Acute organic insecticide poisoning is a major health problem all over the world, particularly in the developing countries, where organophosphates (OPs) are the most common suicidal poisons with high morbidity and mortality and account for a large proportion of patients admitted to intensive care units. Other insecticides less commonly used are organocarbamates, organochlorides, and pyrethroids, which are less toxic and are associated with less morbidity and mortality. Patients with poisoning present with a wide spectrum of gastrointestinal, neurological, and cardiac manifestations. A strong clinical suspicion is necessary to make an early diagnosis and to start appropriate therapy. Treatment is primarily supportive and includes decontamination, anticholinergics, protection of the airway, and cardiac and respiratory support. The use of oximes has been controversial and may be associated with higher mortality owing to a higher incidence of type-II paralysis. They may have other toxic side effects. This paper reviews the literature on OP poisoning.
Eddleston M. Patterns and problems of deliberate self poisoning in the developing world. QJM 2000;93:715-31.
Jeyaratnam J. Acute pesticide poisoning, a major health problem. World Health Stat Q 1990;43:139-45.
Cherian AM, Jeyaseelan L, Peter JV, et al. Pralidoxime in the treatment of organophosphorus poisoning-a randomized double blind, placebo controlled trial. INCLEN Monograph Series on Critical International Health Issues No. 7, Dec 1977.
Shah AC, Trivedi AM, Viswanath N, et al. Intensive respiratory care service, organization, orientation, system and future. Our experience of management of 288 cases. Assoc Physicians India 1990;38:140-3.
Jamil H. Organophosphorus insecticide poisoning. JPMA 1989;39:27-31.
Ganesvaran T, Subramaniam S, Mhadevan K. Suicide in a northern town of Sri Lanka. Acta Psychitrica Scandinavia 1984;69:420-5.
Milby TH. Prevention and treatment of organophosphate poisoning. JAMA 1971;216:2131-3.
Agarwal SB. A clinical, biochemical, neurobehahioral and sociopsychological study of 190 patients admitted to hospital as result of acute oraganophosphorus poisoning. Environ Res 1993;62:63-70.
Haddad LM. Organophosphates and other insecticides. In: Haddad LM, Winchester J, editors, Clinical management of poisoning and drug overdose. New York: Saunders; 1990. pp. 1076-87.
Tayler P. Anticholinesterase agents. In: Gilman AG, Goodman LS, Rall TW, Murad F, editors. The pharmacological basis of therapeutics. New York, NY: McMillan: 1985. pp. 110-29.
Tafuri J, Roberts J. Organophosphate poisoning. Ann Emerg Med 1987;16:193-202.
Karalliedde L, Senanayake N. Acute organophosphorus insecticide poisoning in Sri Lanka. Forensic Sci Int 1988;36:97-100.
Bardin PG, Eden SF, Moolman JA, Foden AP, et al. Organophosphate and carbamate poisoning. Arch Intern Med 1994;154:1433-41.
Samal KK, Sahu CS. Organophosphorus poisoning and intermediate syndrome. J Assoc Physicians India 1990;38:181-2.
Tsao TC, Juang Y, Lan R, Shieh W, Lee C. Respiratory failure of acute organophosphate and carbamate poisoning, Chest 1990;98:631-6.
Senanayake N, Karaliedde L. Neurotoxic effects of organophosphorus insecticides and intermediate syndrome. N Engl J Med 1987;316:761-3.
De Bleecker H, Vogelaers D, Ceuterick C, et al. Intermediate syndrome due to prolonged parathion poisoning. Acta Neurol Scand 1992;86:421-4.
De Bleeker J, Van Den Neucker K, Willems J. The intermediate syndrome in organophosphorus poisoning: presentation of a case and review of literature. Clin Toxicol 1992;30:321-9.
Samuel J, Thomas K, Jeyaseelan L, Peter JV, Cherian AM. Incidence of intermediate syndrome in organophosphorus poisoning. Assoc Physicians India 1995;43:321-3.
De Bleecker J, Van Den Neucker K, Colardyn F. Intermediate syndrome in organophosphorus poisoning: a prospective study. Crit Care Med 1993;21:1706-11.
He F, Xu H, Qin F, Xu L, Huang J, He X. Intermediate myasthenia syndrome following acute organophosphate poisoning-an analysis of 21 cases. Hum Exp Toxicol 1998;17:40-5.
Peter S, Alexander M, Jeyaseelan L, Cherian AM. Electrophysiological study in organophosphorus poisoning [thesis]. In press.
John M, Zachariah A, Oommen A. Myopathy associated with organophosphorus poisoning[thesis]. In press.
Morreto A, Lotti M. Poisoning by organophosphorus insecticides and sensory neuropathy. Neurol Neurosurg Psychiatry 1998;64:463-8.
Lotti M, Becker CE, Aminoff MJ. Organophosphate polyneuropathy: pathogenesis and prevention. Neurology 1984;34:64:463-8.
Senanayake N. Polyneuropathy following insecticide poisoning: a clinical and electrophysiological study. J Neurol 1985; Suppl:203:232.
Baker T, Stanec A. Methylprednisolone treatment of an organophosphorus induced delayed neuropathy. Toxicol Appl Pharmacol 1985;79:348-52.
Jamal GA. Neurological syndromes of organophosphorus compounds. Adverse Drug React Toxicol Rev 1997;16:133-70.
Senanayake N, Sanmughanathan PS. Extrapyramidal manifestations complicating organophosphorus insecticide poisoning. Hum Exp Toxicol 1995;14:600-4.
Ishikawa S, Miyata M, Aoki S, Hanai Y. Chronic intoxication of organophosphorus pesticide and its treatment. Abstract Folia Med Cracow 1993;34:139-51.
Adlakha A, Philip PJ, Dhar KL. Guillain Barre Syndrome sequela of organophosphorus poisoning. Assoc Physicians India 1987;35:665-6.
Patil RK, Bansal SK, Sehgal VK, Chander B. Shincteric involvement in organophosphorus poisoning. Assoc Physicians India 1991;39:492-3.
De Silva HJ, Sanmuganathan PS, Senanayake N. Isolated bilateral laryngeal nerve paralysis: a delayed complication of organophosphorus poisoning. Hum Exp Toxicol 1994;13:171-3.
Ernest K, Thoma M, Poulose M, Rupa V, Gnanamuthu C. Delayed effects of exposure to organophosphorus compounds. Ind J Med Res 1995;101:81-4.
Saadeh AM, Farrakhan M, Ali-Ali MK. Cardiac manifestations of acute carbamate and organophosphorus poisoning. Heart 1997;77:461-4.
Ludomirsky A, Klein H, Sarelli P, Becker B, Hoffman S, Taitelman U, et al. Q-T prolongation and polymorphic (torsade de pointes) ventricular arrhythmias associated with organophosphorus poisoning. Am J Cardiol 1982;49:1654-8.
Kiss Z, Fazekas T. Arrythmias in organophosphorus insecticide poisonings. Acta Cardiol 1979;34:323-30.
Chuang FR, Jang SW, Lin JL, Chern MS, Chen JB, Hu KT. QTc prolongation indicates a poor prognosis in patients with organophosphorus poisoning. Am J Emerg Med 1996;14:451-3.
Martin Rubi JC, Yelamus RF, Laynex BF, et al. Poisoning caused by organophosphate insecticides; study of 506 cases (abstract). Rev Clin Exp 1996;196:145-9.
Moore PG, James OF. Acute pancreatitis induced by acute organophosphorus poisoning. Postgrad Med J 1981;57:600-62.
Meller D, Fraser I, Kryger M. Hyperglycaemia in anticholinesterase poisoning. Can Med Assoc J 1981;124:745-8.
Mambas T, Nolte CT, Jackrel J, Grob D. Poisoning due to organophosphorus insecticides. Am J Med 1971;50:475-92.
Bardin PG, Van Eden SF. Organophosphate poisoning: grading the severity and comparing treatment between atropine and glycopyrrolate. Crit Care Med 1990;18:956-60.
Bobba R, Venkataraman BV, Pais P, Joseph T. Correlation between the severity of symptoms in organophosphorus poisoning and cholinesterase activity (RBC and plasma) in humans. Ind J Physiology Pharm 1996;40:249-52.
Matchevich VA, Simonenkov AP, Ostapenko IN, Zavadovskii MM, Drendel SD, Kashtanova IS. Use of serotonin adipinate in acute oral poisoning. Abstract Anesteziol Reanimatol 1995;3:16-20.
Ram JS, Kumar SS, Jeyarajan A, Kuppuswami G. Continous infusion of high dose of atropine in the management of organophosphorus poisoning. Assoc Physicians India 1991;39:190-3.
Cherian AM, Peter JV, Samuel J, Jeydevan R, Peter S, Joel S, et al. Effectiveness of P2AM in the treatment of organophosphorus poisoning. A randomized, double blind placebo controlled clinical trial. Assoc Physicians India 1997;45:22-4.
Namba T. Cholinesterase inhibition by organophosphorus compounds and its clinical effects. Bull WHO 1971;44:289-307.
Durham WF, Wayland JH. Organic phosphorus poisoning and its therapy. Arch Environ Health 1962;5:27-47.
De Silva HJ, Wijewickrema R, Senanayake N, et al. Does pralidoxime affect outcome of management in acute organophosphorus poisoning. Lancet 1992;339:1136-8.
Thiemann H, Mast U, Klimmek R, et al. Cholinesterase status, pharmacokinetics and laboratory findings during obidoxime therapy in organophosphate poisoned patients. Hum Exp Toxicol 1997;16:473-80.
Wrek F, Reiter G, Eyer P, et al. Reactivation kinetics of acetyl cholinesterase from different species inhibited by highly toxic organophosphates. Arch Toxicol 2002;76:523-9.
Worek F, Backer M, Thiermann H, et al. Reappraisal of indications and limitations of oxime therapy in organophosphate poisoning. Hum Exp Toxicol 1997;16:466-72.
Worek F, Diepold C, Eyer P. Dimethylphodphoryl-inhibited human cholinesterase: inhibition, reactivation and aging kinetics. Arch Toxicol 1999;73:7-14.
Worek F, Eyer P, Szinicz L. Inhibition, reactivation and aging kinetics of cyclohexylmethylphosphonoflouridate-inhibited cholinesterase. Arch Toxicol 1998;72:580-7
Eyer P, Hell W, Kawan A, et al. Studies on the decomposition of oxime HI6 in aqueous solution. Arch Toxicol 1986;59:266-71.
Khan S, Hemalatha R, Jeyaselan L, et al. Neuroparalysis and oxime efficacy in organophosphate poisoning. A study of butyrylcholinesterase. Hum Exp Toxicol 2001;20:169-74.
Eyer P, Kawan A, Ladstetter B. Formation of cyanide after i.v. administration of oxime HI6 to dogs. Arch Toxicol 1987;61:63-9.
Johnson S, Peter JV, Thomas K, Jeyaseelan L, Cherian AM. Evaluation of two treatment regimens of pralidoxime (1 gm single bolus dose vs 12 gm infusion) in the management of organophosphorus poisoning. J Assoc Physicians India 1996;44:529-31.
Eddlestone M, Szinicx L, Eyer P, et al. Oximes in acute organophosphorus poisoning: a systematic review of clinical trials. QJM 2002;95:275-83.
Balali-Mood M, Shariat M. Treatment of acute organophosphate poisoning. Experince of nerve agents and acute pesticide poisoning on the effects of oximes. Abstract J Physiol Paris 1998;92:375-8.
Abdollahi M, Jafari A, Jalali N, et al. A new approach of efficacy of oximes in the management of organophosphate poisoning. Iranian J Med Sci 1995;20:105-9.
Mathew CA, Johnson S, Anand R, Roshini C, Peter JV, Jeyaseelan L, et al. Usefulness of Oximes in acute organophosphorus poisoning. Int Med J, In press.
Scott RJ. Repeated asystole following PAM in organophosphate self poisoning. Anaesth Intensive Care 1986;14:458.
Taylor P. Anticholinesterase agents. In: Gilman AG, Goodman LS, Rall TW, Murad F, editors. The pharmacological basis of therapeutics. New York, NY: MacMillan 1985;122.
Mathew CA, Roshini C, Visalakshi J, Jeyaseelan J, Cherian AM. Biochemical and clinical profile after orgnophosphorus poisoning-a placebo controlled trial using P2AM. J Assoc Physicians India 2005;53:427-31.