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Tanima D, Maisnam I, Kundu AK, Saha SP, Ghosh S, Maity A. Atypical central nervous system involvement in acute organophosphorous poisoning. J Assoc Physicians India 2011; 59:326-327. [PMID: 21751614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Extrapyramidal syndrome is an uncommon sequelae of acute organophosphorous (OP) poisoning. It is a manifestation of the intermediate syndrome described in OP poisoning. It may or may not be associated with neuroimaging changes in the striatum. We present a case of acute OP poisoning with interesting positive CT scan findings.
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Affiliation(s)
- Das Tanima
- R.G. Kar Medical College, Kolkata 700 004, West Bengal
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Abstract
BACKGROUND The usefulness of a low butyrylcholinesterase (BuChE) activity on admission for predicting severity in acute organophosphorus (OP) insecticide poisoning has long been debated. Previous studies have been confounded by the inclusion of multiple insecticides with differing inhibitory kinetics. AIM We aimed to assess the usefulness of admission BuChE activity, together with plasma OP concentration, for predicting death with two specific organophosphorus insecticides. DESIGN A prospective cohort of self-poisoned patients. METHODS We prospectively studied 91 and 208 patients with proven dimethoate or chlorpyrifos self-poisoning treated using a standard protocol. Plasma butyrylcholinesterase activity and OP concentration were measured on admission and clinical outcomes recorded. RESULTS The usefulness of a plasma BuChE activity <600 mU/ml on admission varied markedly--while highly sensitive in chlorpyrifos poisoning (sensitivity 11/11 deaths; 100%, 95% CI 71.5-100), its specificity was only 17.7% (12.6-23.7). In contrast, while poorly sensitive for deaths in dimethoate poisoning [12/25 patients; 48%, (27.9-68.7)] it was reasonably specific [86.4% (75.7-93.6)]. A high OP concentration on admission was associated with worse outcome; however, a clear threshold concentration was only present for dimethoate poisoning. CONCLUSION Plasma BuChE activity on admission can provide useful information; however, it must be interpreted carefully. It can only be used to predict death when the insecticide ingested is known and its sensitivity and specificity for that insecticide has been studied. Plasma concentration of some OP insecticides predicts outcome. The development of rapid bedside tests for OP detection may aid early assessment of severity.
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Affiliation(s)
- M Eddleston
- Scottish Poisons Information Bureau, Royal Infirmary of Edinburgh, and Clinical Pharmacology Unit, University of Edinburgh, UK.
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Yu HN, Jiang XM. [Muscle pathological changes in myasthenia after acute omethoate poisoning in mice]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2007; 25:755-757. [PMID: 18230313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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Wan WG, Zheng SC, Zou HJ, Ma SD, Tao GZ, Xu ZF, Zhang B, Chen JJ, Fang LY, Zhu ZJ. [Different therapeutic efficacy of pralidoxime chloride PAM-Cl on AChE against acute toxicity of methamidophos, dichlorvos and omethoate]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2007; 25:586-589. [PMID: 18070496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To observe the treatments on the patients with acute methamidophos dichlorvos (DDV) and omethoate poisoning and provide the reliable basis for the rational treatments on these three organophosphorus pesticides poisoning. METHODS 101 patients with AOPP in 7 hospitals were divided into three groups: Group A, 59 patients with acute methamidophos poisoning, Group B, 32 patients with acute DDV/dipterex (DEP) poisoning, Group C, 10 patients with acute omethoate/dimethoate poisoning. The levels of erythrocyte AChE and the therapeutic efficacies of pralidoxime chloride (PAM-Cl) were compared among the three groups. RESULTS The AChE activities of all the three groups were inhibited on level of (9.12 +/- 7.99) U/g Hb (group A), 7.32 +/- 4.62 U/g Hb (group B) and (12.01 +/- 9.53) U/g Hb (group C), among which no significant difference was found (P > 0.05). All the patients recovered from acute cholinergic excitation or crisis after the treatment of PAM-Cl. The erythrocyte AChE activities were obviously reactivated in group A three hours later after admission to hospital, each on level of (11.37 +/- 8.67) U/g Hb, (12.51 +/- 6.98) U/g Hb, (15.90 +/- 7.31) U/g Hb, (18.33 +/- 4.78) U/g Hb and (18.91 +/- 7.00) U/g Hb at the 12th, 24th, 48th, 72nd hour and discharge (P < 0.05), and the upgrade tendency was continuous. AChE activities in group B were also reactivated after treatment, each on level of (8.91 +/- 5.89) U/g Hb, (1.31 +/- 6.61) U/g Hb, (13.00 +/- 7.55) U/g Hb, (14.22 +/- 7.80) U/g Hb, (12.78 +/- 7.07) U/g Hb and (16.87 +/- 7.06) U/g Hb at the 3rd, 12th, 24th, 48th, 72nd hour and discharge, but the upgrade tendency turned slowly after 12 hours, the inhibited AChE activities were not reactivated in group C from the beginning to the end. CONCLUSION After the treatment of PAM-Cl, the AChE activities of the patients with acute methamidophos poisoning could be continuously reactivated, the AChE activities of the patients with acute DDV/DEP poisoning could also be reactivated in 12 hours, and then keep stable, but the AChE activities of the patients with acute omethoate/dimethoate poisoning could not be reactivated. However, PAM-Cl has therapeutic efficacy against acute toxicity of all the three organophosphorus pesticides. Oximes should be vigorously used in the treatment of AOPP, including acute omethoate/dimethoate poisoning.
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Affiliation(s)
- Wei-Guo Wan
- Department of Occupational Disease, Huashan Hospital, Fudan University, Shanghai 200040, China.
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Wu QE, Ban TT, Yao XM, Chang XL, Wu Q, Zhou ZJ. [Protective effects of vigabatrin and atropine against dimethoate induced-intoxication in mice]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2007; 25:389-93. [PMID: 17908425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To investigate the protective effects of vigabatrin and atropine against the acute toxicity of dimethoate in male Kun-min mice. METHODS The therapeutic schedules of vigabatrin (50 or 100 mg/kg) and (or) atropine (2.5 or 5.0 mg/kg) were performed according to the L(9) (3(4)) orthogonal test table. The survival time, the righting reflex and the onset of muscle fasciculations were observed after the administration of dimethoate. RESULTS First, the main effects of vigabatrin, atropine and the interaction between them were statistically significant in the Univariate analysis of the survival time at the alpha level of 0.05 (F(V)= 4.73, P(V)= 0.015, F(A)= 50.88, P(A)= 0.000, F(VxA)= 4.17, P(VxA)= 0.007). The range of atropine was more than double of that of vigabatrin or their interaction (R(A)> 2RV or 2R(VxA)). So not only atropine and vigabatrin but also their combination interaction protected mice against dimethoate lethality. The atropine played the major role in diminishing the lethality induced by dimethoate. Second, only vigabatrin, while not atropine, delayed the mice from dimethoate-induced muscle fasciculation according its statistical results (F(V)= 6.87, P(V)= 0.003, F(A)= 0.03, P(A)= 0.968, F(VxA)= 1.134, P(VxA)= 0.356). It should be noted that vigabatrin could not completely prevent dimethoate induced-muscle fasciculation in the test. At last, both atropine and vigabatrin could maintain the righting reflex in the intoxication, however there was no interaction between them (F(V)= 5.81, P(V)= 0.006, F(A)= 9.05, P(A)= 0.001, F(VxA)= 1.34, P(VxA)= 0.257). CONCLUSION Combined treatment with atropine and vigabatrin in the organophosphates intoxication seems reasonable and acceptable.
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Affiliation(s)
- Qiang-en Wu
- Key Laboratory of Public Health and Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China
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Abstract
OBJECTIVE Organophosphate toxicity is the leading cause of morbidity and death in poisoning by insecticides. The clinical symptoms of pesticide toxicity range from the classic cholinergic syndrome to flaccid paralysis and intractable seizures. The mainstays of therapy are atropine, oximes, benzodiazepines and supportive care. The toxicokinetics vary not only with the extent of exposure, but also with the chemical structure of the agent. PATIENTS We report two cases of poisoning with parathion-ethyl and dimethoate. The patients developed a cholinergic syndrome immediately, accompanied by bradycardia and hypotension. INTERVENTIONS The patients were admitted to the intensive care unit (ICU) a few hours after ingestion. Atropine was administered according to the cholinergic symptoms. The patients recovered in the ICU after 10-12 days and were discharged after 3 and 4 weeks. MEASUREMENTS AND RESULTS Organophosphate blood and urine levels were determined on admission and during hospitalisation. The pesticides were rapidly distributed and slow elimination rate of the poisons was documented. In the case of parathion-ethyl the distribution half-life estimated was t(1/2alpha) = 3.1h while the terminal half-life was t(1/2beta) = 17.9 h. Using a one-compartment model for dimethoate the elimination half-life was t(1/2beta) = 30.4 h in plasma and 23.8 h in urine. The serum pseudo-cholinesterase activity was below the limit of detection at admission and recovered during the following 3weeks.
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Affiliation(s)
- Ulrich Hoffmann
- Ernst-Moritz-Arndt University Greifswald, Institute of Pharmacology, Friedrich-Loeffler-Strasse 23d, 17487, Greifswald, Germany.
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Shahar E, Bentur Y, Bar-Joseph G, Cahana A, Hershman E. Extrapyramidal parkinsonism complicating acute organophosphate insecticide poisoning. Pediatr Neurol 2005; 33:378-82. [PMID: 16243228 DOI: 10.1016/j.pediatrneurol.2005.05.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2005] [Revised: 04/12/2005] [Accepted: 05/23/2005] [Indexed: 10/25/2022]
Abstract
The aim of this study is to report our experience with a child who developed extrapyramidal perturbations complicating acute organophosphate insecticides poisoning and to review the literature reporting on basal ganglia impairment associated with this poisoning. Our patient had developed overt parkinsonism presenting with a resting tremor, expressionless face, and lack of blinking along with marked cogwheel rigidity and a stooped, slow gait. He was alert, coherent, and cooperative, yet agitated. The parkinsonian perturbations developed 5 days after an accidental ingestion of a raw eggplant sprayed with the organophosphate dimethoate (Rogor) when he had already recovered from the acute cholinergic crisis, the first stage of organophosphate poisoning. Such a presentation was initially perceived by his caregivers as severe reactive depression or even psychosis. Once a parkinsonian syndrome was diagnosed, he was begun on amantadine and completely recovered within 1 week with no relapse of symptoms. Basal ganglia impairment should be considered in any patient who develops extrapyramidal symptoms such as marked rigidity and bradykinesia or choreoathetosis while recovering from the acute cholinergic phase of organophosphate insecticide poisoning. Thus, administration of a drug such as amantadine, which probably enhances neurotransmission, may hasten the rate of recovery and prevent long-term neurologic and emotional sequelae.
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Affiliation(s)
- Eli Shahar
- Child Neurology Unit, Meyer Children Hospital, Haifa, Israel
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Eddleston M, Eyer P, Worek F, Mohamed F, Senarathna L, von Meyer L, Juszczak E, Hittarage A, Azhar S, Dissanayake W, Sheriff MHR, Szinicz L, Dawson AH, Buckley NA. Differences between organophosphorus insecticides in human self-poisoning: a prospective cohort study. Lancet 2005; 366:1452-9. [PMID: 16243090 DOI: 10.1016/s0140-6736(05)67598-8] [Citation(s) in RCA: 218] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although more than 100 organophosphorus insecticides exist, organophosphorus poisoning is usually regarded as a single entity, distinguished only by the compound's lethal dose in animals. We aimed to determine whether the three most common organophosphorus insecticides used for self-poisoning in Sri Lanka differ in the clinical features and severity of poisoning they cause. METHODS We prospectively studied 802 patients with chlorpyrifos, dimethoate, or fenthion self-poisoning admitted to three hospitals. Blood cholinesterase activity and insecticide concentration were measured to determine the compound and the patients' response to insecticide and therapy. We recorded clinical outcomes for each patient. FINDINGS Compared with chlorpyrifos (35 of 439, 8.0%), the proportion dying was significantly higher with dimethoate (61 of 264, 23.1%, odds ratio [OR] 3.5, 95% CI 2.2-5.4) or fenthion (16 of 99, 16.2%, OR 2.2, 1.2-4.2), as was the proportion requiring endotracheal intubation (66 of 439 for chlorpyrifos, 15.0%; 93 of 264 for dimethoate, 35.2%, OR 3.1, 2.1-4.4; 31 of 99 for fenthion, 31.3%, 2.6, 1.6-4.2). Dimethoate-poisoned patients died sooner than those ingesting other pesticides and often from hypotensive shock. Fenthion poisoning initially caused few symptoms but many patients subsequently required intubation. Acetylcholinesterase inhibited by fenthion or dimethoate responded poorly to pralidoxime treatment compared with chlorpyrifos-inhibited acetylcholinesterase. INTERPRETATION Organophosphorus insecticide poisoning is not a single entity, with substantial variability in clinical course, response to oximes, and outcome. Animal toxicity does not predict human toxicity since, although chlorpyrifos is generally the most toxic in rats, it is least toxic in people. Each organophosphorus insecticide should be considered as an individual poison and, consequently, patients might benefit from management protocols developed for particular organophosphorus insecticides.
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Affiliation(s)
- Michael Eddleston
- South Asian Clinical Toxicology Research Collaboration, Centre for Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, UK.
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Yang YM, Liu HJ, Zhou LX, Tian YP, Li XH, Tong F. [The dynamic change of astrocyte reaction after acute omethoate poisoning in cat]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2005; 23:157-8. [PMID: 16105471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
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Sun YG, Zhou ZJ, Zhang XM, Gu XA, Jin TY. [Expression of M3 receptor gene in peripheral blood lymphocytes of workers exposed to dimethoate]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2004; 22:3-6. [PMID: 15033005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
OBJECTIVE To study the expression of muscarinic receptor M(3) gene in peripheral blood lymphocytes of workers exposed to organophosphorus pesticides (OPPs) and to explore its role in the adverse effects of OPPs. METHODS The lymphocytes of peripheral blood from 33 workers exposed to dimethoate and 15 control people were isolated and treated with saline and dimethoate respectively in vitro. RT-PCR technique was used to determine M(3) gene expression. Basal and inducible gene expression levels were measured. RESULTS There was no significant difference in basal gene expression level between exposed group and control group, while the inducible gene expression level was significantly higher in exposure group (1.92 +/- 1.07) than in control group (1.22 +/- 0.19) and basal level (1.49 +/- 0.45, P < 0.05). No differences in basal and inducible gene expression level were found between male and female people in both exposed and control group. The level of inducible M(3) gene expression increased with the increase in length of exposure time [< 5 a: (1.69 +/- 0.95), 5 - 25 a: (1.91 +/- 1.03), > 25 a: (2.09 +/- 1.25), the latter was significantly different from that of < 5 a (P < 0.05)]. CONCLUSION After long-term exposure to OPPs, the basal M(3) receptor gene expression level in the exposed workers did not show any difference from the control group, but the inducible gene expression level (treated with dimethoate in vitro) was increased and related to the extent of exposure to dimethoate.
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Affiliation(s)
- Yun-guang Sun
- School of Public Health, Fudan University, Shanghai 200032, China
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Abstract
Deliberate self-harm by ingestion of organophosphate insecticides is a common health problem in Sri Lanka. The poisoning results in an initial life-threatening cholinergic crisis and several intermediate and late neurological and psychiatric manifestations. A patient who developed self-limiting cerebellar signs 8 days after ingestion of dimethoate, an organophosphorous insecticide, is reported on.
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Affiliation(s)
- M M D Fonseka
- Department of Medicine, Faculty of Medicine, PO Box 6, Ragama, Sri Lanka.
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Qiu Z, Zhao D, Shi Y, Huang S. [Study on the therapeutic effect of combined use of obidoxime and atropine with respiratory machine on respiratory muscle paralysis caused by omethoate poisoning of rats]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2002; 20:359-61. [PMID: 14694726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
OBJECTIVE To examine the therapeutic effect of combined use of obidoxime and atropine with artificial ventilation on respiratory muscle paralysis caused by omethoate poisoning in rats. METHODS Rats were exposed to 2 times the dose of LD50 omethoate and treated with atropine (10 mg/kg) to counteract cholinergic symptoms. When the rats' respiratory frequency became slower and breathed with difficulty, the trachea intubation and artificial ventilation was carried out. The rats in group A were continuously treated with atropine. The dose of obidoxime for Group B, C and D were 8, 15, 20 mg/kg respectively, given at the same time as artificial ventilation and 1, 2, 3 hours later. The doses of atropine was reduced to 1/3 - 2/3 of the first dose so as to maintain the rats atropinized. If the rat survival was beyond 60 minutes after withdrawal of artificial ventilation, the combined treatment was considered successful. The function of isolated phrenic diaphragm of the rats was observed with MS-302 physiological and pharmacological analysis instrument. RESULTS None of the rats in Group A was successful after withdrawal from artificial ventilation and the function of phrenic diaphragm appeared poor; whereas > 80% of the rats in B, C, D Group were successful after withdrawal from artificial ventilation in 3 h and the function of phrenic diaphragm remained well. The survival rate in B, C and D groups were higher after withdrawal from artificial ventilation than that in Group A(P < 0.01). The function of phrenic diaphragm in Group B, C and D were gradually decreased after ACh was added into the container. CONCLUSIONS Combined use of suitable dose of obidoxime and atropine with artificial ventilation for respiratory muscle paralysis caused by omethoate poisoning could promote the recovery of diaphragm function and reduce the death rate in poisoned rats.
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Affiliation(s)
- Zewu Qiu
- Department of Emergency, Beijing 307 Hospital, Beijing 100039, China
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Abstract
A case of suicide with the insecticide omethoate is reported. An 18-year-old apprentice gardener had ingested an unknown amount of omethoate. His body was found in his room lying in the storage space under his bed. The autopsy first showed multiple superficial incisions in the skin of his wrists, furthermore hemorrhagic pulmonary oedema, dilation of the right cardiac ventricle and oedema of the brain. The gastric mucosa was swollen and showed a dark brownish colour. An intensive, chemical-like smell rose from the corpse and organs. Toxicological analysis detected omethoate in cardiac blood (208 micro g/ml), urine (225 micro g/ml) and bile (524 micro g/ml), in the liver (341 micro g/ml) and kidneys (505 micro g/ml). In the gastric content the level was 48223 micro g/ml. The amount of the active AChE in peripheral blood serum was reduced to less than 0.2% of the normal level. To our knowledge no case of a fatal suicide by ingestion of omethoate has been reported in literature.
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Affiliation(s)
- M Pavlic
- Institute of Legal Medicine, Leopold-Franzens-University of Innsbruck, Muellerstrasse 44, 6020 Innsbruck.
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Abstract
The authors describe the evaluation of an automated rapid emergency drug profiling system (REMEDi HS), which is designed for clinical toxicology and therapeutic drug monitoring, in a severe case of dimethoate poisoning. Successful qualitative and quantitative determination of dimethoate in diluted serum samples was achieved. The authors found that dimethoate serum concentrations were properly measured with the REMEDi method and well correlated with gas chromatography-mass spectrometry. The results provide evidence that besides screening and rapid estimation of drug concentrations in human fluids, this system is a suitable tool in cases of symptomatic dimethoate poisoning.
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Affiliation(s)
- Ralf Regenthal
- Institute of Clinical Pharmacology, Institute of Forensic Sciences, University of Leipzig, Haertelstrasse 16-18, D-04107 Leipzig, Federal Republic of Germany.
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Qiu Z, Zhao D, Shi Y, Huang S. [Experimental treatment of respiratory failure caused by omethoate poisoning in rats]. Zhonghua Nei Ke Za Zhi 2002; 41:259-61. [PMID: 12133440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
OBJECTIVE To examine the therapeutic effect of combined use of pralidoxime-Cl and atropine with artificial ventilation on respiratory muscle paralysis caused by omethoate poisoning in rats. METHODS Rats were administered with same doses of 2LD(50) omethoate and then treated with atropine (10 mg/kg) to resist effectively chlolinergic symptoms. When the rats had slow respiratory frequency and breathed with difficulty, the trachea was intubated and artificial ventilation was carried out (except for group A). The rats in group B were continuously treated with atropine. The doses of pralidoxime-Cl for group C, D and E were 15 mg/kg, 20 mg/kg and 40 mg/kg respectively, given at the same time as artificial ventilation and 1, 2 and 3 hours later. The dose of atropine was reduced to 1/3 to 2/3 of the first dose so as to maintain the rats atropinized. If the rat survived beyond 60 minutes after withdrawal of artificial ventilation, the combined treatment was considered successful. The function of isolated phrenic diaphragm of the rats was observed with MS-302 analyses instrument physiologically and pharmacologically. RESULTS None of the rats in group B successfully withdraw from artificial ventilation. The rats in group C all successfully withdraw from artificial ventilation in 3 hours and the function of the isolated phrenic muscle remained good. The survival rats in group D and E were very low after withdrawal, even though the function of isolated phrenic muscle was good. CONCLUSIONS The therapeutic effect of the combined use of suitable dose of pralidoxime-Cl and atropine with artificial ventilation on respiratory muscle paralysis caused by omethoate poisoning in rats was significant. This measure can facilitate reversal of the function of poisoned diaphragm and reduced the death rate in poisoned rats.
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Affiliation(s)
- Zewu Qiu
- Department of Emergency, Beijing 307 Hospital, Beijing 100039, China.
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Xiao C, Niu Y, He F. [Stimulation single fiber electromyography in rats with myasthenia induced by organophosphorus insecticides and their mixtures poisoning]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2002; 20:125-7. [PMID: 14694629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
OBJECTIVE To study the neuromuscular function and its relation with the occurrence of myasthenia in rats poisoned by dimethoate (D), phoxim (P), methomyl (M), M + D and M + P respectively. METHODS The stimulation single fiber electromyography(SSFEMG) at different stimulus frequencies(5, 10 and 20 Hz) was used. The whole blood cholinesterase (ChE) activity was measured 1 h before and after poisoning. RESULTS (1) Myasthenia occurred in 5 out of 9.5 out of 10.5 out of 5, and 8 rats poisoned by D, P, M + D, and M + P, respectively. (2) The average mean consecutive differences(MCD) at 5, 10, and 20 Hz in myasthenic rats were significantly higher than those of poisoned rats without myasthenia and the control ones. (3) SSFEMG changes at 5, 10 and 20 Hz were significantly consistent with the clinical manifestation of myasthenia, especially at 10 Hz and 20 Hz. (4) ChE activity was significantly lower in rats with P or D poisoning while ChE inhibition was of no difference in rats with M, M + D, and M + P poisoning. In the D poisoning and P poisoning groups, there was no significant difference in ChE inhibition between the rats with and without myasthenia. CONCLUSION Muscle weakness was associated with neuromuscular transmission dysfunction, but not well correlated with ChE inhibition. The SSFEMG with stimulus frequency at 10 Hz or 20 Hz could be used to detect the neuromuscular dysfunction during myasthenia induced by organophosphate insecticides and their mixtures poisoning.
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Affiliation(s)
- Cheng Xiao
- Institute of Occupational Medicine, Chinese Academy of Preventive Medicine, Beijing 100050, China
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Abstract
In order to investigate the mechanism of muscular weakness in the intermediate myasthenia syndrome (IMS) following acute organophosphate poisoning, the effect of dimethoate on the neuromuscular transmission was studied in rats by using the electrical stimulation single fiber electromyography (SSFEMG) and repetitive nerve stimulation (RNS). The results showed that there was a prolongation of mean consecutive difference (MCD) of the latencies of single fiber potential shown by SSFEMG in dimethoate intoxicated rats during the presence of muscle weakness when the stimuli were given at 10 or 20 Hz, and there was a remarkable decrement of compound muscle action potential (CMAP) of gastrocnemius muscle evoked by RNS on the sciatic nerve at 20 Hz in some rats with myasthenia. The frequency of neuromuscular transmission abnormalities detected by SSFEMG was significantly higher than those detected by RNS. This study demonstrates that the SSFEMG is a more sensitive electrophysiological method in the detection of neuromuscular transmission block occurred in rats of acute organophosphate poisoning with muscle weakness.
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Affiliation(s)
- Y Dongren
- Institute of Occupational Medicine, Chinese Academy of Preventive Medicine, Beijing, People's Republic of China
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Li Y, Liu X, Xue SZ. Antidotal effect of glucoside extracted from Astragalus membranaceus on dimethoate intoxication in guinea pigs. LA MEDICINA DEL LAVORO 1999; 89 Suppl 2:S136-41. [PMID: 10217935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Therapeutic effect of the glucoside extracted from the root of Astragalus Membranaceus (AM) was studied in guinea pigs intoxicated with 600 mg/kg doses of Dimethoate (D). Four groups of guinea pigs, each consisting of two males and two females, were treated with (a) D, (b) D + Atropine, and (c) D + AM, (d) D + Atropine + AM. The survival time of the animals increased from an average of 70 minutes without AM to an average of 235 minutes with AM. Severe changes in ECG were observed prior to respiratory distress in groups without AM, and Atropine did not modify such changes. Differently, severe ECG disorders appeared only after respiratory distress in groups treated with AM. Prolongation of the Q-T interval and changing of the T wave configuration were significantly mitigated in the AM treated animals, while, arrhythmias were minimized and postponed. Moreover, muscular fasciculation and fibrillation, seizures and secretion in the respiratory tract were also significantly reduced by AM treatment. Results have shown that AM could be a promising drug to be used after cholinergic crisis in the treatment of cardiac complications with severe organophosphate intoxication.
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Affiliation(s)
- Y Li
- Department of Toxicology, Shanghai Medical University, China
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Tsatsakis AM, Manousakis A, Anastasaki M, Tzatzarakis M, Katsanoulas K, Delaki C, Agouridakis P. Clinical and toxicological data in fenthion and omethoate acute poisoning. J Environ Sci Health B 1998; 33:657-670. [PMID: 9830131 DOI: 10.1080/03601239809373170] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
This study paper reports on two cases of poisoning with the organophosphorus insecticides, fenthion and omethoate. The two victims were admitted in the Intensive Care Unit (ICU) a few hours after ingestion of the two insecticides. They received appropriate treatment for organophosphorous poisoning (gastric lavage, activated charcoal, atropine and pralidoxime) and supportive care. Both patients survived. Organophosphate blood levels were determined on admission (fenthion 2.9 micrograms/ml, omethoate 1.6 micrograms/ml) and during the hospitalisation and proved to be considerably high. Slow elimination rate of the poison already distributed in the body was indicated for both pesticides. The patient with omethoate poisoning remained clinically well (Glasgow Coma Scale: 15) and was discharged three days later. The patient with fenthion poisoning, who had also ingested 30 mg of bromazepam and 720 mg of oxetoron, developed cholinergic crisis six hours after admission and was intubated for 24 days, with concomitant complications.
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Affiliation(s)
- A M Tsatsakis
- Department of Medicine, University of Crete, Iraklion, Greece
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20
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Abstract
Six patients with acute organophosphate pesticide poisoning in whom electrodiagnostic studies influenced or supported specific decisions in management are described. One patient was admitted to hospital with a diagnosis of acute alcoholic intoxication. Electrodiagnostic studies revealed single stimulus induced repetitive responses and decrement-increment responses at 30 and 50 Hz repetitive nerve stimulation, findings that are indicative of a depolarization block due to inactivation of acetylcholinesterase at the motor end-plate. The patient was subsequently treated as a case of acute organophosphate poisoning. The administration of edrophonium (0.1 mg) to another patient with normal neuromuscular transmission studies unmasked the latent electrophysiological abnormalities. Three instances are described in which electrodiagnostic studies were useful in predicting whether pralidoxime administration was likely to be useful and for how long was pralidoxime therapy to be continued. Phrenic nerve conduction study in one patient with impending respiratory failure revealed an unstimulable phrenic nerve. The potential role of phrenic nerve conduction studies and neuromuscular transmission studies in influencing decisions like intubation and mechanical ventilation is discussed.
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Affiliation(s)
- G Singh
- Department of Medicine, Dayanand Medical College, Ludhiana, India
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21
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Tsatsakis AM, Aguridakis P, Michalodimitrakis MN, Tsakalov AK, Alegakis AK, Koumantakis E, Troulakis G. Experiences with acute organophosphate poisonings in Crete. Vet Hum Toxicol 1996; 38:101-107. [PMID: 8693683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Nine human acute poisonings due to intentional ingestion of organophosphorous pesticides are presented. Six of the victims died. Six patients were treated in the Intensive Care Unit (ICU) from 34 h to 45 d, while 3 were found dead by relatives. Two of the patients treated in the ICU fully recovered after 15 and 24 d while the third survivor developed delayed neuropathy. Organophosphate blood levels were determined on admission and during therapy, and in 1 case atropine and pralidoxime levels were also detected. Significant fluctuations of the plasma cholinesterase activity were observed during therapy. Postmortem analysis revealed higher levels of pesticides in organs (eg 23.1 micrograms fenthion/g kidney) and in fat (135.2 micrograms fenthion/g) than in blood (eg 4.8 micrograms fenthion/ml) and vitreous humor. Considerable pesticide was measured in testis (eg 5.8 micrograms fenthion/g, 0.8 micrograms methidathion/g) and uterus (170.5 micrograms malathion/g). Extracorporeal decontamination to enhance pesticide elimination is a therapeutic challenge.
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Affiliation(s)
- A M Tsatsakis
- Laboratory of Toxicology, School of Medicine, University of Crete, Greece
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22
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Tripathi AK, Misra UK. Ophthalmoplegia in dimethoate poisoning. J Assoc Physicians India 1996; 44:225. [PMID: 9251332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- A K Tripathi
- Dept. of Medicine, K.G. Medical College, Lucknow, India
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23
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Bouros D, Agouridakis P, Tsatsakis A, Askitopoulou E, Siafakas NM. Orthodeoxia and platypnoea after acute organophosphorus poisoning reversed by CPAP: a newly described cause and review of the literature. Respir Med 1995; 89:625-8. [PMID: 7494917 DOI: 10.1016/0954-6111(95)90232-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The case of a 60-year-old male patient, who survived severe organophosphorus poisoning, and subsequently developed platypnoea and orthodeoxia is described. The patient was mechanically ventilated for a long period of time in the intensive care unit. During the weaning trial, he developed platypnoea and orthodeoxia (PaO2 85 mmHg in recumbency, and 40 mmHg in upright position). Interestingly, the patient's orthodeoxia was alleviated on continuous positive airway pressure (CPAP) treatment. This is a newly described cause of the platypnoea-orthodeoxia syndrome. The possible pathophysiological mechanisms are discussed and a review of the reported abnormal states associated with this condition is presented.
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Affiliation(s)
- D Bouros
- Department of Pulmonary Medicine, Medical School University of Crete, Greece
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24
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Alekperov RU. [Antimutagenic protection of the human genetic system in acute intoxication]. Vestn Ross Akad Med Nauk 1995:49-51. [PMID: 7767119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The results of clinical studies and model experiments have shown that human genome damages are widely spread in patients with acute intoxication. For neutralization of the negative effects, biologically active compounds-antimutagens, alpha-tocopherol, and new plant mutagen were used. The application of antimutagens has been found to increase the level of genetic damages induced by acute intoxication.
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25
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Betrosian A, Balla M, Kafiri G, Kofinas G, Makri R, Kakouri A. Multiple systems organ failure from organophosphate poisoning. J Toxicol Clin Toxicol 1995; 33:257-60. [PMID: 7760452 DOI: 10.3109/15563659509017994] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A 68-year-old man was admitted to an intensive care unit after a suicidal ingestion of dimethoate with organophosphate poisoning. Despite temporary improvement, the patient's condition progressively deteriorated with the development of adult respiratory distress syndrome and acute renal failure. Hemodynamic measurements substantiated the evidence of non cardiogenic pulmonary edema, while renal indices the presence of acute tubular necrosis. Despite vigorous organ specific support the patient died on the 12th hospital day. An autopsy confirmed the presence of adult respiratory distress syndrome and acute tubular necrosis. Organophosphate poison can be added to the list of toxins that caused adult respiratory distress syndrome and acute tubular necrosis and provoked the development of multiple systems organ failure.
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Affiliation(s)
- A Betrosian
- Intensive Care Unit, Hippokration General Hospital, Athens, Greece
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26
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Jastrzebski J, Złotorowicz M, Szczepański M. Activation of blood coagulation induced by organophosphate pesticide. Mater Med Pol 1994; 26:33-4. [PMID: 7808040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A case of suicidal poisoning with organophosphate pesticide, associated by acute activation of blood coagulation is presented. The heparin treatment efficiently inhibited this activation.
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Affiliation(s)
- J Jastrzebski
- 1 Department of Anaesthesia and Intensive Care, Medical Center of Postgraduate Education, Warsaw, Poland
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27
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Buckley NA, Dawson AH, Whyte IM. Organophosphate poisoning: peripheral vascular resistance--a measure of adequate atropinization. J Toxicol Clin Toxicol 1994; 32:61-8. [PMID: 8308950 DOI: 10.3109/15563659409000431] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We report severe organophosphate poisoning complicated by hypotension and ischemic sequelae in two patients with pre-existing vascular disease. Both patients had a low total peripheral resistance and high cardiac output that were significantly reversed by doses of atropine in excess of those required to control other muscarinic symptoms. Cerebral infarcts and gangrene requiring a below knee amputation were complications of the poisonings. It is proposed that the ischemic complications are due to paradoxical vasoconstriction by acetylcholine at sites of endothelial injury. One patient, who had taken fenthion, also had a significantly delayed peak and prolonged, 2-3 week, systemic toxicity. We propose that stability of the plasma cholinesterase at 6 to 8 h after temporarily suspending oxime provides a rapid guide to the duration of therapy, especially in patients whose complications make clinical assessment difficult.
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Affiliation(s)
- N A Buckley
- Department of Clinical Pharmacology & Toxicology Mater Misericordiae Hospital, Warath, Australia
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28
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Willems JL, De Bisschop HC, Verstraete AG, Declerck C, Christiaens Y, Vanscheeuwyck P, Buylaert WA, Vogelaers D, Colardyn F. Cholinesterase reactivation in organophosphorus poisoned patients depends on the plasma concentrations of the oxime pralidoxime methylsulphate and of the organophosphate. Arch Toxicol 1993; 67:79-84. [PMID: 8481105 DOI: 10.1007/bf01973675] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We measured in nine patients, poisoned by organophosphorus agents (ethyl parathion, ethyl and methyl parathion, dimethoate, or bromophos), erythrocyte and serum cholinesterase activities, and plasma concentrations of the organophosphorus agent. These patients were treated with pralidoxime methylsulphate (Contrathion), administered as a bolus injection of 4.42 mg.kg-1 followed by a continuous infusion of 2.14 mg.kg-1/h, a dose regimen calculated to obtain the presumed "therapeutic" plasma level of 4 mg.l-1, or by a multiple of this infusion rate. Oxime plasma concentrations were also measured. The organophosphorus agent was still detectable in some patients after several days or weeks. In the patients with ethyl and methyl several days or weeks. In the patients with ethyl and methyl parathion poisoning, enzyme reactivation could be obtained in some at oxime concentrations as low as 2.88 mg.l-1; in others, however, oxime concentrations as high as 14.6 mg.l-1 remained without effect. The therapeutic effect of the oxime seemed to depend on the plasma concentrations of ethyl and methyl parathion, enzyme reactivation being absent as long as these concentrations remained above 30 micrograms.l-1. The bromophos poisoning was rather mild, cholinesterases were moderately inhibited and increased under oxime therapy. The omethoate inhibited enzyme could not be reactivated.
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Affiliation(s)
- J L Willems
- Heymans Institute of Pharmacology, University of Ghent, Medical School, Belgium
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29
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Passeron D, De Laville O, Durmont P, Aubas S. [Acute liver and kidney failure after the ingestion of cyclohexanone]. J Toxicol Clin Exp 1992; 12:207-11. [PMID: 1295971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- D Passeron
- Centre Anti-Poisons du Languedoc-Roussillon, Hôpital Lapeyronie, Montpellier, France
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30
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De Bleecker J, Van Den Neucker K, Willems J. The intermediate syndrome in organophosphate poisoning: presentation of a case and review of the literature. J Toxicol Clin Toxicol 1992; 30:321-9; discussion 331-2. [PMID: 1324992 DOI: 10.3109/15563659209021546] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A dimethoate-poisoned woman gradually developed a moderately severe cholinergic crisis that was readily treated by atropine. After being symptom-free for nearly two days, she suffered from sudden life-threatening respiratory paresis and weakness of the facial, extraocular, neck flexor and proximal limb muscles. Muscarinic symptoms were absent. Cholinesterase inhibition was severe, and EMG revealed marked decrements at low rates of repetitive nerve stimulation, and increments at a high rate. The clinical course was compatible with the Intermediate Syndrome. This syndrome seems due to persistent cholinesterase inhibition presumably leading to combined pre- and postsynaptic impairment of neuromuscular transmission. Inadequate pralidoxime therapy is proposed but not established as contributory. Prolonged monitoring of respiratory function in patients poisoned by particular organophosphate agents is mandatory.
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Affiliation(s)
- J De Bleecker
- Department of Neurology, Ghent University Hospital, Belgium
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31
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Lie B, Jacobsen D, Strømme JH, Breder O, Rygnestad T, Wickstrøm E. [Organophosphate poisoning]. Tidsskr Nor Laegeforen 1990; 110:3006-8. [PMID: 2237852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Three cases of poisoning by organophosphate dimethoate are described and the importance of correct diagnosis and adequate treatment emphasized. Therapy consists of large doses of atropine, to counteract the muscarinic and other effects on the central nervous system, followed by a reactivator (e.g. toxogonin) to reverse muscle weakness (nicotinic effects).
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Affiliation(s)
- B Lie
- Medisinsk avdeling, Ullevål sykehus, Oslo
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32
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Plevir VN, Skliarenko IP, Berzovetskaia EM. [Toxic myocardiodystrophy caused by acute phosphamide poisoning]. Vrach Delo 1990:35-6. [PMID: 2284762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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33
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Abstract
A 20-year-old male who attempted suicide by injecting subcutaneously 10 ml of Sistemin 40 (40% dimethoate) was admitted 16 h later. General weakness, muscular fibrillations and a marked inhibition of red blood cell and serum cholinesterases were the prominent signs of intoxication. 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. In contrast to the marked general improvement of the patient, the return of cholinesterase activities was very slow. The patient was discharged 24 d after the poisoning with no notable consequences which could be ascribed to the intoxication.
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Affiliation(s)
- D Jovanović
- Military Technical Institute, Medical Department, Belgrade, Yugoslavia
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34
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Deike S, Wosnitzka H. [Behavior of serum cholinesterase and acetylcholinesterase activity in acute dimethoate poisoning]. Z Gesamte Inn Med 1989; 44:548-9. [PMID: 2588727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
With a patient who in suicidal intention had orally taken a larger quantity of Bi 58 EC (dimethoate) especially the behaviour of the serum cholinesterase activity and the whole blood acetylcholinesterase activity was observed over a period of 38 days and it was compared with the clinical appearance. For the serum cholinesterase activity and the acetylcholinesterase activity a three-phase course that with statistically proven adaption could be described only by a three-membered e-function could be shown. Till the 3rd day an extreme decrease of activity of 80-85 per cent occurred. Both cholinesterases provide the same information with regard to the consequences of intoxication. They are only quantitatively different from each other.
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Affiliation(s)
- S Deike
- Abteilung für Pathologische Physiologie, Bereiches Medizin der Ernst-Moritz-Arndt-Universität Greifswald
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35
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Besser R, Hopf HC, Gutmann L, Dillmann U. [The decrement-increment phenomenon in disorders of neuromuscular transmission by inhibition of acetylcholinesterase]. EEG EMG Z Elektroenzephalogr Elektromyogr Verwandte Geb 1989; 20:28-33. [PMID: 2539961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Repetitive stimulation of the median nerve elicited a so far unknown course of the muscle action potentials in four patients with organophosphate intoxications. The amplitude of the initial muscle action potential decreased with the second stimulus and gradually increased to normal values by subsequent stimuli. With the second stimulus a loss of the repetitive muscle action potentials occurred. The Decrement-increment phenomenon was seen in early and/or late stages of severe intoxications when fasciculations were prominent. We suppose that the repetitive muscle action potential following the first stimulus results from backfiring. The second orthodromic nerve action potential collides with this antidromic activity leading to a partial extinction. Loss of backfiring with the second stimulus abolishes the phenomenon of collision and enables a recovery of the muscle action potential amplitudes.
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Affiliation(s)
- R Besser
- Neurologische Universitätsklinik Mainz
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36
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Besser R, Dillmann U, Gutmann L, Hopf HC. [The repetitive muscular action potential in neuromuscular transmission disorders due to acetylcholinesterase inhibition]. EEG EMG Z Elektroenzephalogr Elektromyogr Verwandte Geb 1988; 19:85-91. [PMID: 2841086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Neuromuscular transmission was studied in 11 patients with organophosphate intoxication. The compound muscle action potential (MAP) was recorded from the thumb after single, repetitive (1-50 Hz) and paired stimulation. All patients showed a prolonged MAP. The duration increased with the severity of intoxication. The number of peaks varied only slightly. In all cases repetitive stimulation reduced the later components of the MAP. There was no correlation with tetanic fade of the initial negative component. One patient had a pronounced tetanic fade but a slight reduction of repetitive components. In view of experimental studies a combined pre- and postsynaptic effect seems to be responsible.
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Affiliation(s)
- R Besser
- Neurologische Universitätsklinik Mainz
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37
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Marrosu F, Pisano A, Giagheddu M. Paradoxical neurovegetative symptoms in organophosphate intoxication. A case report. Acta Neurol (Napoli) 1987; 9:208-11. [PMID: 3630792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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38
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Pach J, Groszek B, Bogusz M. Haemoperfusion in treatment of acute poisoning with organophosphate pesticides. Mater Med Pol 1987; 19:118-21. [PMID: 3448415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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39
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Abstract
Acute neurotoxic effects during the cholinergic phase of organophosphorus insecticide poisoning and delayed neurotoxic effects appearing two to three weeks later are well recognized. We observed 10 patients who had paralysis of proximal limb muscles, neck flexors, motor cranial nerves, and respiratory muscles 24 to 96 hours after poisoning, after a well-defined cholinergic phase. The compounds involved were fenthion, monocrotophos, dimethoate, and methamidophos. Four patients urgently required ventilatory support. The paralytic symptoms lasted up to 18 days. A delayed polyneuropathy later developed in one patient. Three patients died. Electromyographic studies showed fade on tetanic stimulation, absence of fade on low-frequency stimulation, and absence of post-tetanic facilitation, suggestive of a postsynaptic defect. This neuromuscular junctional defect may have been the predominant cause of the paralytic symptoms, with neural and central components contributing to various degrees. Our patients appeared to have a distinct clinical entity (a so-called intermediate syndrome) that developed after the acute cholinergic crisis and before the expected onset of the delayed neuropathy.
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41
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Abstract
A 68-year-old male attempted suicide by drinking three ounces of concentrated Cygon 2-E (23.4% dimethoate). He was immediately brought to the hospital, responded to standard treatment (ipecac, activated charcoal, 2-PAM, atropine), and was transferred from the ICU to general care 24 hours after the exposure. Within eight hours of the transfer, he relapsed and was moved to the CCU, where he required five milligrams of atropine every ten minutes for 24 hours, before being started on an atropine drip. The patient was maintained on the atropine drip (0.5-2.4 mg/kg/hr) for five weeks. He required a total atropine dose of 30 grams, the largest amount ever reported to have been administered to a human. Although S-ChE activities gradually increased they were not found to be helpful in determining when the drip could be safely stopped. Control of hypersecretions served as the best monitoring parameter for titration of the drip rate. The patient recovered completely with the exception of a detectable sensorineural hearing deficit, a slight, nonspecific personality change, and minimal spastic rigidity thought to be secondary to several anoxic episodes.
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42
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Bolgár G, Jójárt G, Túri J. [Spontaneous delivery of a pregnant women after dimetoate (BI 58 EC) poisoning]. Orv Hetil 1985; 126:3213-4. [PMID: 4080382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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43
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Abstract
In anaesthetized guinea-pigs treated with lethal doses of dimethoate, cardiac failure and serious ECG disturbances developed in the early phase of intoxication. The toxic cardiac phenomena appeared to be unrelated to the degree of cholinesterase inhibition, but showed a close correlation with myocardial dimethoate concentration. Cardiac failure and mortality were first observed at a critical pesticide level of about 110 micrograms/g, while a level of 221 micrograms/g resulted in death in all cases. The present investigation refers to the direct effect of the pesticide on the myocardium, independent of its anticholinesterase action.
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44
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45
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Fetcher A. Suspected dimethoate toxicity in cattle. Mod Vet Pract 1984; 65:283-5. [PMID: 6738494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Dimethoate, an organophosphorus insecticide, was the suspected cause of toxicosis in a group of young cattle grazing on pasture that had been sprayed 6 weeks before the onset of clinical signs. Affected animals had primarily nicotinic signs, such as muscle twitching, stiffness, weakness and paralysis, though muscarinic signs, such as diarrhea, salivation and pollakiuria, were also observed. Whole blood acetylcholinesterase activity was depressed in 3 animals. The atypical clinical syndrome and poor response to treatment with atropine and other anticholinergics may have been due to coexistent hypomagnesemia.
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46
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Prandota J, Nienartowicz B, Nowicka J. [Dramatic course of poisoning with a organophosphate compound in a 4-year-old boy treated with obidoxime chloride and atropine sulfate]. Pediatr Pol 1982; 57:975-9. [PMID: 6763186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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47
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Biscaldi G, Pugliese F, Terzi R, Alfonsi E, Moglia A. [Acute poisoning by Vantal (combination of dimethoate and DDT) in a group of longshoremen]. G Ital Med Lav 1982; 4:203-6. [PMID: 7185635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
In this work the authors describe a case of acute intoxication by "VANTAL" (DDT and Dimethoate) occurred in a group of six longshoremen. The authors particularly consider the reports about the gastroenteric apparatus and the central and peripheric nervous system. It has in fact been possible to document all kinds of pathologic condition from gastritis to duodenal ulcer in all subjects; whereas only three subjects out of six showed alterations in E.E.G. and E.M.G.
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48
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Matos E, Larripa I. Effect of an accidental exposure to dimethoate and derivatives. Medicina (B Aires) 1982; 42:381-4. [PMID: 15171018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
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49
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Curtes JP, Develay P, Hubert JP. Late peripheral neuropathy due to an acute voluntary intoxication by organophosphorus compounds. Clin Toxicol (Phila) 1981; 18:1453-62. [PMID: 6277553 DOI: 10.3109/15563658108990354] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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50
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Lotti M, Ferrara SD, Caroldi S, Sinigaglia F. Enzyme studies with human and hen autopsy tissue suggest omethoate does not cause delayed neuropathy in man. Arch Toxicol 1981; 48:265-70. [PMID: 7316761 DOI: 10.1007/bf00319654] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Levels of acetylcholinesterase and neurotoxic esterase were measured in brain autopsy material. In tissue from a fatal human poisoning and from hens given 4-8 x unprotected LD50 AChE was highly inhibited and neurotoxic esterase uninhibited. The findings correlate with the inhibitory power of omethoate against these enzymes in vitro. It is concluded that omethoate has negligible potential to cause delayed neuropathy and a published report of human neuropathy due to omethoate is criticised.
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