Abstract

ORGANOPHOSPHORUS PESTICIDE POISONING: CLINICAL FEATURES AND MANAGEMENT

Feba Mariyam Mathew*, Rani Manju, Pheba Susan Thomas and Santhosh M. Mathews

ABSTRACT

Acute poisoning by organophosphorus (OP) pesticides is a major global clinical problem, with thousands of deaths occurring every year. Most of these pesticide poisoning and subsequent deaths occur in developing countries following a deliberate self-ingestion of the poison. Methyl parathion and Dichlorvos are commonly ingested OP pesticides. The toxicity of these OP pesticides is due to the irreversible inhibition of acetylcholinesterase (AChE) enzyme leading to accumulation of acetylcholine and subsequent over-activation of cholinergic receptors in various parts of the body. Acutely, these patients present with cholinergic crisis; intermediate syndrome and delayed polyneuropathy are other sequel of this form of poisoning. The diagnosis depends on the history of exposure to these pesticides, characteristic manifestations of toxicity and improvements of the signs and symptoms after administration of atropine. The supportive treatment of OP poisoning includes the same basic principles of management of any acutely poisoned patient i.e., rapid initial management of airways, breathing, and circulation. Gastric lavage and activated charcoal are routinely used decontamination procedures, but their value has not been conclusively proven in this poisoning. Atropine is the mainstay of therapy, and can reverse the life-threatening features of this acute poisoning. However, even with such therapy, the mortality from these agents is as high as 40%. This review article focuses at organophosphorus poisoning, its mechanism of action, clinical features and management strategies.

Keywords: Acute poisoning, Organophosphorus pesticides, Acetylcholinesterase.