Síndrome intermedio en el transcurso de una intoxicación por organofosforados a pesar de una infusión continua de pralidoxima

Abstract

Acute organophosphate poisoning leads to a cholinergic crisis secondary to an acetylcholine rise, developed by an acetylcholinesterase inhibition. In some cases, after the resolution of the initial cholinergic signs and symptoms, an intermediate syndrome occurs, characterized by a delayed development of proximal and diaphragmatic muscle paralysis. We describe a case of a 67-year-old man who developed an intermediate syndrome after oxydemeton-metryl ingestion in a suicide attempt, despite a continuous pralidoxime infusion. Several hypotheses have been developed to explain the aetiology of this intermediate syndrome (neuromuscular junction dysfunction, inadequate poisoning treatment, late beginning of the oxime administration, etc). Intermediate syndrome manifestation will depend on the organophosphate's organism persistence and its chemical structure, and also on the time elapsed between the poisoning and the antidote administration.

Preparación Hospitalaria en incidentes NBQ

“…Y es que no se puede olvidar que los preparativos individuales y colectivos que se establezcan no sólo servirán para los desastres provocados por el hombre, ya sean accidentales o provocados, criminales o no, sino que también servirán y sirven de forma directa para enfrentarnos a la amenaza de las enfermedades emergentes o reemergentes, ya se trate del caso Litvinenko, un intento de autolisis, el Síndrome Agudo Respiratorio Grave o la gripe A donde el nivel asistencial requerido supone un reto para la organización sanitaria [10][11][12][13][14][15] .…”