Organophosphate Poisoning Research Paper

ORGANOPHOSPHORUS POISONING

Description
Description
Organophosphate poisoning results from exposure to organophosphates (OPs), which cause the inhibition of acetylcholinesterase(AChE), leading to the accumulation of acetylcholine (ACh) in the body. Organophosphates and carbamates are the most frequently used insecticides worldwide. These compounds cause 80% of the reported toxic exposures to insecticides. Organophosphates produce a clinical syndrome that can be effectively treated if recognized early. The typically described clinical syndrome in adults often does not occur in young children.

Causes
Organophosphate poisoning most commonly results from exposure to insecticides or nerve agents. The use of the organophosphates in aviation

Immediate aggressive use of atropine may eliminate the need for intubation.
5. Decontamination of the skin, mucous membrane and gut (if skin is contaminated, clean and wash using copious amount of soap water and change the clothing; gastric lavage and catharsis, if poison has been ingested)
6. Health care providers must avoid contaminating themselves while handling patients.
7. Use personal protective equipment at all times—mask, impermeable gown, rubber gloves. If spills occur—wipe over with dilute hypochlorite solution (household bleach) to inactivate the organophosphorus ester.)
8. Inj. Atropine IV 0.05 mg/kg every 10 minutes until signs of atropinism appear; maintain it for 24 hours.
9. The signs of high dose of atropine intake are:
• Drying of all

These symptoms should be closely monitored since there is no fixed dose of atropine in OP poisoning. The aim is to keep patient atropinised till poison effect weans off. As much as 10 times of usual dose of atropine may be required.
10. In moderate to severe cases, immediately give Inj. Pralidoxime (PAM) 25-50 mg/kg IV; in older children and in infants 250 mg IV over 5-10 minutes; and then 8 hourly up to 36 hours. (Caution: Do not use in carbamate poisoning such as neostigmine, physostigmine, rivastigmine).
11. Administer paracetamol and non-opioid analgesia for relief of muscle pain.
12. Continuous monitoring is required for 72 hours or longer as organophosphate may be intermittently released from fat stores with ECG, arterial BP monitoring, SpO2, CVC access, CXR.
13. Observe for deterioration post-reduction of drug therapies, auscultate lung bases for crackles. If crackles heard or there is a return of miosis, bradycardia or sweating, re-establish atropinization. Note: Morphine, succinylcholine, theophylline, phenothiazines, reserpine are contraindicated.

References
1. First Aid during Emergency. National Portal of India. www.India.gov.in reviewed on