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Intravenous organophosphate injection: an unusual way of intoxication.

Organophosphate insecticides strongly inhibit both true cholinesterase and pseudocholinesterase activities. In this report, we have reported a patient who injected himself a strong organophosphate compound, methamidophos, and showed the typical clinical picture of organophosphate intoxication. As far as we know, this is the first case of intoxication by intravenous (i.v.) injection. With the appropriate therapy, his symptoms disappeared in a few days.

Adult↗

Acute renal failure from organophospate poisoning: a case of success with haemofiltration.

Severe organophosphate poisoning (OPP) has a high mortality rate. Respiratory and neurological complications are common in OPP. Multiple organ distress syndrome (MODS) and renal impairment are relatively rare but correlated with death. In previous publications, in patients who did not survive OPP, their deaths were due to MODS or acute renal failure. A case of intentional ingestion of an organophosphate with renal and multiple organ complications is described. In addition to the standard atropine/oxime regimen, continuous venous-venous haemofiltration (CVVH) therapy was started; the patient survived this intoxication. The pathogenesis of renal injury by OPP is unclear and more insight is required. In our experience, CVVH can be a valid therapy, considering in particular the toxicokinetics of the organophosphate.

Acute Kidney Injury↗

Reactivation of VX-inhibited cholinesterase by 2-PAM and HS-6 in rats.

Atropinized rats intoxicated with ethyl-S-2-diisopropyl aminoethyl methyl phosphonothioate (VX), 15 mg/kg iv, were divided into three groups and were treated with normal saline, iv, 30 mg/kg of 2-PAM C1, iv, and 30 mg/kg of HS-6, iv. One hr after administration of therapy they were decapitated and cholinesterase (ChE) activity was determined on blood, brain and diaphragm tissue. Both 2-PAM C1 and HS-6 markedly reactivated VX-inhibited blood and diaphragm ChE. Brain ChE activity was not significantly reactivated by either oxime. The effectiveness of these oximes in restoration of VX-inactivated ChE in vivo offers an explanation as to why conventional atropine/oxime therapy is so effective against VX intoxication.

Animals↗

[Intermediate syndrome after acute organophosphorus pesticides poisoning: clinical analysis of 10 cases].

Ten patients with intermediate syndrome (IMS) after acute organophosphorus (OP) pesticides poisoning were observed. The occurrence rate of IMS was 5.4% among total inpatients of acute OP poisoning in the same period. The majority of IMS cases were of severe oral OP poisoning. Seven to 68 hours after poisoning there were initial signs including motor weakness of muscles innervated by the 9th and 10th cranial nerves (e.g. dysphagia, hoarse voice). The neck flexor muscles and proximal limb muscles were also involved. Patients with respiratory muscle paralysis usually required urgent tracheal intubation and mechanical ventilation. The IMS in this group persisted for 6-30 days (mean 13 days) with no fatality. The relevant kinds of pesticide, the development and regression of IMS, and the treatment and possible mechanism of IMS were discussed.

Adult↗

Myocardial and endocardial lesions in rabbit after acute poisoning with Intration and after treatment with some detoxifying agents.

The hearts of rabbits killed 24 hours after intoxication with Intration in the dose of LD50 and rabbits treated at the same time with PAM or atropine were studied pathomorphologically. Twenty-four hours after administration of Intration toxic lesions of the myocardium and endocardium were observed, which were more pronounced in rabbits treated simultaneously with the detoxifying agents as compared with those which received only Intration. The intensity of the changes was due to overdosage of the detoxifying agents, especially PAM which was particularly harmful.

Animals↗

Effects of organophosphates on bioelectrical activity of the brain.

Effects on electroencephalogram of acute and chronic exposure of two main groups of organophosphates: classic anticholinesterases (OP) and new bicyclic organophosphates (PTBO) are described. The role of muscarinic receptors of the midbrain reticular formation in the mechanism of action of OP and the possible mechanism of action of PTBO as blockers of a chloride ionophore of the GABA receptor complex are presented. The mechanism of convulsive activity of both groups are also discussed.

Animals↗