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Abstract
Organophosphate insecticides are the most widely used insecticides available nowadays. Most of them are currently registered for use and all run the risk of acute and subacute toxicity. Oragnophosphates are used in agriculture, homes, gardens and veterinary practice. They all apparently shaire a common mechanism of cholinesterase inhibition and can cause similar toxic manifestations.
The present study aimed to evaluate the role of clinical scoring systems using poisoning severity score (PSS), acute physiology and chronic health evaluation (APACHE II) and Glasgow coma score (GCS) in assessment of severity and the outcome of acute organophosphorus poisoning. The study also designed to determine the need for intensive care management in cases of organophosphorus intoxication.
Another main aim from this study to survey the incidence of organophosphorus insecticide as the study was conducted for a period of six months starting from the first of September 2006 till the end of February 2007.
The study was carried out on the first two hundred patients suffering from acute organophosphorus poisoning admitted to Alexandria Poisoning Unit and Department of Critical Care at Alexandria Main University Hospital during a period of the six months from the first of September 2006 till the end of February 2007.
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All the patients were examined clinically and blood samples were collected for laboratory investigation. The age of the studied cases ranged from 8 to 70 years in females with mean 25.816.3 years while in males ranged from 9 to 65 years with a mean 31.713.97 years and the highest incidence in age group 30 to 40 years in both sexes. There was no significant difference between males and females regarding the age.
The highest frequency of organophosphorus poisoning was during the farmers followed by students then the housewives and finally the manual workers.
Most of the studied patients (79%) took the poison intentionally aiming for suicide, while accidental exposure was encountered among 21% of all cases. 92% of patients gave history of exposure to the poison by oral route, while dermal intoxication occured only among few patients.
No history about insecticide exposure could be recorded from 12 patients due to loss of consciousness. No conclusive history was available about the names or amount of poison.
As regards clinical manifestations, all cases had miosis. Muscurinic effects were predominant in the studied patients followed by CNS and nicotinic manifestations. Laboratory investigations performed for the studied cases revealed significant hypokalemia in most of patients (50%) Moreover 71% of case were acidotic and 32% of recovered patients were hypoxic, and more than 50% of patients have changes in renal functions.