ID/CC A 30-year-old farmer is brought to the emergency room with severe abdominal cramps and vomiting.
HPI The patient is also restless and is salivating profusely. He has been working with a new pesticide for the past 3 months.
PE Patient is nearly stuporous; cyanosis with marked respiratory distress; bilateral miotic pupils; marked salivation and lacrima-tion; moderate dehydration; hyperactive bowel sounds; fecal and urinary incontinence.
Labs ABGs: marked hypoxemia with hypercapnia; uncompensated respiratory acidosis. Prerenal azotemia on RFTs. Lytes: hyperkalemia.
Treatment Specific therapy includes administration of atropine (to offset cholinergic effects) and pralidoxime (chemically restores acetylcholinesterase if administered early); supportive management for respiratory support and hemodialysis.
Discussion Organophosphates like parathion and carbamates are widely used as pesticides, and several nerve agents developed for chemical warfare are rapid-acting and potent organophosphates. All of these toxins inhibit the enzyme acetylcholinesterase, preventing the breakdown of acetylcholine at cholinergic synapses. Whereas the organophosphates may cause irreversible inhibition of the enzyme, carbamates have a transient and reversible effect.
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