Organophosphate Poisoning in a Paediatric Intensive Care Unit: A Retrospective Analysis Based on Ten Years of Experience

Abstract

Background Organophosphate (OP) poisoning is one of the most common etiologies of poisoning in the pediatric age group. Objective This study aimed to evaluate the demographic characteristics, clinical features, clinical course, and outcomes of children with toxicity from organophosphates admitted to the pediatric intensive care unit. Methods A retrospective review of hospital medical records of all children aged 14 years and younger who were admitted to the PICU with a provisional diagnosis of organophosphate poisoning at King Fahad Hospital of the University (KFHU), Alkhobar, Saudi Arabia, between January 1, 2008, and December 31, 2018, was conducted. Patients with incomplete medical record information or with suspicion or evidence of one or more agents other than organophosphate were excluded from the study. Results Thirty-one patients were enrolled in the study. The median age of the study population was 2 years, and 19 (61%) were males. The majority of patients (68%) had more than one route of organophosphate exposure. Skin exposure was reported in 26 patients (84%). Only three patients (10%) had suicidal organophosphate exposure from organophosphates, while the majority (28 patients; 90%) had accidental poisoning. Bronchorrhea was the most prevalent presenting feature, reported in 28 patients (90%). 17 patients (55%) were treated with intravenous atropine and (45%) were used a combination of pralidoxime with atropine for treatment. Five patients (16%) developed acute respiratory distress syndrome. Twelve patients (39%) needed endotracheal intubation and mechanical ventilation secondary to respiratory failure. Conclusion The presenting features of organophosphate poisoning differ widely in children. Risk factors for mortality for PICU patients with organophosphate poisoning include delayed hospital arrival by more than 1 hour, inhalational route of exposure, need for mechanical ventilation, and high lactate levels in the first 24 hours post-exposure.

Organophosphorus Poisoning: Acute Respiratory Distress Syndrome (ARDS) and Cardiac Failure as Cause of Death in Hospitalized Patients

“…This causes an annual 200,000–350,000 deaths due to acute poisoning [ 11 , 12 , 13 , 14 , 15 , 16 ] not only in adults and also children [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. Probably many more cases (several million) of poisoning in human subjects who are “chronically” exposed to pesticides every year remain undetected [ 25 , 26 , 27 , 28 , 29 , 30 ].…”

“…Although rules for the use of these extremely toxic compounds have been issued in all countries of the world, and the WHO continuously reports on toxicity numbers, the numerous publications about acute and “chronic” occupational and non-occupational toxic consequences for children [ 19 , 22 , 23 , 24 ] and adults [ 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ] around the world can only be considered anecdotical or the tip of the iceberg.…”