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Organophosphorus

poisoning
?? Blessing to developing nations.
-Common poisoning agent
•Suicidal
•Accidental
•Homicidal
-300000 people die every year
Pharmacology
• OPs are highly lipid soluble
• Primary target: “Acetyle choline
esterase”
• Inhibit AChE: increases Acetyl choline
at cholinoceptors
• Increased acetyle choline act on –
Muscarinic

Nicotinic
CNS synapses
Pharmacology
3 types of choline esterase enzyme
inhibitors
 Simple alcohol bearing quaternary
ammonium group e.g. edrophonium
 Carbonic acid esters of alcohol e.g.
carbamate (Baygon)
 Organic acid derivatives of
phosphoric acid e.g. all OPS
Clinical features
• Depends upon principle site of action
• Usually develops over 15mins-2hrs
A: Muscarinic effect:
• Rhinorrhoea,bronchorrhoea,bronchconstri
ction,wheezing,pulmonary edema
• GI symptoms:
salivation,nausea,vomiting,abd
cramps,tenismus,diarrhoea
• CVS:Bradycardia,Hypotension
• Urogenital: Urinary incontinence and
frequency
• Eyes: constrited pupils,blurred
Clinical features

B: Nicotinic Features:
• Muscle
fasiculation,weakness,cramps,paralysi
s
• Respiratory muscle weakness and
paralysis
• Ocular,bulbar.neck,proximal muscle
of limb paresis
C: CNS effects:
Anxiety,restlesness,ataxia,insomnia,co
Diagnosis
 History
 Signs and symptoms
 Charcteristic smell from
mouth,cloths and gastric lavage
 Atropin test: 0.6-3mg i.v ;look for
signs of atropinisation
 Estimation of Acetyl choline esterase
level in blood < 50% of normal
(3000-6000IU/lt)
Management
Non Pharmacological
 ABC
 Removal of soiled clothes
 Thorough cleaning of whole body with
soap water
 Gastric lavage till returning fluid is
clear
 Airway clearing
 If needed intubation and ventilatory
support
Management
Pharmacological management:
Atropin Sulphate: start with 0.6mg-
3mg i.v. and access every 5-15 mins
for signs of atropinisation
Clear chest on auscultation with no
wheezes
Heart rate >100
Pupil no longer pin point
Dry axilla
Systolic pressure>90 mm of Hg
(Over atropinisation leads to fever
dellirium,Psychosis)
Management contd……
OXIMES:
• Pralidoxime chloride(PAM)
• -30mg/kg loading over 10-20mins followed
by 10mg/kg i.v.6-8 hrly for at least 48 hrs
(not useful for carbamate poisoning)
At ward daily assess for
• Consciousness
• Pulse/HR
• Blood Pressure
• Pupil
• Muscle power
• Dryness of lungs
Complications
Acute:
• Aspiration Pneumonia
• Pulmonary edema
• ARDS
• Acute pancreatitis
• Hypoglycemia
• Lactic acidosis
• Acute renal failure
• Cardiac arrhythmias-
bradycardia,tachycardia,AV
dissociation,Torsades de pontis
Complications
Chronic:
• Intermediate syndrome
• Delayed neuropathy
• Depression