PESTICIDE POISONING: A POTENTIALLY PAINFUL PROBLEM WITHOUT PRALIDOXIME

TOPIC: Critical Care TYPE: Fellow Case Reports INTRODUCTION: Cholinergic toxicity can result from ingestion of generic pesticides, which contain organophosphates or carbamates. These compounds act by inhibiting red blood cell acetylcholinesterase (RBC AChE), resulting in an overabundance acetylcholine at the neural synapse and neuromuscular junction. Early suspicion for this toxidrome is essential, as diagnosis thus management are based mainly on clinical grounds. Herein we report a patient with cholinergic due to intentional pesticide poisoning. CASE PRESENTATION: A 65-year-old man asthma, chronic alcohol dependence, bipolar disorder presented acute encephalopathy after ingesting unknown substance. Additional symptoms included increased salivation, frothy sputum, urinary fecal incontinence, jerking movements limbs, shortness breath. Vital signs showed sinus bradycardia heart rate 50 beats per minute. On exam, had miosis, wheezing, oral secretions. He was admitted intensive care unit further management. Bystanders noted drinking heavily prior what thought be pesticide. Lab work revealed lactic acidosis elevated serum osmolar gap. Toxicology recommended empiric treatment ethylene glycol poisoning fomepizole. Despite management, developed cardiopulmonary arrest asystole. After obtaining return spontaneous circulation, started organophosphate atropine pralidoxime. RBC AChE level drawn presentation eventually resulted decreased 115 IU/L (reference 1801–3537 IU/L). development organophosphate-induced myopathy, made full recovery discharged short-term rehab three weeks admission. DISCUSSION: potentially fatal if not promptly recognized treated. Clinical findings include lacrimation, urination/defecation, emesis, bronchorrhea, bronchospasm, bradycardia. The most devastating consequences respiratory failure cardiac severe progressing Prompt pralidoxime should soon there order avoid complications. Although levels provide measure degree toxicity, it readily available hospital laboratories, measurement delay appropriate treatment. CONCLUSIONS: well-documented condition established plan, now rare occurrence critical medicine standardization proper safety protocols involving hazardous materials. this, clinicians aware lethal so therapy. REFERENCE #1: Eddleston M, Phillips MR. Self pesticides. BMJ. 2004 Jan 3;328(7430):42-4. doi: 10.1136/bmj.328.7430.42. PMID: 14703547; PMCID: PMC313909. #2: Roberts D, Buckley N. Management organophosphorus Crit Care. 2002 Jun;6(3):259. 10.1186/cc1499. Epub Apr 25. 12133188; PMC137450. #3: Eyer P, Worek F, Juszczak E, Alder N, Mohamed Senarathna L, Hittarage A, Azher S, Jeganathan K, Jayamanne von Meyer Dawson AH, Sheriff MH, NA. Pralidoxime insecticide poisoning--a randomised controlled trial. PLoS Med. 2009 Jun 30;6(6):e1000104. 10.1371/journal.pmed.1000104. 30. 19564902; PMC2696321. DISCLOSURES: No relevant relationships Mansur Assaad, source=Web Response apurwa karki, Rajamurugan Meenakshisundaram,