An intravenous organophosphate poisoning with intermediate syndrome: An unusual way of intoxication

Abstract

Organophosphate (OP) poisoning is very common form of poisoning in Indian population because of its availability and easy access. Intoxication occurs following the absorption of OP agents through gastrointestinal tract, skin and respiratory tract and rarely by intramuscular or intravenous route. The clinical features depend on the amount of the poison consumed, it's concentration, the route of administration and the time of instituting therapy. We are reporting a case of an intravenous monochrotophos poisoning, an unusual way of intoxication, which was managed in our ICU.

A Rare Case of Intravenous Pesticide Poisoning with Upper Extremity Necrosis

“…Carbamates are commonly found in household insecticides and are reversible cholinesterase inhibitors [1]. These agents accumulate acetylcholine at nerve synapses and cause both nicotinic and muscarinic symptoms such as excessive salivation, urination, nausea, vomiting, bronchorrhea, bronchoconstriction, skeletal muscle weakness, miosis, bradycardia and hypo-or hypertension [3][4][5]. The severity of symptoms varies depending on the amount, composition, and exposure route, and can lead to coma or death in severe cases.…”

Intra-aural route of insecticide poisoning

“…[34] Badhe and Sudhakar described intravenous monocrotophos poisoning resulting in intermediate syndrome requiring ventilator support. [5] Peiris et al . reported an acute cholinergic crisis and intermediate syndrome requiring mechanical ventilation in a patient who had an accidental spill of monocrotophos over the face.…”

“…There are also many reports of administration of OP compounds with suicidal intent by intravenous, intramuscular, and subcutaneous routes. [2345] However, intra-aural route of poisoning with intent for deliberate self-harm is very unusual and has never been reported in the literature.…”

Epidemiological Studies of Anticholinesterase Pesticide Poisoning in India

“…The patient developed intermediate syndrome and was managed with atropine, pralidoxime, and ventilatory support, leading to full recovery (Badhe and Sudhakar, 2006). The patient developed intermediate syndrome and was managed with atropine, pralidoxime, and ventilatory support, leading to full recovery (Badhe and Sudhakar, 2006).…”