Presentation
We present the following case in accordance with the CARE reporting checklist (available at https://jeccm.amegroups.com/article/view/10.21037/jeccm-22-64/rc). [jeccm.amegroups.com]
Entire Body System
- Weakness
General weakness, muscular fibrillations and a marked inhibition of red blood cell and serum cholinesterases were the prominent signs of intoxication. [pubmed.ncbi.nlm.nih.gov]
Typically, onset 24–96 h after exposure to the OPs, causes fasciculation and proximal muscle weakness, with ascending paralysis leading to respiratory failure, the main cause of death (9,13). [jeccm.amegroups.com]
- Unconsciousness
A male, 84 years old, was find in a state of unconsciousness in his agricultural field and transported in red code to the Emergency Department (ED) of Mazzini Hospital in Teramo. Upon arrival, no anamnestic data were available. [jeccm.amegroups.com]
Gastrointestinal
- Vomiting
Muscarinic syndrome (acute cholinergic syndrome): early presentation, characterized by miosis, impaired consciousness, hyper-salivation, agitation, bradycardia (sometimes tachycardia), muscle weakness, vomiting and diarrhea (9). [jeccm.amegroups.com]
Cardiovascular
- Hypotension
Marked hypotension with AF undergoing ECV 200 J was observed. [jeccm.amegroups.com]
Eyes
- Miosis
Muscarinic syndrome (acute cholinergic syndrome): early presentation, characterized by miosis, impaired consciousness, hyper-salivation, agitation, bradycardia (sometimes tachycardia), muscle weakness, vomiting and diarrhea (9). [jeccm.amegroups.com]
Neurologic
- Agitation
Muscarinic syndrome (acute cholinergic syndrome): early presentation, characterized by miosis, impaired consciousness, hyper-salivation, agitation, bradycardia (sometimes tachycardia), muscle weakness, vomiting and diarrhea (9). [jeccm.amegroups.com]
Workup
Serum
- Hyperglycemia
Hyperglycemia is frequently found in critically ill patients and, as is known, has a negative impact on the outcome (17). [jeccm.amegroups.com]
Laboratory
- Leukocytosis
Hematological changes such as leukocytosis with neutropenia and thrombocytopenia, have been frequently reported. [jeccm.amegroups.com]
Treatment
The antidotal treatment of intermittent boluses of atropine, oxime HI-6 and diazepam was combined with symptomatic therapy. Cholinesterase activity decreased within the next 3 d. [pubmed.ncbi.nlm.nih.gov]
We present a rare case of OPs intoxication occurred in developed European country, where timely resuscitation treatment with ventilatory/hemodynamic support and treatment with anticholinesterases led to a favorable outcome. [jeccm.amegroups.com]
Prognosis
Glasgow Coma Scale score and QTc interval in the prognosis of organophosphate poisoning. Acad Emerg Med 2004;11:925-30. [Crossref] [PubMed] Yavuz T, Delibas N, Yildirim B, et al. [jeccm.amegroups.com]
Epidemiology
PMID: 15674996 German study on sudden infant death (GeSID): design, epidemiological and pathological profile. Findeisen M, Vennemann M, Brinkmann B, Ortmann C, Röse I, Köpcke W, Jorch G, Bajanowski T. Findeisen M, et al. [pubmed.ncbi.nlm.nih.gov]
Epidemiology of organophosphate intoxication and predictors of intermediate syndrome. Turk J Med Sci 2014;44:279-82. [Crossref] [PubMed] Pannu AK, Bhalla A, Vishnu RI, et al. [jeccm.amegroups.com]
Pathophysiology
Timely and prolonged resuscitation treatment not only guaranteed the patient’s survival, but also allowed various pathophysiological mechanisms that characterize the intoxications of cholinesterase inhibitors to emerge. [jeccm.amegroups.com]
Prevention
However, it should be emphasized that pralidoxime administration, even if early, did not lead to a rapid resolution of the clinical picture nor did it prevent the onset of IMS or later neurological complications. [jeccm.amegroups.com]