DOI QR코드

DOI QR Code

A case of severe organophosphate poisoning used a high-dose atropine

고용량 아트로핀을 사용한 중증 유기인산염 중독 환자 증례

  • Received : 2022.03.24
  • Accepted : 2022.06.27
  • Published : 2022.06.30

Abstract

In this study, we report the case of a 59-year-old male patient with organophosphate pesticide poisoning. He visited the local emergency medical center after ingesting 250 ml of organophosphate pesticide. The patient's symptoms improved after the initial intravenous infusion of pralidoxime 5 g and atropine 0.5 mg. However, 18 hours after admission, there was a worsening of the symptoms. A high dose of atropine was administered to improve muscarinic symptoms. A total dose of 5091.4 mg of atropine was used for 30 days, and fever and paralytic ileus appeared as side effects of atropine. Anticholinergic symptoms disappeared only after reducing the atropine dose, and the patient was discharged on the 35th day without any neurologic complications.

Keywords

References

  1. Buckley NA, Eddleston M, Li Y, Bevan M, Robertson J. Oximes for acute organophosphate pesticide poisoning. Cochrane Database Syst Rev 2011. DOI: 10.1002/14651858.CD005085.pub2.
  2. Eddleston M, Eyer P, Worek F, Mohamed F, Senarathna L, von Meyer L, et al. Differences between organophosphorus insecticides in human self-poisoning: a prospective cohort study. Lancet 2005;366:1452-59. https://doi.org/10.1016/S0140-6736(05)67598-8
  3. Kharel H, Pokhrel NB, Ghimire R, Kharel Z. The Efficacy of Pralidoxime in the Treatment of Organophosphate Poisoning in Humans: A Systematic Review and Meta-analysis of Randomized Trials. Cureus 2020. DOI: 10.7759/cureus.7174.
  4. Eddleston M, Dawson A, Karalliedde L, Dissanayake W, Hittarage A, Azher S, et al. Early management after self-poisoning with an organophosphorus or carbamate pesticide: a treatment protocol for junior doctors. Crit Care 2004;8:R391-7 https://doi.org/10.1186/cc2953
  5. Eddleston M, Buckley NA, Checketts H, Senarathna L, Mohamed F, Sheriff MH, et al. Speed of initial atropinisation in significant organophosphorus pesticide poisoning-a systematic comparison of recommended regimens. J Toxicol Clin Toxicol 2004;42(6):865-75. https://doi.org/10.1081/CLT-200035223
  6. LeBlanc FN, Benson BE, Gilg AD. A severe organophosphate poisoning requiring the use of an atropine drip. J Toxicol Clin Toxicol. 1986;24(1):69-76. https://doi.org/10.3109/15563658608990447
  7. Ortiz-Prado E, Simbana K, Gomez L, Olmedo M, Acosta T, Bramwell H. 760 atropine ampules used to treat a patient with severe pesticide intoxication in a low resources setting. Rev Med Vozandes 2017;28:35-8.
  8. Kim MS, Jin SC, Kim SJ, Choi WI. Study on Current Changes of Atropine Regimen in Organophosphate Pesticides Poisoning. Keimyung Med J. 2015;34(2):108-13.
  9. Tintinalli JE, Ma OJ, Yealy D, Meckler G, Stapczynski S, Cline M. Emergency Medicine: A comprehensive study guide 9th ed. New York; Mcgraw-Hill;2019. p.1301-2.
  10. Hoffman RS, Howland MA, Lewin NA, Nelson LS, Goldfrank LR. Goldfrank's toxicologic emergencies. 10th ed. New York; Mcgraw-Hill;2015. p.1425-6.
  11. Singh S, Chaudhry D, Behera D, Gupta D, Jindal SK. Aggressive atropinisation and continuous pralidoxime (2-PAM) infusion in patients with severe organophosphate poisoning: experience of a northwest Indian hospital. Hum Exp Toxicol. 2001; 20(1):15-8. https://doi.org/10.1191/096032701671437581
  12. Karakus A, Celik MM, Karcioglu M, Tuzcu K, Erden ES, Zeren C. Cases of organophosphate poisoning treated with high-dose of atropine in an intensive care unit and the novel treatment approaches. Toxicol Ind Health. 2014;30(5):421-5. https://doi.org/10.1177/0748233712462478
  13. Beards SC, Kraus P, Lipman J. Paralytic ileus as a complication of atropine therapy following severe organophosphate poisoning. Anaesthesia. 1994;49(9):791-3. https://doi.org/10.1111/j.1365-2044.1994.tb04454.x
  14. Robenshtok E, Luria S, Tashma Z, Hourvitz A. Adverse reaction to atropine and the treatment of organophosphate intoxication. Isr Med Assoc J. 2002;4(7):535-9.