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

Abstract

Industrial production of food for animals and humans needs increasing amounts of pesticides, especially of organophosphates, which are now easily available worldwide. More than 3 million cases of acute severe poisoning are estimated to occur worldwide every year, and even more cases remain unreported, while 200,000–350,000 incidentally or intentionally poisoned people die every year. Diagnostic and therapeutic procedures in organophosphate poisoning have, however, remained unchanged. In addition to several neurologic symptoms (miosis, fasciculations), hypersecretion of salivary, bronchial, and sweat glands, vomiting, diarrhea, and loss of urine rapidly induce dehydration, hypovolemia, loss of conscience and respiratory distress. Within hours, signs of acidosis due to systemic hypoxia can be observed at first laboratory investigation after hospitalization. While determination of serum-cholinesterase does not have any diagnostic value, it has been established that hypoalbuminemia alone or accompanied by an increase in creatinine, lactate, or C-reactive protein serum levels has negative prognostic value. Increased serum levels of C-reactive protein are a sign of systemic ischemia. Protective mechanical ventilation should be avoided, if possible. In fact, acute respiratory distress syndrome characterized by congestion and increased weight of the lung, accompanied by heart failure, may become the cause of death. As the excess of acetylcholine at the neuronal level can persist for weeks until enough newly, locally synthesized acetylcholinesterase becomes available (the value of oximes in reducing this time is still under debate), after atropine administration, intravenous albumin and fluid infusion should be the first therapeutic interventions to reestablish normal blood volume and normal tissue oxygenation, avoiding death by cardiac arrest.

The Role of Neutrophil-to-Lymphocyte Ratio in Predicting Outcomes of Acute Organophosphorus Poisoning: A Comprehensive Review

“…As evidenced by the NLR, the equilibrium between neutrophils and lymphocytes has been under scrutiny as a potential prognostic marker in AOPP. Elevated NLR levels may signify a more robust inflammatory response and poorer outcomes in poisoning cases [16][17][18][19]. The interaction between neutrophils and lymphocytes holds critical importance in the immune response to poisoning, with the NLR serving as a valuable gauge of inflammatory status and prognosis in AOPP.…”

Intelligent Rapid Detection Techniques for Low-Content Components in Fruits and Vegetables: A Comprehensive Review

“…However, excessive pesticide usage leads to the presence of pesticide residues in these crops. In China, the maximum residue limit (MRL) for organophosphorus pesticides in fruits and vegetables falls between 0.01 mg/kg and 0.5 mg/kg, according to the national standard GB2763-2021 [16]. Consuming fruits and vegetables with pesticide residues poses significant health risks.…”

Pollutants, including Organophosphorus and Organochloride Pesticides, May Increase the Risk of Cardiac Remodeling and Atrial Fibrillation: A Narrative Review

“…Various clinical reports support that acute and prolonged exposure to organophosphorus is associated with the occurrence of cardiac arrhythmias, including AF [ 58 , 59 , 60 , 61 , 62 ]. In addition to cardiac rhythm abnormalities, the manifestations of organophosphorus intoxication can also include central nervous system perturbation, acute myocardial injury, heart failure, acute renal damage, hepatic dysfunction, and respiratory disorder [ 63 , 64 ]. In a case report published in 2017, Dr M. Maheswari and Dr S. Chaudhary described that a patient accidentally poisoned with organophosphorus was admitted to the emergency room with acute-onset AF.…”