Accidental organophosphate insecticide intoxication in children: a reminder

Heel, Willemijn van; Hachimi-Idrissi, Saı̈d

doi:10.1186/1865-1380-4-32

Cited by 21 publications

(8 citation statements)

References 13 publications

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“…13,25 Organophosphates lead to irreversible inhibition of the enzyme acetyl cholinesterase leading to the accumulation of acetylcholine in various tissues and excessive parasympathetic activity. 26 Patients present within few hours of ingestion with respiratory distress, excessive salivation, vomiting and diarrhoea; muscle twitching, convulsions, coma and shock, most of which were observed in the index case, can be seen in severe cases. 19,27 The diagnosis is based on the history of exposure and findings of classical signs of organophosphate poisoning on examination, sometimes captured in the mnemonic "Dumbels" (Diarrhoea, Diaphoresis, Urination, Miosis, Bronchorrhoea, Bronchospasm, Bradycardia, Emesis, Lacrimation and Salivation).…”

Section: Discussionmentioning

confidence: 99%

Accidental organophosphate poisoning in a child in Uyo, Nigeria: a public health alert

et al. 2016

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<p class="abstract"><span lang="EN-US">Organophosphates are often constituents of pesticides and insecticides. Some of these products are sold by unregistered vendors on the streets and in market places in sub-Saharan Africa. When purchased, and improperly stored, children may easily have access to, and inadvertently consume them. The clinical features of organophosphate poisoning include diarrhoea, diaphoresis, urination, miosis, bronchorrhoea, bronchospasm, bradycardia, emesis, lacrimation and salivation. Atropine administration is an important cornerstone of the management of this condition, with a good outcome in this instance. A case of organophosphate poisoning is herein reported to illustrate the effect of the predisposing factors to accidental childhood poisoning. It is hoped that this will help make an urgent case to raise public awareness on the prevention of accidental childhood poisoning, as well as the enforcement of regulations on the production, labeling, distribution and sale of these organophosphate compounds.</span></p>

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Section: Discussionmentioning

confidence: 99%

Accidental organophosphate poisoning in a child in Uyo, Nigeria: a public health alert

et al. 2016

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“…Fatal organophosphate poisoning or non-fatal intoxication has been reported by most routes of exposure. 5,8,9,13–16 Van Heel 13 reported non-fatal accidental organophosphate intoxication in siblings with absorption by skin, mouth and/or respiratory tract while spraying pesticide solution on each other in bathroom at play. The same was kept by mother for eradicating insects out of the house.…”

Section: Discussionmentioning

confidence: 99%

Fatal monocrotophos poisoning by cutaneous absorption while sleeping: A remarkable case study

et al. 2019

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Organophosphate poisoning is a continued menace associated with high morbidity and mortality in both resource-crunched developing and developed countries. Cases have been described of deliberate self-poisoning which has higher mortality than accidental exposure. Fatal poisoning by accidental dermal absorption is rarely reported for monocrotophos. Authors detail fatal accidental monocrotophos poisoning in adult female by dermal exposure while sleeping. Pesticide was detected in post-mortem blood and skin by chromatography and spectroscopy. Extraction along with review of literature for monocrotophos poisoning is adjuncted in this study.

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“…Possibility of OPP in this infant was remote due to 1) its uncommonness in this age group; 2) it rarely causes seizures (Moreover with excessive secretions and respiratory insufficiency hypoxia may be a cause of seizures) and most important; 3) absent history of exposure to the toxin. Younger children are prone to poisoning accidently due to their active and curious nature [1]. In new born, OPP can be explained by trans-placental acquisition of the chemical if mother ingests the compound during delivery [2].…”

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Infantile Status Epilepticus and No Evident History of Exposure – Can it Still be Organophosphate Poisoning?

2015

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To the Editor : Organophosphate poisoning (OPP) is rare during infancy and difficult to suspect when present with atypical presentation. A 4-mo-old, previously healthy baby girl was referred to us gasping in status epilepticus [multifocal seizures (first episode)] after receiving midazolam, phenytoin and mannitol from outside. There was no history of fever or abnormal birth events. She had hypotonia, depressed deep tendon reflexes, bilateral pinpoint pupils, normal anterior fontanelle and poor response to pain. She was treated as sepsis and ventilated. Her blood investigation, cranial imaging and CSF were normal. During monitoring, profuse oral, endotracheal secretions and sweating were noted. This along with miosis fitted into OPP. Atropine and Pralidoxime were started empirically. She improved with antidote therapy and was extubated on 6th day. Later OPP was confirmed with low pseudocholinesterase levels <1 kU/L (3.93-10.80). Possibility of OPP in this infant was remote due to 1) its uncommonness in this age group; 2) it rarely causes seizures (Moreover with excessive secretions and respiratory insufficiency hypoxia may be a cause of seizures) and most important; 3) absent history of exposure to the toxin. Younger children are prone to poisoning accidently due to their active and curious nature [1]. In new born, OPP can be explained by trans-placental acquisition of the chemical if mother ingests the compound during delivery [2]. During infancy homicidal attempt can be thought of, as female infanticide is common in north India. But such a history was unavailable. Moreover the secretion of these chemicals in breast milk is not known and future studies would be required to know if this can be the source of the chemical during infancy. Possible source of OPP may have been dermal contact with adult skin/clothes, floor as the father was a gardener and used to keep OP compounds at home. The presence of toxidrome of OPP like excessive secretions was disregarded initially as excessive salivation can be associated with seizure. This later on along with miosis and low heart rate made the basis of our suspicion. Further, absence of fever propelled us to think noninfectious causes of seizures. Though rarely, seizure can occur in OPP [3]. It is also possible that patient had muscle fasciculation and those were recorded as multifocal seizures but then these will not subside with antiepileptics. We recommend that full consideration should be given to the symptom constellation of OPP even in the absence of history of exposure as this is not uncommon and is fully treatable.

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Accidental organophosphate insecticide intoxication in children: a reminder

Cited by 21 publications

References 13 publications

Accidental organophosphate poisoning in a child in Uyo, Nigeria: a public health alert

Accidental organophosphate poisoning in a child in Uyo, Nigeria: a public health alert

Fatal monocrotophos poisoning by cutaneous absorption while sleeping: A remarkable case study

Infantile Status Epilepticus and No Evident History of Exposure – Can it Still be Organophosphate Poisoning?

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