A Comparative Toxidrome Analysis of Human Organophosphate and Nerve Agent Poisonings Using Social Media

Abstract

Here we utilized social media to compare the toxidrome of three lethal chemical exposures worldwide. YouTube videos were the main source from which the data were collected, but published reports and news were also utilized to fill in some gaps. All videos were organized in a database detailing symptoms and severity of each victim, along with demographics such as approximate age and gender. Each symptom was rated as mild, moderate, or severe and corresponding pie graphs for each incident were compared. The videos displayed symptoms ranging from mild to severe cholinergic toxicity and life‐threatening convulsions. Social media may represent an important resource in developing a viable approach to the early detection and identification of chemical exposure, reinforce our preparedness for better antidotes, long‐term follow up, and training about deadly chemical nerve agent attacks.

Phenobarbital as alternate anticonvulsant for organophosphate‐induced benzodiazepine‐refractory status epilepticus and neuronal injury

“…OP nerve agents are among the most deadly chemical warfare agents that can cause respiratory arrest within minutes of absorption or inhalation. Acute exposure to OPs causes a set of predictable acute toxic signs such as hypersecretion, fasciculations, tremors, convulsions, respiratory distress, and possibly death 1‐2,7,8 . Controlling persistent seizures at an early stage is critical for survival and preventing long‐term neurological dysfunction after OP intoxication.…”

“…OPs such as parathion and diisopropylfluorophosphate (DFP) are highly toxic chemicals that inhibit acetylcholinesterase (AChE) at central and peripheral cholinergic synapses. Thus, OP intoxication results in dramatic accumulation of acetylcholine leading to cholinergic crisis that manifests into predictable signs and symptoms, including constriction of the pupil, hypersecretion, bradycardia, tremors, fasciculations, persistent seizures, respiratory distress, and ultimately death 4‐8 . Among the most serious immediate results of OP poisoning is the onset of prolonged seizures known as status epilepticus (SE) 8,9 .…”

Midazolam-Resistant Seizures and Brain Injury after Acute Intoxication of Diisopropylfluorophosphate, an Organophosphate Pesticide and Surrogate for Nerve Agents

“…Nerve agents and organophosphate (OP) pesticides are chemical threat agents. Nerve agents are chemical warfare agents that have long attracted the attention of terrorists for attacking a civilian population (Pereira et al, 2014;Reddy and Colman, 2017). Military nerve agents (sarin, soman, tabun, cyclosarin, and VX) directly target the nervous system and rapidly impair neural signaling within minutes of exposure.…”

“…Pittel et al, 2006Pittel et al, , 2018. Acute exposure to OPs results in cholinergic hyperactivation and causes a set of predictable and well-documented toxic signs: hypersecretion, miosis, headache, fasciculations, tremors, convulsions, respiratory distress, and death (Bakry et al, 1988;Bajgar, 1997;McDonough and Shih, 1997;Shih et al, 1991Shih et al, , 2003Hájek et al, 2004;Bajgar et al, 2008;Sirin et al, 2012;Abou-Donia et al, 2016;Reddy and Colman, 2017;Pittel et al, 2018).…”

Benzodiazepine-refractory status epilepticus, neuroinflammation, and interneuron neurodegeneration after acute organophosphate intoxication

“…These agents act by irreversible inhibition of acetylcholinesterase (AChE), the enzyme that hydrolyzes the excitatory neurotransmitter acetylcholine in the central and peripheral nervous systems [4]. Neurotoxic manifestations following OP exposure includes hypersecretion, miosis, tremors, respiratory distress and convulsions leading to status epilepticus (SE) [5–8]. OP induced SE can last several hours, causing profound brain damage resulting in long-term neuronal dysfunction or death [6–8].…”