Assessment of hospitalizations of patients after intoxication with organophosphates used in agriculture.

INTRODUCTION: Clinical manifestation of organophosphates toxicity may be differentiate and include cholinergic toxidrome, intermediate syndrome, OP-induced delayed polyneuropathy to chronic OP-induced neuropsychiatric disorder (OPIDN). Patients symptoms, along with decrease in cholinesterase serum level, determines the possible diagnosis of organophosphate poisoning. OBJECTIVE: The aim of the study was to present the clinical manifestation and cholinesterase level changes in intoxication with organophosphorus compounds in patients. MATERIAL AND METHODS: A data base was created by analysis of the hospital documents of 34 patients hospitalized due to organophosphate intoxication. Statistical analysis involved frequency tables with percentage values, the application of non-parametric Chi-square test and parametric t-Student test (with homogeneity of variance Levine test). The level of static significance was set to p=0.05. RESULTS: In fatal hospitalizations (20.6%), cholinesterase level was significantly lower (265.87 U/l) than in other patients (4254.78 U/l; p<0.05). Similarly, levels of cholinesterase were decreased in group of patients with acute respiratory failure (999.79 U/l vs 4943.86 U/l in other patients; p<0.05), patients with multi-organ dysfunction syndrome (244.13 U/l vs 4914.89 U/l in other patients; p<0.05) and those with cardiac arrest (547 U/l vs 4636.25 U/l in other patients). A statistically significant difference was also observed in cholinesterase level of patients who required mechanical ventilation (548.17 U/l vs 5219.71 U/l in other group). The study revealed that 29.4% of poisonings were suicidal. CONCLUSIONS: The management of a patient with organophosphate poisoning remains challenging and requires continuous control. A significant step in the diagnostic process is the assessment changes in both the clinical picture and cholinesterase level.

Severe carbamates intoxication of 43-year-old farmer - case report.

INTRODUCTION: Carbamate insecticides are methyl carbamic acid esters and reversible cholinesterase inhibitors. In contrast to the long-term action of organophosphate insecticides, this complex undergoes rapid hydrolysis. CASE REPORT: A suicidal poisoning by exposure to carbofuran in a 43-year-old farmer is reported. The patient had a sudden respiratory and cardiac arrest in the mechanism of bradycardia asystole. He was additionally diagnosed with metabolic acidosis and massive aspiration pneumonia. After applied treatment, the patient's general condition improved - alignment of efficiency of both respiratory and circulatory efficiency were reached. CONCLUSION: Carbofuran is one of the most toxic carbamate insecticides. It is therefore important to react quickly and choose the right treatment. Differentiation between organophosphate and carbamate intoxication is essential.