Failure to metabolize ACh determines its accumulation at the synaptic level, initially causing over-stimulation of nervous system (NS) and, subsequently, complete block in nerve impulses transmission ( 7).Ĭlinical manifestations observed in OPs agents were due to the action exerted by the latter on muscarinic (M) and nicotinic (N) receptors ( 8). The OPs bind cholinesterase enzymes responsible for the hydrolysis of acetylcholine (ACh), leading to their inactivation. In 2/3 of the most severe cases, the pesticides involved are parathion and dimethoate ( 3). This rises to 50% for those with prolonged mechanical ventilation, complications such as pneumonia or weaning difficulties ( 6). Mortality from OPs intoxication ranges from 3% to 30% and often correlates with delayed diagnosis or improper treatment ( 5). The diagnosis is clinical and based on anamnestic data, exposure to OPs for self-injurious or accidental, provided by victims or people informed of the facts ( 4). OPs intoxication can occur in different ways: ingestion, inhalation, and contact with skin, eyes, and mucous membranes. However, other potential causes of OPs toxicity include ingestion of contaminated food or contact with contaminated clothing. Generally, OPs toxicity was caused by accidental, intentional ingestion or exposure to agricultural pesticides ( 3). It is estimated that around 3,000,000 per people worldwide are exposed to OPs, with up to 300,000 deaths ( 3). report approximately 30% of suicide cases globally to be caused by OP intoxication ( 2). In developing countries, due to poverty, unemployment and social degradation, these products are often taken for self-harm. Unfortunately, the potential use of OPs as nerve agents in terrorist attacks should also be reported ( 1). Organophosphates compounds (OPs) are synthetized to produce pesticides in agricultural industry since the 1930s they are also used in medicine for treatment of diseases such as glaucoma, Alzheimer’s or myasthenia gravis and, to revers of neuromuscular block in anesthesia. Received: 07 June 2020 Accepted: 09 October 2022 Published: 30 October 2022. Keywords: Case report organophosphate (OP) dimethoate acute cholinergic syndrome pralidoxime An aggressive resuscitation approach in the face of a complex initial differential diagnosis, with careful monitoring of vital alterations and a strict cardio-neuro-respiratory follow-up at discharge from intensive care, make our case report unique, especially in a very elderly patient in which there are generally high mortality rates.Ĭonclusions: We describe how the immediate support of vital functions starting from the ED and then to intensive care unit (ICU), guided by clinical evolution in the various developmental phases, has allowed the patient to survive without major sequels after OP poisoning. In most cases an acute respiratory failure, by central and peripheral mechanisms, is the primary cause of death.Ĭase Description: We report a peculiar case of an accidental acute intoxication in industrialized European country not for suicidal purposes, due to multimodal exposure to dimethoate, in an 85-old-year male with important cardiovascular involvements, neurovegetative symptoms, low Glasgow Coma Scale (GCS) and acute respiratory failure in Emergency Department (ED) presentation. These anticholinesterase compounds cause an acute cholinergic syndrome (with decreased consciousness, respiratory failure), an intermediate syndrome after 2 or 3 days from exposure (that requires prolonged ventilation), and finally a delayed neuropathy.
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