A 45-year-old female brought to emergency room hospital with history of OP poisoning. Apparently, she consumed chlorpyrifos poison on 02/05/2022 at her Residence. She was taken to nearby private hospital and got admitted.
Her sensorium started deteriorating on 5thMay. She was intubated and started on mechanical ventilation. She was brought to Medicover hospital Kakinada for further management. On examination, patient is in altered sensorium, agitated, irritable, moderately dehydrated, GCS – 11/15, E4M4V3, BP 140/100 mm Hg. Pulse rate-90 per minute. Respiratory rate-20 per minute, RBS 144mg /dl, temperature 98.6-degree F, SPO2 100% with room air. CVS - sinus tachycardia, Respiratory system and abdomen were normal. Pupil bilaterally 0.5mm dilated and sluggishly reacting to light. However, she was not able to move her both upper and lower limbs.
She was admitted in ICU after thorough evaluation. Serum electrolytes showed Hypernatremia and Hypokalaemia. D-dimer was 2,819ng FEU/ml. Serum Cholinesterase levels was low with 1,537U/L. All other reports were normal limits. During hospitalization she had an episode of generalized seizures, for which she was treated with Leviphil and phenytoin.
She developed both upper and lower limb neuropathy. Nerve condition studies (NCS) was done and diagnosed motor and sensory axonal neuropathy of both upper limbs and lower limbs. Venous doppler of both lower limbs showed thrombosis of right superficial, femoral popliteal and proximal posterior tibial vein for which Inj. heparin was started.
In view of prolonged ventilation, tracheostomy was done on 14th may. She was treated with atropine, PAN, empirical antibiotics, broncho dilator nebulization, IRON injections, PPIs, IV fluids, and supportive measures. Physiotherapy was done regularly. Antibiotics were changed according to Culture/Sensitivity patterns. Three units of PRBC transfused to treat anaemia. Ventilator gradually weaned off and kept on oxygen with mask ventilation. She responded well to the above treatment and symptoms improved, serum cholinesterase and potassium levels improved.
She returned to hospital for follow-up after a month for tracheostomy closure. She completely recovered and was able to walk without any support.
Organophosphorus compounds are widely used in agriculture, domestic pest control and chemical warfare. Pesticide self-poisoning accounts for one sixth to one eighth of world’s suicide. OP pesticides inhibit cholinesterase enzyme leading to lost stimulation of
(MBBS, MD (Anaesth), Dip (Critical Care Medicine)
(MBBS, Diploma Inanaesthesiology) Consultant Critical Care
Consultant Physician And Diabetologist
