Pulmonary thrombosis in acute organophosphate poisoning—Case report and literature overview of prothrombotic preconditioning in organophosphate toxicity

Pereska, Zanina; Chaparoska, Daniela; Bekarovski, Niko; Jurukov, Irena; Simonovska, Natasha; Babulovska, Aleksandra

doi:10.1016/j.toxrep.2019.06.002

Cited by 8 publications

(6 citation statements)

References 57 publications

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“…Moreover, it was noticed that most of the pulmonary blood vessels showed atrophy and loss of the media and endothelial cells, respectively. This might clarify the thrombotic activity of the organophosphorus compounds 49 . The adverse effect of the malathion inhalation was mitigated by TQ supplementation in a dose-dependent manner.…”

Section: Discussionmentioning

confidence: 93%

Protective effect of thymoquinone against lung intoxication induced by malathion inhalation

Abdo

Elmadawy

Abdelhiee

et al. 2021

Sci Rep

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Malathion is considered one of the vastest pesticides use all over the world. Malathion-inhalation toxicity commonly occurred in many occupational farmers. Therefore, this study aimed to ameliorate the possible malathion-induced pulmonary toxicity through thymoquinone administration. Forty animals were used to conduct our study, divided into five groups; G1 control group, G2 thymoquinone (50 mg/kg) group, G3 malathion group (animals inhaled 100 mg/ml/m3 for 15 min for 5 days/week for three weeks), G4 and G5 were subjected to the same malathion inhalation protocol beside oral thymoquinone administration at doses of 25 and 50 (mg/kg), respectively. Malathion-inhalation induced marked systemic toxicity as hepatotoxicity and nephrotoxicity associated with increased serum hepatic and renal enzymes, and hypersensitivity accompanied with increased total IgE serum level. The lung showed severe interstitial pneumonia associated with severe vascular damage and marked eosinophil infiltration. Moreover, the lung showed a marked decrease in the pulmonary surfactant protein, especially SP-D gene expression. While, thymoquinone treatment to malathion-inhaled animals decremented the following; hepatic enzymes and renal function tests, total IgE as well as pneumonia and hypersensitivity pathological features, and augmented the expression of SP-D. In conclusion, thymoquinone could be potentially used in pest control workers to ameliorate the systemic and pulmonary intoxication caused by one of the most field-used pesticides.

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Section: Discussionmentioning

confidence: 93%

Protective effect of thymoquinone against lung intoxication induced by malathion inhalation

Abdo

Elmadawy

Abdelhiee

et al. 2021

Sci Rep

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“…The leading maxim in the treatment of AOPP intoxication should, therefore, be “treat the patient, not the poison” [ 13 ], as has been successfully practiced in recently published case reports [ 164 , 167 , 168 , 169 , 170 ]. Elevated serum levels of inflammation markers in combination with hypoalbuminemia must be interpreted more as signs of tissue ischemia caused by hypovolemia than as direct consequences of the reduced acetylcholine degradation at the neuronal level.…”

Section: Discussionmentioning

confidence: 99%

“…The proper interpretation of the origin and significance of markers of tissue damage such as increased levels of C-reactive protein, fibrinogen, lactate, amylase [ 165 ] or serum troponin level and other markers of cardiac damage [ 166 ] in combination with hypoalbuminemia is of crucial importance in guiding treatment of the “secondary” effects of acute AOPP ( Figure 1 ) if we wish to improve survival in such patients [ 167 , 168 , 169 , 170 ] after decades of therapeutic stagnation [ 171 , 172 , 173 ].…”

Section: Acetylcholinesterase and Albumin Measurement: Importance For...mentioning

confidence: 99%

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

Ramadori

2023

IJMS

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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.

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“…A recent report has also been published of pulmonary thrombosis in acute organophosphate poisoning. (11) Another case of OP poisoning presenting with clinical features of coronary thrombosis and pulmonary thromboembolism has been reported that occurred during the delayed phase. (12) A rare case of upper extremity deep vein thrombosis in OP poisoning has also been published.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Thromboembolism in Organophosphorus Poisoning – A Rare Complication

Dsouza

Anita²,

Shetty

et al. 2020

IJFMT

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Organophosphate based insecticides constitute the cause of a large number of mortality and morbidity cases in the developing world. The reasons include easy availability, being inexpensive, and lack of regulations regarding their sale and storage. Another factor that has made organophosphate insecticides a major source of suicidal ingestion is the perceived fatality associated with them. Though the muscarinic, nicotinic and central nervous system complications of organophosphate poisoning are well known, the organophosphate toxidrome can sometimes present with unusual presentations and unexpected complications. In the scenario that exists wherein there are substantial number of cases, there arises the possibility that these presentations and complications will only increase in number. In this context it becomes important to know the possible mechanisms that cause unusual presentations and take adequate safeguards. In the case examined herein, a geriatric patient consumed organophosphorus insecticide. Treatment included an initial stomach wash, standard atropine therapy and supportive management. The patient experienced multiple diverse presentations related to the poisoning before eventually succumbing after 1 month. On autopsy the immediate cause of death was found to be pulmonary thromboembolism. The increased susceptibility of thromboembolism could have multiple reasons such as increased immobilization, myopathy resulting in inefficient venous return and deep vein thrombosis, or vessel damage due to inflammatory mediators. This case illustrates the need to consider pulmonary thromboembolism as a potential lethal complication of organophosphorus poisoning.

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Pulmonary thrombosis in acute organophosphate poisoning—Case report and literature overview of prothrombotic preconditioning in organophosphate toxicity

Cited by 8 publications

References 57 publications

Protective effect of thymoquinone against lung intoxication induced by malathion inhalation

Protective effect of thymoquinone against lung intoxication induced by malathion inhalation

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

Pulmonary Thromboembolism in Organophosphorus Poisoning – A Rare Complication

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