Organophosphorus poisoning

Poisoning happens by eating or smelling the insecticide.

Clinical picture:

1- Pin point pupil (important sign).

2- Blurring of vision.

3- Incontinence of urine and stool.

4- nausea, vomiting and diarrhea.

5- Difficult respiration (bronchospasm - increased bronchial secretions - pulmonary edema).

6- Decreased heart rate - decreased blood pressure - pallor - increased salivation.

7- May be convulsions - coma - death.

8- History (child eat insecticide).

Treatment:

1- Antidote = Atropine.

At first : cannula insertion.

Then : give 2 ml Atropine IV.

Continue to give Atropine IV till pupil is dilated (Atropine till mydriasis).

* If heart rate reaches 120, wait till heart rate decrease then give atropine till mydriasis as before.

* In children: atropine is diluted in 9 ml saline  then give atropine as before.

* Sometimes we may use up to 50 ampoule atropine.

* To save patient life we should reach mydriasis in 24 hours.

2- Stomach wash using NaHCO3 5%.

3- Oxygen with 5% CO2.

4- Bronchodilators for bronchial spasm.
R/ Minophylline ampoule very slow IV.

5- Morphine is avoided as it may lead to respiratory depression.

6- Prophylactic antibiotics.

7- Diazepam if convulsions.
R/ Valpam ampoule.
R/ Farcozepam ampoule.