ORGANOPHOSPHOROUS POISONING

EMERGENCY MANAGEMENT IN INTENSIVE CARE UNIT

Abstract

Objective: To evaluate the clinical presentation, management and outcome of organophosphorous pesticides poisoning in
intensive care unit. Design: A retrospective study. Place & Duration: Intensive Care Unit of Combined Military Hospital
Pano Aqil from January 2002 to August 2003. Subjects & Methods: 26 patients of organophosphorous(OP) poisoning
admitted to intensive care unit during this period were included. Diagnosis was based upon history and clinical findings.
Decontamination of skin, gastric lavage with activated charcoal and intravenous administration of atropine were the mainstays
of therapy, pralidoxime could not be given to any patient due to its non-availability. Endotracheal intubation and mechanical
ventilation was performed in case of altered conscious state, respiratory insufficiency and circulatory collapse. Ventilatory
support was provided on synchronized intermittent mandatory ventilation with pressure support and positive end expiratory
pressure (Bennet-7200 ventilator). Data is presented as + standard deviation. Results: There were 16 male and 10 female
patients. Mean age was 35 + 15 yrs. 14 were suicidal and 12 were accidental exposures. 21 patients were affected through
gastrointestinal route, 4 persons through inhalation and 1 patient through abraded skin. Diagnosis was delayed in 3 patients.
Excessive salivation, altered mental state and miosis were the most frequent signs at the time of presentation. Initially, 17
patients presented with gastrointestinal symptoms, 7 with neuromuscular weakness and 2 patients had chest pain with
syncope. 14 patients required ventilatory support. Overall complications were observed in 16 patients, 7 patients developed
respiratory, (aspiration, pulmonary oedema, pneumonia, sepsis), 3 had neurological problems (convulsions, coma,
polyneuropathy), 2 had cardiac arrhythmias, and 1 had renal failure. 3 patients developed intermediate syndrome. 5 patients
died. Average duration of stay in intensive care unit was 6.2 + 2.8 days. Conclusion: Organophosphorous insecticide
poisoning is a common, rapidly progressive and potentially fatal clinical entity. Such patients need careful thorough
assessment, early diagnosis, vigilant monitoring and aggressive supportive management in the intensive care setting.
Mechanical ventilation is life saving in many of such cases.