A Case Study on Organophosphate Poisoning in Dehradun

Praveen Kumar Jaiswal

M.Sc. Nursing, State College of Nursing, Dehradun.

*Corresponding Author E-mail: jaiswalprav@gmail.com

ABSTRACT:

Organophosphate compounds are used as commercial insecticides and applied as aerosols or dust. Consuming these compounds intentionally or unintentionally lead to dangerous conditions even to fatality. The most common obstacle in treating organophosphorus poisoning is the availability of sufficient medical care, equipment to provide proper emergency care observed in rural areas where there is a lot of gaps between intensive care and acute care. Atropine use is as an antidote in organophosphorus poisoning. The dose of atropine mainly depends on the organophosphorus toxic doses. Atropine is a competitive antagonist of acetylcholine at the muscarinic postsynaptic membrane. Atropine blocks all the muscarinic effects in the body. The authors present a case of suicidal OP poisoning with an overview of management of the acute intoxication. The early recognition of symptoms and prompt treatment helps in reducing the morbidity and mortality.

KEYWORDS: Organophosphate, Poisoning, Atropine, Psychosis, Antidote, Patient.

INTRODUCTION:

Organophosphorus (OP) pesticide suicidal poisoning is a major public-health concern across the majority of the rural Asia, including the rural Indian population, owing to its easy and cheap availability in these countries.^1-4. Organophosphorus compounds are available as dust, granules, or liquids, and some products are required to diluted with water before use⁵. Early recognition of the toxic syndrome and its prompt management is the key for saving the patient’s life. The deaths due to organophosphorus poisoning are increasing in rural areas of India. The author presents a case of alleged suicidal OP poisoning with an overview of management of acute intoxication.

Organophosphorus compounds are available as dust, granules, or liquids, and some products are required to diluted with water before use¹. The deaths due to organophosphorus poisoning are increasing in rural areas of India

CASE REPORT:

A case report on organophosphate poisoning in a 56-year-old male who ingested mathion followed by vomiting. The patient was taken to the emergency department of govt. doon hospital from PHC Maldevta. He was treated by gastric irrigation. Examination showed patient was unconscious, pupils bilateral equal with diameter of 3mm each with sluggish reaction and GCS E1V1M². There was no history of breathlessness and abnormal body movement. Patient blood pressure was 90/60mmHg, pulse rate was 118beat/min with excessive oral secretion. Clinical features were suggestive of organophosphorus poisoning. in ICU immediately aldopam, Ceftriaxone and O₂ administration at 3ltr/min through non-rebreather mask and continuous cardiac monitoring was given to patient. Patient was given atropine 1mg/hour with 500ml Normal saline which was maintained by infusion at 30ml/hour for next three days. Patient’s initial investigations was done including complete hemogram, liver function and renal function tests, abdominal ultrasonography and chest x-ray. Liver function test revealed increased SGPT and SGOT and chest x-ray showed Bilateral Haziness suggesting acute respiratory syndrome. Patient showed improvement in symptoms with no further signs of intoxication over the next five days.

DISCUSSION:

In organophosphorus poisoned patient though atropine is used as an antidote to counteract the OP action yet larger doses of atropine given for a prolonged time causes psychosis where patients show signs such as muscle twitching, mentally disorganized behavior, and flushed skin. Respiratory depression is one of the severe conditions leading to fatality. Mechanical ventilation with oxygen is the foremost criterion in treatment (Table 1) to prevent respiratory depression. Physostigmine drug can also use as an antidote in OP poisoning drug which was not in stock during the treatment. However, physostigmine causes convulsions, epigastric pain, and salivation reported in several case revent.

Physostigmine drug can also use as an antidote in OP poisoning drug which was not in stock during the treatment. However, physostigmine causes convulsions, epigastric pain, and salivation reported in several cases. In organophosphorus poisoning atropine is widely used as an antidote to counteract the OP action yet larger doses of atropine given for a prolonged time causes psychosis where patients show signs such as dryness of the mouth, blurred vision, dry eyes, photophobia, confusion, headache, dizziness, fatigue, tachycardia, palpitations, flushing, urinary hesitance or retention, constipation, abdominal pain, abdominal distention, nausea, vomiting, loss of libido, and impotency. Respiratory depression is one of the severe conditions leading to fatality. Mechanical ventilation with oxygen is the foremost criterion in treatment (Table 1) to prevent respiratory depression. Physostigmine drug can also use as an antidote in OP poisoning drug which was not in stock during the treatment. However, physostigmine can also cause convulsions, epigastric pain, and salivation.

Table 1: Treatment regimen for organophosphorus poisoned patient

Name of drug	Action	Dose	Route	Frequency
Inj. Ceftriaxone	Antibiotic	1gm	IV	Twice a day (BD)
Inj. Pantop	Proton pump inhibitor	40 mg	IV	Twice a day (BD)
Inj. Emset	Antiemetic	4mg	IV	Trice a day (TDS)
Inj. PAM in 100 ml NS	Anticholinesterase drugs	2gm	IV	QID in day (QID)
Inj. Atropine 50 amp with 500 ml NS	Antiarrthymatic	1mg/hr	IV	Infusion @ 30 ml/hr
Inj Metrogyl	Antibiotices	100ml	IV	Trice a day (TDS)
Ivf RL /NS	Intravenous fluid restores fluid and electrolyte balance	6 unit (per unit 500 ml)	IV	75 ml/hr

Inj- Injection (drugs administered intravenously as the patient was in an unconscious state)

CONCLUSION:

Organophosphorus pesticide self-poisoning is a clinical problem in many developing countries due to the lack of efficient medical techniques, machinery leading to a severe increase in the fatality rate. Atropine used in a clinical setting, dose modulation, and recording the response of the patient for each dose is essential, especially in poisoning cases. Any overlook when dealing with an emergency case may lead to morbidity. Ensuring patient safety and providing appropriate therapy are crucial in any poisoning cases.

ACKNOWLEDGMENT:

I sincerely thank my ICU doctors and my senior residents who guided in understanding and analyzing the case and sharing their profound knowledge with me. I also thank the patient and her family for being cooperative and giving information regarding the patient details and conditions

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Received on 01.05.2023 Modified on 30.05.2023

Int. J. of Advances in Nur. Management. 2023; 11(4):227-228.

DOI: 10.52711/2454-2652.2023.00051