ORGANOPHOSPHOROUS COMPOUND

POISONING

INSECTICIDAL POISONING ( OR) BUG KILLER

POISONING

OPC Agents:

CHLORTHION TRICHLORFON
DIAZINON DICHLORFOS
DIOXATHION ABATE
DEMETHOATE NALED
EPN GARDONA
MALATHION CHLORPYRIFOS
FENTHION FENITROTHION
METHYL PARATHION DICAPTHON
PARATHION RONNEL

COMMONEST POISONING IN INDIA

INGESTION FOR SUICIDE/ACCIDENTALLY DURING SPRAY.

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CLINICAL MANIFESTATIONS:

1.CHOLINERGIC CRISIS
2.INTERMEDIATE SYNDROME
3.DELAYED NEUROPATHY

1.CHOLINERGIC CRISIS

OPC BLOCKS ACH ESTERASE - Increases Ach

Ach ACTS ON RECEPTORS

MUSCARINIC RECEPTORS:

MIOSIS
BRONCHORRHOEA
SALIVATION
BRADYCARDIA
HYPERSECRETION
PULMONARY EDEMA
SWEATING ,DIARRHOEA

NICOTINIC RECEPTORS:

FASCICULATION
MUSCLE PARALYSIS

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CNS:

COMA
BRADYCARDIA
HYPOTENSION
RESPIRATORY DEPRESSION

• DEGREE OF POISONING PARALLELS PLASMA

CHOLINESTERASE LEVEL
• LOWER THE LEVEL – SEVERE IS THE POISONING.

2.INTERMEDIATE SYNDROME

PARALYSIS APPEAR AFTER ADMISSION & BEFORE

DELAYED NEUROTOXICITY DEVELOPS.

3.DELAYED NEUROPATHY

AGENTS LIKE TOCP,TCP PRODUCE THESE KIND OF

NEUROPATHY

THEY DO NOT PRODUCE SIGNIFICANT CHOLINERGIC

CRISIS, BUT 7 –20 DAYS LATER DEVELOPS A PURE
MOTOR AXONAL NEUROPATHY-WRIST DROP & FOOT
DROP.

WAR GAS POISONING

NERVE GASES USED IN WARFARE ARE

ORGANOPHOSPHATES- SOMAN,SARIN, DFP

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INVESTIGATIONS:

CHOLINESTERASE MEASUREMENT –RBC, PLASMA

GRADING:

BARDIN ET AL GRADED,

1.MILD:

NORMAL CONSCIOUSNESS,MILD INCRESE IN SECRETIONS

& FASCICULATIONS

2.SEVERE:

IMPAIRED CONSCIOUSNESS,COPIOUS SECRETIONS &

MULTIPLE FASCICULATIONS

3.LIFE THREATENING:

STUPOR,ABNORMAL CXR & PAO2 LESS THAN 60 MM HG.

THESE PTS NEED VENTILATOR SUPPORT..

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MANAGEMENT:

1. REMOVE POISON

• WASH THE PATIENTS EYES, SKIN WITH PLENTY

OF WATER
• AND REMOVE THE CLOTHES
• GASTRIC LAVAGE
• INSTILL ACTIVATED CHARCOAL 25 GM 4TH
HRLY

2. SEND FOR ABG

3. ESTABLISHING PATIENT AIRWAY

• START HIGH FLOW O2

• INTUBATE AND VENTILATE IF NECESSARY

4. MONITOR AND MAINTAIN CIRCULATION

• IV LINE – IVF
• VASOPRESSORS – DOPAMINE

5. URINARY BLADDER CATHETERISATION

6. ATROPINE

CORRECT CYANOSIS BEFORE STARTING ATROPINE

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 • 5 AMP – IV BOLUS
• REPEAT EVERY 10MTS UNTIL PATIENT IS
ATROPINISED
• MAINTAIN THE DOSE AT PATIENT IS
ATROPINISED
• THERE IS NO FIXED DOSE OF ATROPINE

SIGNS OF ATROPINISATION

• DELIRIUM
• RESTLESSNESS
• MYDRIASIS ( DILATED AND FIXED PUPILS)
• DECREASED SECRETION ( MOST RELIABLE )
• NO BRONCHIAL SECRETION
• FEVER
• TACHYCARDIA
• DRYNESS OF TONGUE

AFTER SIGNS OF INITIAL RECOVERY PATIENT MAY AGAIN

WORSEN BECAUSE OF RELEASE OF POISON FROM BODY
FAT STORES- INTERMEDIATE SYNDROME

7. PAM(PRALIDOXIME)

• 1-2 GM IV STAT
• REPEAT EVERY 8 HRLY FOR 24 HRS

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 • MOST EFFECTIVE WITH IN 24 HRS OF
CONSUMING POISONING

8. ANTIBIOTICS TO PREVENT USING CATHETER,

IV CANNULA AND RESPIRATORY INFECTION

9. RANITIDINE 50 MG IV Q 8HR

10. IVF, MULTI VITAMIN AND CORRECTION OF

ELECTROLYTES .

11. PATIENTS ON ATROPINE SHOULD NOT TO

FEED THROUGH MOUTH (OR) RT, BECAUSE OF
ATROPINE INDUCED PARALYTIC ILEUS.

12. CARE OF UNCONSCIOUS PATIENT.