Comparative analysis of organophosphorus versus carbamate pesticide poisoning: a case study

Jia-ding Xia; Hui Wang; Li-wei Hua; Min Xu; Xin Zheng; Kun Zhang

doi:10.2478/aiht-2024-75-3781

Abstract

Organophosphorus poisoning is a critical condition that can cause central nervous system depression, respiratory failure, and death early on. As its clinical manifestations closely resemble those of carbamate pesticide poisoning, the aim of this case study is to present a case of misdiagnosis, initially identifying carbofuran poisoning as organophosphate in a patient suspect of a heatstroke. We also present a case of intentional self-poisoning with organophosphate dichlorvos to underline the likelihood of pesticide poisoning in patients exhibiting acute cholinergic symptoms when the ingested substance is not known. In such cases, empirical treatment with atropine and oxime can be started pending timely differential diagnosis to adjust treatment as necessary.

References

Eddleston M, Karalliedde L, Buckley N, Fernando R, Hutchinson G, Isbister G, Konradsen F, Murray D, Piola JC, Senanayake N, Sheriff R, Singh S, Siwach SB, Smit L. Pesticide poisoning in the developing world – a minimum pesticides list. Lancet 2002;360:1163–7. doi: 10.1016/s0140-6736(02)11204-9
Open DOI Search in Google Scholar Back to article
Mew EJ, Padmanathan P, Konradsen F, Eddleston M, Chang SS, Phillips MR, Gunnell D. The global burden of fatal self-poisoning with pesticides 2006–15: systematic review. J Affect Disord 2017;219:93–104. doi: 10.1016/j.jad.2017.05.002
Open DOI Search in Google Scholar Back to article
Hekmat R, Samini F, Dadpour B, Maghsudloo F, Mojahedi MJ. Should guidelines for conventional hemodialysis initiation in acute methanol poisoning, be revised, when no fomepizloe is used? Iran Red Crescent Med J 2012;14:743–5. doi: 10.5812/ircmj.3467
Open DOI Search in Google Scholar Back to article
Worek F, Thiermann H, Wille T. Organophosphorus compounds and oximes: a critical review. Arch Toxicol 2020;94:2275–92. doi: 10.1007/s00204-020-02797-0
Open DOI Search in Google Scholar Back to article
Aman S, Paul S, Chowdhury FR. Management of organophosphorus poisoning: standard treatment and beyond. Crit Care Clin 2021;37:673–86. doi: 10.1016/j.ccc.2021.03.011
Open DOI Search in Google Scholar Back to article
Eddleston M, Chowdhury FR. Pharmacological treatment of organophosphorus insecticide poisoning: the old and the (possible) new. Br J Clin Pharmacol 2016;81:462–70. doi: 10.1111/bcp.12784
Open DOI Search in Google Scholar Back to article
Peter JV, Sudarsan TI, Moran JL. Clinical features of organophosphate poisoning: a review of different classification systems and approaches. Indian J Crit Care Med 2014;18:735–45. doi: 10.4103/0972-5229.144017
Open DOI Search in Google Scholar Back to article
Kumar S, Baggi TR, Zughaibi T. Forensic toxicological and analytical aspects of carbamate poisoning - a review. J Forensic Leg Med 2022;92:102450. doi: 10.1016/j.jflm.2022.102450
Open DOI Search in Google Scholar Back to article
Rosman Y, Makarovsky I, Bentur Y, Shrot S, Dushnistky T, Krivoy A. Carbamate poisoning: treatment recommendations in the setting of a mass casualties event. Am J Emerg Med 2009;27:1117–24. doi: 10.1016/j.ajem.2009.01.035
Open DOI Search in Google Scholar Back to article
King AM, Aaron CK. Organophosphate and carbamate poisoning. Emerg Med Clin North Am 2015;33:133–51. doi: 10.1016/j.emc.2014.09.010
Open DOI Search in Google Scholar Back to article
Maček Hrvat N, Kovarik Z. Counteracting poisoning with chemical warfare nerve agents. Arh Hig Rada Toksikol 2020;71:266–84. doi: 10.2478/aiht-2020-71-3459
Open DOI Search in Google Scholar Back to article
Eddleston M, Dawson A, Karalliedde L, Dissanayake W, Hittarage A, Azher S, Buckley NA. Early management after self-poisoning with an organophosphorus or carbamate pesticide - a treatment protocol for junior doctors. Crit Care 2004;8(6):R391–7. doi: 10.1186/cc2953
Open DOI Search in Google Scholar Back to article
Gupta RC. Brain regional heterogeneity and toxicological mechanisms of organophosphates and carbamates. Toxicol Mech Methods 2004;14:103–43. doi: 10.1080/15376520490429175
Open DOI Search in Google Scholar Back to article
Lee BK, Jeung KW, Lee HY, Jung YH. Mortality rate and pattern following carbamate methomyl poisoning. Comparison with organophosphate poisoning of comparable toxicity. Clin Toxicol (Phila) 2011;49:828–33. doi: 10.3109/15563650.2011.617309
Open DOI Search in Google Scholar Back to article
Hulse EJ, Haslam JD, Emmett SR, Woolley T. Organophosphorus nerve agent poisoning: managing the poisoned patient. Br J Anaesth 2019;123:457–63. doi: 10.1016/j.bja.2019.04.061
Open DOI Search in Google Scholar Back to article
Bereda G. Poisoning by organophosphate pesticides: a case report. Cureus 2022;14(10):e29842. doi: 10.7759/cureus.29842
Open DOI Search in Google Scholar Back to article
Yurumez Y, Yavuz Y, Saglam H, Durukan P, Ozkan S, Akdur O, Yucel M. Electrocardiographic findings of acute organophosphate poisoning. J Emerg Med 2009;36:39–42. doi: 10.1016/j.jemermed.2007.08.063
Open DOI Search in Google Scholar Back to article
Balmuchu G, Mohanty MK, Sahu MR, Hansda U, Naveen A, Lenka PK. Outcome prediction using sequential organ failure assessment (SOFA) score and serum lactate levels in organophosphate poisoning. J Family Med Prim Care 2023;12:777–82. doi: 10.4103/jfmpc.jfmpc_1713_22
Open DOI Search in Google Scholar Back to article
Ibrahim AE, Ghantarchyan H, Le T, Bhagat A, Maknouni B, Arabian S. A rare presentation of severe organophosphate poisoning: a case report and review of literature. Cureus 2022;14(11):e31497. doi: 10.7759/cureus.31497
Open DOI Search in Google Scholar Back to article
Vale A, Lotti M. Organophosphorus and carbamate insecticide poisoning. Handb Clin Neurol 2015;131:149–68. doi: 10.1016/B978-0-444-62627-1.00010-X
Open DOI Search in Google Scholar Back to article
Kabra R, Patel M, Bhansali PJ, Kumar S, Acharya S. Intermediate syndrome and Marchiafava-Bignami syndrome: double trouble in weaning off. Cureus 2022;14(7):e26694. doi: 10.7759/cureus.26694
Open DOI Search in Google Scholar Back to article
Easnem K, Ashraful I, Mohammad S, SM Rafiqul I, Rezaul H PK. Management of OPC and carbamate poisoning in Intensive Care Unit of Enam Medical College & Hospital, Savar, Dhaka. J Enam Med Col 2018;8:144–52. doi: 10.3329/jemc.v8i3.38364
Open DOI Search in Google Scholar Back to article
23. Robb EL, Regina AC, Baker MB. Organophosphate Toxicity. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [displayed 13 February 2024]. Available at https://www.ncbi.nlm.nih.gov/books/NBK470430/
RobbEL ReginaAC BakerMB Organophosphate Toxicity In: StatPearls [Internet] Treasure Island (FL) StatPearls Publishing 2024 [displayed 13 February 2024]. Available at https://www.ncbi.nlm.nih.gov/books/NBK470430/

Back to article
Rawas-Qalaji M, Bafail R, Ahmed IS, Uddin MN, Nazzal S. Modulation of the sublingual microenvironment and pH-dependent transport pathways to enhance atropine sulfate permeability for the treatment of organophosphates poisoning. Int J Pharm 2021;606:120898. doi: 10.1016/j.ijpharm.2021.120898
Open DOI Search in Google Scholar Back to article

Comparative analysis of organophosphorus versus carbamate pesticide poisoning: a case study

Abstract

Paradigm

My account