Organophosphorus Poisoning - Diagnosis and treatment

Diagnosis and Treatment

Organophosphorus poisoning is diagnosed from the patient's clinical features and estimation of certain enzymes. Drugs used to treat the poisoning include atropine, pralidoxime/ obidoxime and diazepam.


Organophosphorus or organophosphate poisoning is diagnosed based on history of exposure and the symptoms and signs of the patient. Certain enzymes may also be estimated to confirm the diagnosis.

As soon as poisoning with organophosphorus compounds is suspected, the patient should be removed from the site of exposure. The patient's clothes should be removed and the entire body should be washed well with soap and water to prevent any further absorption from the skin. Health care providers should wear protective clothes and gloves before handling the patient. A stomach wash with activated charcoal may be performed to prevent absorption of poison from the stomach.

Breathing may be maintained by inserting a tube into the trachea. Artificial ventilation may be needed in some cases. Pulse, blood pressure and heart rate and rhythm should be carefully monitored. The patient may need intravenous fluids to maintain the blood pressure.

Treatment with drugs should be started as early as possible. Drugs used to treat the poisoning are:

Atropine - Atropine blocks the action of acetylcholine, thus preventing symptoms like difficulty in breathing and increased secretions. It however does not reverse the muscle weakness and paralysis caused by organophosphorus compounds.

Pralidoxime / Obidoxime - These drugs cause regeneration of choline esterase enzyme. Thus they can reverse the effects of organophosphorus compounds.

Diazepam - Diazepam is used to treat seizures caused by the poisoning.

References:

1. Cherian MA, Roshini C, Peter JV, Cherian AM. Oximes in organophosphorus poisoning Indian Journal of Critical Care Medicine 2005 ; 9 (3): 155-163.
2. Goodman and Gilman. The Pharmacological Basis of Therapeutics 11^th edition.

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