Management of acute organophosphorus poisoning at a university hospital

Introduction

Organophosphorus (OP) insecticides are widely used in agriculture, usually as pesticides, and frequently cause ill health and death for hundreds of thousands of people each year. The majority of deaths occur following deliberate self-poisoning. They are common suicidal agents in Pakistan, India, Sri Lanka and other South Asian countries. The Accident & Emergency Department of Liaquat University Hospital Hyderabad routinely receives victims of OP poisoning from the farming communities all around. Our objective was to document the management, complications and subsequent outcome of patients with acute organophosphorus poisoning in the ICU of Liaquat University Hospital.

Methods

All victims of OP poisoning admitted to the ICU of Liaquat University Hospital admitted from May 2004 to October 2006 were included in the study. Diagnosis of OP poisoning was confirmed from history and clinical findings. Management, complications and subsequent outcome were noted. Statistical analysis was performed using SPSS 10.

Results

A total of 111 patients of OP poisoning were admitted to the ICU during the study period; 60.4% of patients were males. The mean age was 25.26 ± 8.52 years; 85.6% were within the age limit of 12–30 years. Of patients, 89.2% were a suicidal attempt. In 94.6% of patients, ingestion was the route of exposure. The mean ICU stay was 2.3 ± 3.2 days. Twenty (18%) patients needed mechanical ventilatory support. The overall mortality ratio was 9% (n = 10). The mortality rate for the patients who required mechanical ventilation was 40% (n = 8), but the rate was 2.2% (n = 2) for the patients who were not mechanically ventilated.

Conclusion

Because of widespread use of OP pesticides by farming communities of the developing world, it is very difficult to reduce mortality by primary prevention. Immediate shifting of the victim to a well-equipped and well-staffed ICU, careful resuscitation with appropriate use of antidotes and good supportive care and observation can help reduce the number of deaths in the period after admission to the hospital. Awareness and education of general practitioners in the rural areas regarding emergency management, as well as prompt referral to an appropriate facility, is also recommended to reduce the mortality rate.