Jammu and Kashmir, India
  • Yasir Bashir Department of Critical Care Medicine, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
  • Shakeeb Nabi Department of General Surgery, Government Medical College, Srinagar, Jammu and Kashmir, India
  • Nusrat Bashir Department of Pathology, Government Medical College, Srinagar, Jammu and Kashmir, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20180957

Keywords:

Intensive care, Management, Organophosphorus

Abstract

Background: Organophosphate (OP) insectide poisoning results from occupational, accidental and intentional exposure. The mortality rate of OP poisoning is high. Early diagnosis and appropriate treatment is often lifesaving.

Methods: This study “Intensive care management of organophosphorous poisoning in Govt. medical college Srinagar (Sgr) hospital was a prospective one and was conducted over a period of two. All the patients with a provisional diagnosis of Organophosphorous poisoning who reported to the medical casualty and intensive care unit of SMHS hospital Sgr were included in this study.

Results: Out of a total of 1258 Organophosphorous poisoning cases, males were (34.5%) and females were (65.5%). Suicidal mode of poisoning was most common in our patients and constituted 63.20%. Out of 254 Organophosphorous poisoned patients admitted in ICU, 184 survived and 70 expired. Therefore, mortality rate for Organophosphorous poisoned patients who needed mechanical ventilation was 27.55.

Conclusions: OP poisoning is a serious problem in Kashmir Valley. Efforts should be directed towards rapid diagnosis and management of this condition. Additionally, close intensive monitoring of these patients for early recognition of respiratory failure which is one of the serious complication of OP poisoning with intensive care support will help in decreasing the mortality rate in these patients.

References

Clark, R.F. Insecticides: organic phosphorus compounds and carbamates. In: Gold frank’s Toxicological Emergencies. 7 ed. New York: McGraw 8 Hill Professional. 2002;1346-60.

Michael O’ Malley MD Clinical evaluation of pesticides exposure and poisoning. Lancet. 1997;349:1161-6.

Bami HL. Misuse of Insecticides in relation to Forensic Toxicology. Indian J Plant Proc. 1981;8: 99-104.

Murat Sungur and Mohammad Guven. Intensive care management of organophorous poisoning. Critical care. 2001;5:211-5.

Bardin PG, Van Eeden SF, Moolman JA, Foden AP and Joubert JR. Organophosphate and Carbamate Poisoning. Arch. Intern Med. 1994;154:1433-41.

Paudyal BP. Organophosphorous Poisoning. J. Nepal Med. Assoc. 2008;47(172):251-8.

Taylor P.“Anticholineesterase agents” in Goodman & Gillman’s. The pharmacological basis of therapeutics. 11th edition. 2006. 478-80. Eds: Lawrence L. Brunton; McGraw Hill publications; 2006.

WHO Task Group on Organophosphorous Insecticides. Organophosphorous Insecticides: A General Introduction. WHO Geneva; 1986.

Eddleston M, Singh S, and Buckley N. Organophosphorus poisoning (acute). Clinical Evidence. 2004;12:1938-50.

Eyer P. The role of oximes in the management of organophosphorus pesticide poisoning. Toxicol. Rev. 2003;22:165-90.

Darvesh S, Hopkins DA, and Geula C. Neurobiology of butyrylcholinesterase. Nat. Rev. Neurosci. 2003;4:1318-38.

Worek F, Diepold C, and Eyer P. Dimethylphosphoryl 8 inhibited human cholinesterases: Inhibition, reactivation, and aging kinetics. Arch. Toxicol. 1999;73:7814.

Bardin PG, SF Van Eeden and JR. Joubert.Intensive care management of acute organophosphorous poisoning. South Afric Medic J.1987;72:593-7.

Jeyaratnam J. Acute poisoning: A major Health Problem. World Health Stat Q. 1990;43:139-45.

Michael O’ Malley MD. Clinical evaluation of pesticides exposure and poisoning. Lancet. 1997;349:1161-6.

Natrajan AR. NJ Modi’s Medical Jurisprudence and Toxicology.19th Edition. 1975:512.

Bami HL. Misuse of Insecticides in relation to Forensic Toxicology. Indian J Plant Proc. 1981;8:99-104.

Sungur M, Guven M. Intensive care management of organophorous poisoning. Critical care. 2001;5:211-5.

Hayes WJ. Organophosphate Insecticides: In Pesticides studied in Man. Eds: Hayes WJ Williams and Wilkins. 1982:285-315.

Singh S and Sharma N. Neurological syndromes following organophosphate poisoning. Neurol India. 2000;48:308-13.

Chugh SN, Agarwal N, Dabla S, Chhabra B. Comparative evaluation of Atropine alone with Pralidoxime in the management of OP poisoning. Journal of Indian Academy of clinical Medicine. 2005;6:33-7.

Singh B and Unnikrishnan B. A profile of acute poisoning at Mangalore. J Clinic Forensic Medic. 2003;13(3):112-6.

Dash SK, Raju AS, Manoj KM, Kiran KM and Mohanty S. “Sociodemographic profile of poisoning cases.” JIAFM. 2005;27(3):971-3.

Ram S, Kumar SS and Jayarajan A. Continuous infusion of high doses of atropine in the management of organophosphorous compound poisoning. JAPI. 1991;39:190.

Roy A. Suicide In: Sadock BJ, Sadock VA. Eds. Kaplan and Sadock’s Comprehensive text book of Psychiatry- Philidelphia. Lippincott Williams and Wilkins. 2000:2031-5.

Davies JOJ, Eddleston M and Buckley NA. Predicting outcome in acute organophorous poisoning with poison severity score or the Glasgow coma scale.QJ Med. 2008;4:1-9.

Du Toit PW, Muller FO, Van Tonder WM and Ungerer MJ. Experience with intensive care management of organophosphorous insecticide poisoning.South African Med J. 1981;60:227-9.

Malik GM, Romshoo GJ, Mubarik M, Basu JA, Rashid S, Hussain Tand Wani MA. Increasing Incidence of Organophosphorous Poisoning in Kashmir Valley ( A Preliminary Study). JK Pract. 1998;5(2):117-20.

Downloads

Published

2018-03-21

Issue

Section

Original Research Articles