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VOLUME 27 , ISSUE 6 ( June, 2023 ) > List of Articles

Original Article

Quantification of Organophosphorus Insecticide Removed by Gastric Lavage in Acutely Poisoned Patients: An Observational Study

Asisha Janeela Mathansingh, Arun Jose, Jude Joseph Fleming, Kundavaram Paul Prabhakar Abhilash, Vignesh Kumar Chandiraseharan, Audrin Lenin, Samuel George Hansdak, Ramya Iyyadurai, Thenmozhi Mani, Michael Eddleston

Keywords : Efficacy, Gastric lavage, Insecticide poisoning, Organophosphorus

Citation Information : Mathansingh AJ, Jose A, Fleming JJ, Abhilash KP, Chandiraseharan VK, Lenin A, Hansdak SG, Iyyadurai R, Mani T, Eddleston M. Quantification of Organophosphorus Insecticide Removed by Gastric Lavage in Acutely Poisoned Patients: An Observational Study. Indian J Crit Care Med 2023; 27 (6):397-402.

DOI: 10.5005/jp-journals-10071-24475

License: CC BY-NC 4.0

Published Online: 31-05-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Introduction: The effectiveness of gastric lavage in organophosphorus (OP) poisoning has not been established. We assessed the ability of gastric lavage to remove OP insecticides as a preliminary stage in assessing effectiveness. Patients and methods: Organophosphorus poisoning patients presenting within 6 hours were included, irrespective of prior gastric lavage. A nasogastric tube was placed and gastric contents aspirated, followed by at least three cycles of gastric lavage with 200 mL of water. Samples from the initial aspirate and the first three lavage cycles were sent for identification and quantification of the OP compounds. Patients were monitored for complications of gastric lavage. Results: Around 42 patients underwent gastric lavage. Eight (19.0%) patients were excluded from the study because of a lack of analytical standards for ingested compounds. Insecticides were detectable in the lavage samples of 24 of 34 (70.6%) patients. Lipophilic OP compounds were detected in 23 of 24 patients, while no hydrophilic OP compounds could be detected in six patients with reported ingestion of hydrophilic compounds. For chlorpyrifos poisoning (n = 10), only 0.65 mg (SD 1.2) of the estimated ingested amount (n = 5) of 8,600 mg (SD 3,200) was recovered by gastric lavage. The mean proportion of the compound removed by initial gastric aspirate was 79.4% and subsequent three cycles removed 11.5, 6.6, and 2.7%. Conclusion: Lipophilic OP insecticides could be quantified in the stomach contents of OP poisoning patients with the first aspiration or lavage being most effective. The amount removed was very low; hence, routine use of gastric lavage for OP poisoning patients arriving within 6 hours is unlikely to be beneficial.

  1. Bertolote JM, Fleischmann A, Butchart A, Besbelli N. Suicide, suicide attempts and pesticides: A major hidden public health problem. Bull World Health Organ 2006;84(4):260. DOI: 10.2471/blt.06.030668.
  2. Gunnell D, Eddleston M. Suicide by intentional ingestion of pesticides: A continuing tragedy in developing countries. Int J Epidemiol 2003;32(6):902–909. DOI: 10.1093/ije/dyg307.
  3. Gunnell D, Eddleston M, Phillips MR, Konradsen F. The global distribution of fatal pesticide self-poisoning: Systematic review. BMC Public Health 2007;7(1):357. Available from:
  4. Rao CS, Venkateswarlu V, Surender T, Eddleston M, Buckley NA. Pesticide poisoning in south India – Opportunities for prevention and improved medical management. Trop Med Int Health 2005;10(6):581–588. DOI: 10.1111/j.1365-3156.2005.01412.x.
  5. Eddleston M, Dawson A, Karalliedde L, Dissanayake W, Hittarage A, Azher S, et al. Early management after self-poisoning with an organophosphorus or carbamate pesticide – A treatment protocol for junior doctors. Crit Care 2004;8(6):R391–397. DOI: 10.1186/cc2953.
  6. Meulemans A, Van den Berghe G, Winnen B, Delooz H. Gastrointestinal decontamination for acute poisoning. Acta Clin Belg Suppl 1990;13:13–19. DOI: 10.1080/17843286.1990.11718123.
  7. Li Y, Tse ML, Gawarammana I, Buckley N, Eddleston M. Systematic review of controlled clinical trials of gastric lavage in acute organophosphorus pesticide poisoning. Clin Toxicol 2009;47(3):179–192. DOI: 10.1080/15563650701846262.
  8. Wang C-Y, Wu C-L, Tsan Y-T, Hsu J-Y, Hung D-Z, Wang C-H. Early onset pneumonia in patients with cholinesterase inhibitor poisoning. Respirology 2010;15(6):961–968. DOI: 10.1111/j.1440-1843.2010.01806.x.
  9. Eddleston M, Haggalla S, Reginald K, Sudarshan K, Senthilkumaran M, Karalliedde L, et al. The hazards of gastric lavage for intentional self-poisoning in a resource poor location. Clin Toxicol (Phila) 2007;45(2):136–143. DOI: 10.1080/15563650601006009.
  10. Benson BE, Hoppu K, Troutman WG, Bedry R, Erdman A, Höjer J, et al. Position paper update: Gastric lavage for gastrointestinal decontamination. Clin Toxicol (Phila) 2013;51(3):140–146. DOI: 10.3109/15563650.2013.770154.
  11. Naderi S. The use of gastric lavage in India for poisoned patients. J Clin Toxicol 2012;2(1):118. Available from:
  12. Namba T, Nolte CT, Jackrel J, Grob D. Poisoning due to organophosphate insecticides: Acute and chronic manifestations. Am J Med 1971;50(4):475–492. DOI: 10.1016/0002-9343(71)90337-8.
  13. Jose A, Selvakumar R, Peter JV, Karthik G, Fleming DH, Fleming JJ. Estimation of monocrotophos renal elimination half-life in humans. Clin Toxicol 2015;53(7):629–632. DOI: 10.3109/15563650.2015.1054500.
  14. Pichamuthu K, Jerobin J, Nair A, John G, Kamalesh J, Thomas K, et al. Bioscavenger therapy for organophosphate poisoning – An open-labeled pilot randomized trial comparing fresh frozen plasma or albumin with saline in acute organophosphate poisoning in humans. Clin Toxicol 2010;48(8):813–819. DOI: 10.3109/15563650.2010.518970.
  15. Chillistone S, Hardman JG. Factors affecting drug absorption and distribution. Anaesth Intensive Care Med 2014;15(7):309–313. DOI: 10.1016/j.mpaic.2014.04.004.
  16. Chlorpyrifos technical fact sheet [Internet] [cited 2020 Jan 11]. Available from:
  17. PubChem. Triazophos [Internet] [cited 2020 Jan 11]. Available from:
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