case report on organophosphorus poisoning

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Miss. Sonali V. Fating, Miss. Darshana Khobragade, Mr. Ashish Bhagat,Ms. Vaishali Balpande, P.S. Pande

Abstract

In India, organophosphate (OP) poisoning is widespread. There have only been a few case reports of parenteral OP poisoning. We describe a case of self-injected  methyl parathion poisoning that resulted in seizure, altered sensorium, and respiratory distress four days later, posing a diagnostic and therapeutic conundrum. Despite the lack of a history of OP poisoning, he was treated on suspicion and had a satisfactory clinical response to an atropine and pralidoxime treatment trial, as well as a successful recovery. Following parenteral injection of OP poison, atypical presentations may occur, and even a remote suspicion of this necessitates thorough evaluation and treatment to ensure a positive outcome. Persistently low plasma cholinesterase level is a helpful diagnostic sign.


Main symptoms and/ or clinical finding :-A typical toxidrome in organophosphate (Op) poisoning comprises of the salivation, lacrimation, urination, defection, Gastric cramps, Emesis (SLUDGE) symptom.


Diagnostic Evaluation:-History collection and physical examination, RBS, BUN, Electrolytes, prothrombin time , liver function studies, plasma cholinesterase measurement. Other laboratory finding included  the leucocytosis, Haemoconcentration, metabolic and /or respiratory acidosis, hyperglycaemia, hypomagnesemia, elevated troponin level, elevated amylase levels, elevated liver function tests.


Therapeutic Intervention:-The patient was treated with Inj. Pan 40 mg in 5ml/1hourly, Inj. Vit-k 10 mg (Iv) in OD, Inj. Emset 4mg (IV) in TDS, Inj. Mucomix  70mg/kg every 4 hourly (9 vials) in 500ml D5,inj.perinorm 10 mg (IV) in TDS.


Outcome:- Patient’s general condition is improved.


Nursing perspectives:-Administered fluid replacement i.e. DNS and RL, monitor vital signs, and check blood pressure per hourly, maintained intake and output chart, and provide adequate rest and sleep to the patients. Administered medication according to the doctor’s order.


Conclusion: The diagnosis of OP compound toxicity via the parenteral route is difficult.  Symptoms may appear later than expected, and presentations may be unusual. Even if the symptoms are moderate at first, a longer time of monitoring is essential. Because there are no decontamination procedures in place, even a small amount of injection could be lethal. In the event of suspicion of OP poisoning, treating physicians must be attentive and offer proper treatment. In the event of suspicion of OP poisoning, treating physicians must be attentive and offer proper treatment.

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