Organophosphate poisoning

(Ops)

A CASE AND ARTICLE PRESENTATION ON

Examples

Examples of organophosphates include:

- insecticides (malathion, parathion, diazinon, fenthion, dichlorvos, chlorpyrifos, ethion)

- nerve gases (soman, sarin, tabun, VX)

- ophthalmic agents (echothiophate, isoflurophate)

- antihelmintics (trichlorfon).

- Herbicides (tribufos [DEF], merphos) are tricresyl phosphate–containing industrial chemicals.

Frequency

Organophosphate compounds were first synthesized in the early 1800 when Lassaignereacted alcohol with phosphoric acid.

Shortly thereafter in 1854, Philip de Clermountdescribed the synthesis of tetraethyl pyrophosphate at a meeting of the French Academy of Sciences.

Eighty years later, Lange, in Berlin, and, Schrader, a chemist at Bayer AG, Germany, investigated the use of organophosphates as insecticides.

History

COVALENT BOND

AGING

MECHANISM OF ACTION OF ORGANOPHOSPATE POISONING

9

PHYSIOLOGY REVISITED

11

Inhalation

• Cough

• Difficulty in breathing

• Bronchitis

• Pneumonia

Eye contact• Irritation

• Pain

• Lacrimation

• Miosis

• Blurring vision

• Photophobia

clinical featuresdepends on route of entry

ingestion inhalation eye contact

GASTRIC LAVAGE ACTIVATED CHARCOAL

OROPHARYNGEAL AIRWAY USED AMBU VENTILATION & ET TUBE

MANAGEMENT OF OP POISONING

NAME: Mr.Krishna reddy.GENDER: MALE

AGE: 33 years

DEPARTMENT: General Medicine (male medical (IV)

DATE OF ADMISSION: 05-02-2015.

CHIEF COMPLAINTS:Vomiting present – 5 episodes.Burning sensation of throat and abdomen.

HISTORY OF PRESENT ILLNESS: No h/o swelling neck and micturationpresent

DEMOGRAPHIC DETAILS

FAMILY HISTORY: Not relevantGENERAL EXAMINATION:PHYSICAL EXAMINATION:

Conscious and oriented

TEMP : AfebrileBP : 130/90 mm HgPULSE : 124 bpmSYSTEMS EXAMINATION:CVS : S1, S2 (+) CNS : pupils-NSRL+RS : BLAE +RR :16 cpm.P/A : soft.

PAST MEDICAL HISTORY:

not a K/c/o Diabetic, Hypertensive, Epileptic, TB.

PERSONAL HISTORY AND HABITS:

known alcoholic, and not a smoker.

FAMILY HISTORY:

Nothing is relevant.

PAST SURGICAL HISTORY:No h/o previous surgery.

PROVISIONAL DIAGNOSIS: An alleged case ofop poisoning @

7.30p.m near Badvel.

ASSESSMENT

ORGANOPHOSPHORUS COMPOUND POISONING

DRUG CHART

S.no DRUGS GENERIC NAME INDICATION DOSE ROA FREQUENCY DURATION

1. Inj. Atropine Atropine Antidote(anti

cholinergic)

2mg

(amp)

IV TID 5/2/115 to

12/2/15

2. Inj. PAM Pralidoxime Antidote 1 gm

(amp)

IV BD 5/2/15 to

12/2/15

3. IVF Intravenous

fluids

Electrolyte

balance

2 NS

2 RL

IV INFUSION

OD

9/2/15 to

12/2/15

4. Inj. Pantop Pantaprazole Anti ulcerative 40 mg IV BD 5/2/15 to

12/2/15

5. Inj. Ceftriaxone Ceftriaxone Antibacterial 1 g IV BD 5/2/15 to

9/2/15

Progress chartPROGNOSIS TREATMENT

Day 1,

O/E, Pt-unconscious,vomiting BP-

130/90mmHg,PR-110bpm,RS-

BLAE+, P/A-soft, CNS-NSRL+

Rx, Inj. Atropine 2 amp-IV TID in 1 NS

Inj. Pantop 40mg IV BD

Inj. PAM 1gm IV BD

Inj. Ceftriaxone 1 gm IV BD

Inj. Ondansetron 4mg IV BD

Day 2, O/E, vomiting

Pt is conscious, coherent, pupils-

NSRL+

Rx, CST

stop Inj ondansetron

Day 3,O/E

Pt-c/c, BP-130/80mm/Hg, PR-

110bpm

Rx, CST

Progress chart….Day 4 , O/E,

Pt- c/c, irritable, burning sensation,

pupils-B/L dilated, reacting to

light,BP-130/90mm Hg,PR-94bpm,

Rx, CST

Day 5,

Pt-c/c, ↓ irritability,BP-

110/70mmHg,pupils dilated, PR-

92bpm,

Rx, CST

IVF 2DNS, 1RL, 1NS

Day 6,

Pt-general condition is fair ,C/O

body pains , headache

Rx, CST

T.PCT 500mg BD

T. Cefixime 200 mg- P/O- BD

Day 7,

Pt- symptomatically, BP- 120/80

mm HG, PR-90bpm, CNS-NAD, RS-

Clear

Rx, CST

Progress chart…

Discharge medication:Patient general condition is symptomatically better,

Rx,

T. B-Complex OD

T. Rantac 150mg BD

T. Amoxiclav 625mg BD

T.PCT 500mg TID

Asked to review after 1 week.

PHARMACIST INTERVENTIONS

Possible drug- drug interactions: No specific drug interactions

were observed.

Possible ADRs are:

Atropine:

Dry mouth, dysphagia, constipation, flushing, dryness of skin,

palpitations

Ceftriaxone:

super infection, rash, fever, pruritis, nephrotoxicity

Amoxyclav:

GI disturbances, anaphylactic shock, pruritis, skin rashes

PATIENT COUNSELING

REGARDING DISEASE CONDITION :

Organophosphorus compound poisoning is a lethal one

if not treated with antidote immediately. The compound

may cause respiratory depression, bradycardia,

hypotension,

sweating(cholinergic),unconsciousness…etc

REGARDING DRUGS MEDICATION PROFILE:

Inj. Atropine: Anti cholinergic drug which act as

antidote for the poisoning

Inj. PAM (Pralidoxime): it is an antidote.

Inj. Ceftriaxone: antibacterial to treat hospital acquired

infections.

REGARDING LIFE STYLE MODIFICATIONS

Advised family to support the patient by any means

After knowing that poisoning occur ,water with mustard

or water with excess salt is given and vomiting should be

induced.

Referred and counseled given by psychiatrist:

The causes for suicidal attempts is to be analyzed based

on that counseling is done.

To do meditation or yoga to relieve stress and to relax

well

Advised him if any suicidal tendencies are seen in him, to

consult a psychiatrist immediately

TITLE

“ INCIDENCE AND ASSESSMENT OF ANTIDOTES IN OP

POISONING AT TERTIARY CARE HOSPITAL,

SOUTH INDIA”

Corresponding author:

Daghari Zakieh Jasem,Nikitha,Rajeswari Ramaswamy,Arpan Dutta Roy,Dr. Anjani M. Reddy

OP compounds and other pesticides are commonly used for suicide.

Globally, OP Poisoning is a major problem though its types varies in different countries.

Organophosphate (OP) poisoning is always having high morbidity and mortality rates, both in poor and in well-developed countries.

INTRODUCTION

OP POISONING

Major cause of morbidity and mortality is due to self-poisoning and because of their easy availability.

The causes of poisoning are many-civilian, industrial, accidental & deliberate.

Since the exact causative agents is not known there is a greater need for understanding the clinical characteristics of OP Poisonings.

In the majority of situations there is a lack of analytical assistance in most of the primary health care systems.

The physicians mostly depend on clinical signs and symptoms for diagnosis.

However, the toxicity might become irreversible or even fatal because onset of symptoms may take some time to develop.

The Purpose of the study was to find out the incidence of OP (Organo Phosphate) poisoning cases in the ED (Emergency Department), and to assess the antidotes.

METHODOLOGY

Study design : A Prospective observational study.

Study site :MVJ Medical College and Research Hospital,Bangalore.

Study duration : The study carried out over for 6 months.

Sample size : 90 op poisoning patients.

Inclusion criteria : OP poisoning cases in Emergency Department

including casualty and ICU are included in the study.

Exclusion criteria : All other poisoning, other than OP cases, were

excluded from the study.

METHODOLOGY………

STUDY MATERIALS:

Patient demographic data collection form.

Patient informed consent form.

Case Report Form (CRF).

ANALYSIS

STATISTICAL ANALYSIS

All the cases included in the study, were analyzed for the reasonfor Poisoning; appropriateness of gastric lavage, selection andrational use of antidotes by the investigators, using Micromedexdatabase.

DATA ANALYSIS

The data including demographic information (age, sex), toxic substances involved, type of poisoning, clinical symptoms, laboratory tests and patient outcome were evaluated.

Necessary steps were taken to determine the impact of clinical

pharmacist involvement in poison management.

RESULTS AND DISCUSSION

CONCLUSION

There are considerable variations in the practice of gastric lavageand antidote utilization in practicing clinicians in the study site.

In many cases the dosing interval was wrong which lead toproblems like Atropine induce Psychosis.

This Study would help in prompt and appropriate poisoningtreatment, and prevent the prolonged hospitalization & betterpatient outcome.