Electrocardiographic Findings of Acute Organophosphate Poisoning

Yürümez, Yusuf; Yılmaz, Yücel; Sağlam, Hayrettin; Durukan, Polat; Özkan, Seda; Akdur, Okhan; Yücel, Murat

doi:10.1016/j.jemermed.2007.08.063

Cited by 41 publications

(36 citation statements)

References 13 publications

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“…OP intoxication can be observed in all age groups (11-13). The average age of the patients in the present study was 39.4 years, which was consistent with that described in the literature (12,14,15). Many studies have reported a female predominance with respect to OP intoxication.…”

Section: Discussionsupporting

confidence: 91%

Epidemiology of organophosphate intoxication and predictors of intermediate syndrome

Çolak¹,

Erdoğan²,

Baydın³

et al. 2014

Turk J Med Sci

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In the cotton zone of Punjab, Pakistan, only 20% of wheat is sown at the optimum sowing time, i.e. the first fortnight of November, while the remaining sowing is done from late November (30%) to December (50%) (Khan et al. 2002). Wheat has a determinate growth habit and a delay of each day in sowing from mid-November onward decreases the number of tillers, leaf area, and total dry matter. Moreover, late sowing of wheat also delays anthesis, which ultimately reduces grain yield at a rate of 30-40 kg day -1 ha -1 (Hussain et al. 1998;Akmal et al. 2011). Late-sown wheat has to complete its life cycle in a short duration because starch accumulation terminates at the same time in both normal and late-sown plants ( Khan et al. 2010). Late sowing results in poor germination and delayed emergence due to the prevalence of low temperatures at that time. In consequence, a weak crop stand and less tillering affect grain yields. Moreover, high temperatures at later growth stages enforce shortening of the grain filling period and early maturity.Limited availability of canal irrigation water and low precipitation are also common in the cotton-wheat cropping system of the South Punjab, Pakistan, and when coupled with late sowing, they severely affect wheat yields. Crop production in this region mainly depends on irrigation, but unfortunately per capita water availability is declining at an alarming rate, from 5260 m 3 in 1951 to 1066 m 3 in 2010, and it will be less than 870 m 3 per capita by 2025 (Ahmad et al. 2009). Due to scarcity in irrigation and water supply, and increasing competition for water demand from nonagricultural sectors, the focus is already shifting from maximizing the production per unit area towards the maximization of the production per unit of water consumed, often termed as water productivity (Fereres and Soriano 2007). For that purpose, and to optimize crop economic returns under conditions of less irrigation water use (irrigation supply below full crop water requirement, evapotranspiration [ETo]), new strategies should be developed. These challenges may be overcome either by minimizing the water losses or by improving the crop water use efficiency. These can be achieved by promoting a large and early canopy development of growing plants.

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Section: Discussionsupporting

confidence: 91%

Epidemiology of organophosphate intoxication and predictors of intermediate syndrome

Çolak¹,

Erdoğan²,

Baydın³

et al. 2014

Turk J Med Sci

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“…Multifocal PVC's, Idioventricular arrhythmias, AF, VF, transient ST-T changes and different grades of heart blocks including complete heart block are also seen in OPC-Poisoning. [8][9][10][11] The mechanism of cardiac toxicity is caused by more than one mechanism and are sympathetic, parasympathetic overactivity, hypoxemia, acidosis, electrolyte derangements and direct toxicity on myocardium and conduction system of the heart. 12,13 The antidote Atropine may itself induce arrhythmia.…”

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confidence: 99%

Study of clinical profile of organophosphorus poisoning with special reference to electrocardiographic changes and electrolyte derangement

et al. 2018

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Background: Organophosphorus Compounds (OPC) are main cause of accidental and suicidal poisoning in agrarian countries like India. Aim was to study the clinical profile of OPC-Poisoning and correlate it with the electrocardiographic (ECG) changes and electrolyte abnormalities.Methods: Hundred consecutive cases admitted to Medicine Department underwent clinical examination, ECG, electrolytes, Acetyl Choline Esterase (AChE) estimation from time to time and Paradeniya Organophosphorus Poisoning (POP) score at the time of admission. All these parameter with duration of hospital stay and outcome were statistically analysed using X2 test, Fisher exact test, and inference was drawn.Results: In hundred OPC-Poisoning patients [Male (n=48), Female (n=52), M: F ratio 0.92:1] with mean age of 37.78±12.95 years, commonest poison was cholropyrifos+cypermethrin and was mostly suicidal (96%). Common symptoms were sweating (48%), salivation, blurring of vision, breathlessness and signs were smell of poison (90%), tachypnea, altered sensorium, miosis and fasciculation. POP scoring found 41% of patients in mild, 26% in moderate and 33% in sever grade of poisoning. Hospital stay ranged from 4-18 days. Complications were pulmonary Edema (PE) in 28%, Respiratory Failure (RF) 18%, Aspiration Pneumonia (AP) 15% and Intermediate Syndrome (IS) 4%. 10 died out of 42 patients who had complications and the cause of death was RF in 4, Ventricular Fibrillation (VF) 2 and IS in 2. ECG finding showed sinus tachycardia (31%), prolonged corrected QT (QTc) interval (28%), sinus bradycardia (25%), ST-T changes (17%) and Premature Ventricular Contraction (PVC) in 4% which degenerated to VF in 2%. 24 patients were Hypokalemic from which 16 developed complications.Conclusions: Similar to earlier studies we observed poisoning which was suicidal. QTc prolongation and Hypokalemia are associated with high morbidity and mortality in OPC-Poisoning.

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“…In a cohort of 85 patients with OP poisoning, QT prolongation was the most common EKG abnormality, followed by sinus tachycardia. VT or cardiac asystole was not observed in any of these patients [10].…”

Section: Discussionmentioning

confidence: 73%

Late Onset, Prolonged Asystole Following Organophosphate Poisoning: A Case Report

Chacko

Elangovan

2010

J. Med. Toxicol.

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Introduction Organophosphate (OP) compounds are commonly used as suicidal agents and produce characteristic toxic effects. Cardiac arrhythmias are often observed in the acute phase of toxicity; late onset polymorphic ventricular tachycardia preceded by prolonged QT interval on the EKG is also known to occur. However, there are no reports of late onset, prolonged asystole without preceding arrhythmias and after acute toxicity had abated. Case Report We report a case of prolonged asystole 12 days after ingestion of an OP compound, after apparent recovery from the acute toxic effects. Asystole persisted for 25 min, followed by successful resuscitation without any sequelae. Discussion Although cardiac arrhythmias and circulatory arrest are known to occur following OP ingestion, these are often in the acute phase of toxicity. Our patient had no preceding cardiac manifestations but developed prolonged refractory asystole after 12 days of ingestion of the compound when the acute effects had subsided. We emphasize the importance of being aware of the potential for OP compounds to cause late onset asystole and the need for continued EKG monitoring even after the acute symptoms appear to have settled.

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Electrocardiographic Findings of Acute Organophosphate Poisoning

Cited by 41 publications

References 13 publications

Epidemiology of organophosphate intoxication and predictors of intermediate syndrome

Epidemiology of organophosphate intoxication and predictors of intermediate syndrome

Study of clinical profile of organophosphorus poisoning with special reference to electrocardiographic changes and electrolyte derangement

Late Onset, Prolonged Asystole Following Organophosphate Poisoning: A Case Report

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