Prevalence of Intermediate Syndrome among Admitted Patients with Organophosphorous Poisoning in a Tertiary Care Hospital

Abstract

Introduction: Organophosphorous poisoning is a common problem prevalent in Nepal. Intermediate syndrome is a common clinical feature seen among the patients those have ingested poison. There is a scarcity of data related to intermediate syndrome and other general complications in patients with organophosphorous poisoning in context of Nepal. This study was carried out to observe the prevalence of intermediate syndrome and the general complications of oraganophosphorus poisoning among admitted patients in a tertiary care hospital.
 Methods: This was a descriptive cross-sectional study conducted at a tertiary care hospital from April 2008 to June 2009 after ethical approval was from Institiutional Review Board of tertiary care hospital. Forty four patients with history of ingestion of organophosphorus poisoning within 24 hours were included in our study through convenience sampling. Clinical examinations were done to look for Intermediate syndrome. Data was entered in Statistical Package for Social Sciences and point estimate at 95% of CI was calculated along with frequency and proportion for binary data.
 Results: Out of 44 patients, features of intermediate syndrome were seen in 40 (90.9%) at 95% of CI (84.2-97.6) patients in the study. The frequency of intermediate syndrome signs like weakness of neck flexion, inability to sit up and swallowing difficulty were seen among the patients. Complications like pneumonia 4 (9.09%), hyponatremia 3 (6.8%), hypokalemia 1 (2.27%) and bradycardia 1 (2.27%) were seen in the study. Mortality seen in the study was 2 (4.5%) among the admitted patients.
 Conclusions: Prevalence of intermediate syndrome was higher compared to other studies done in similar settings. Complications like pneumonia, hyponatremia, hypokalemia and bradycardia were seen among the patients.

Platypnea–orthodeoxia syndrome

“…The proposed mechanism behind intermediate syndrome remains the incorporate distinctive vulnerability seen in different cholinergic receptors, muscle corruption, delay in acetylcholinesterase hindrance, deficiency in the oxime treatment, downregulation or desensitization of postsynaptic acetylcholine receptors, postsynaptic acetylcholine receptors, postsynaptic acetylcholine discharge disorder and myopathy related to oxidative stress. [ 6 ] The intermediate syndrome has an incidence of 20 percent in patients presenting with an intake of organophosphorus pesticides and has shown no relation with the type of organophosphorus pesticide. [ 7 ] It normally occurs two to four days after the presentation when the side effects and indications of the acute cholinergic disorder such as muscle fasciculations and muscarinic signs are not seen anymore.…”

Síndrome neuroléptico maligno asociado con intoxicación aguda por un organofosforado: reporte de caso

“…La intoxicación aguda por organofosforados es un problema mundial de salud 1 . Las manifestaciones clínicas se asocian con la unión del tóxico al residuo de serina, lo que inhibe de forma irreversible la acción de la acetilcolinesterasa por fosforilación, con la consecuente estimulación excesiva de los receptores muscarínicos y nicotínicos.…”

“…Las manifestaciones clínicas se asocian con la unión del tóxico al residuo de serina, lo que inhibe de forma irreversible la acción de la acetilcolinesterasa por fosforilación, con la consecuente estimulación excesiva de los receptores muscarínicos y nicotínicos. Esto produce una crisis colinérgica aguda que puede cursar con complicaciones específicas, como el síndrome intermedio y la neuropatía retardada 1 , 2 . En un caso reportado, dicha intoxicación se asoció con la aparición del síndrome neuroléptico maligno 2 .…”