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January 26, 2014

YUGAL JYOTY NEPAL
MODERATOR: Dr. Rabin Sharma

ORGANOPHOSPHORUS
AND ORGANOCHLORINE
POISONING
CLINICAL MA...
How do Organophosphates work?
 Inactivate

Acetylcholinesterase

Choline
 Increase


Acetic acid

Acetylcholine level

...
Increased

Ach levels result in overstimulation of
muscarinic and nicotinic receptors
Overview
of
muscarinic
receptors
Overview
of
muscarinic
receptors
contd…
Overview
of
nicotinic
receptors
Routes of absorption

Organophosphates
absorbed

ingested
 inhaled
injected


can be

cutaneously
Although most patients rapidly become symptomatic,
the Onset and Severity of symptoms depend on
specific

compound

amou...
 Signs

and symptoms of organophosphate poisoning
can be divided into 3 broad categories

1. muscarinic
2. nicotinic
3. C...
MUSCARINIC effects
SLUDGE
salivation, lacrimation, urination, diarrhea, GI upset, emesis

DUMBELS
diaphoresis and diarrh...
Muscarinic effects by organ systems include the following:
Cardiovascular

- Bradycardia, hypotension

Respiratory

- Rh...
NICOTINIC effects
 muscle

fasciculations

 cramping
 Weakness

and

 diaphragmatic

failure

Autonomic nicotinic effe...
CNS effects
 anxiety
 emotional

liability

 restlessness
 confusion
 ataxia
 tremors
 seizures
 coma
ORGANOCHLORINES
 Organic

chlorines are strongly lipid soluble and
sequester in body tissues with high lipid content, suc...
Routes of absorption
 Ingestion
 Skin

absorption or inhalation

 Chronic

exposure
Ingestion produces the following manifestations:
Nausea

and vomiting

Confusion,

tremor, myoclonus, coma, and seizures...
Skin absorption or inhalation produces the following
manifestations:
Ear,

nose, and throat irritation

Blurred

vision
...
Long-term occupational exposure to organochlorine pesticides may
result in various nonspecific symptoms - headaches, nause...
Presentation
 Onset

– abrupt

  CNS

excitation and depression are the primary effects
observed in acute organochlorine...
Peradeniya Organophosphorus Poisoning (POP) scale
 Laboratory

estimation of blood cholinesterase and OP levels are not
a...
Parameter
Pupil size >2mm

0

Pupil size <=2mm

1

Pinpoint pupil

2

None

1.

Score

0

Miosis

2. Fasciculation
Present...
 POP

score 0-3 : Mild

 POP

score 4-7 : Moderate

 POP

score 8-11 : Severe

Based on results from the initial study,...
THANK YOU
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Organophosphorus and organoochlorine poisoning clinical features

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Transcript of "Organophosphorus and organoochlorine poisoning clinical features"

  1. 1. January 26, 2014 YUGAL JYOTY NEPAL MODERATOR: Dr. Rabin Sharma ORGANOPHOSPHORUS AND ORGANOCHLORINE POISONING CLINICAL MANIFESTATIONS
  2. 2. How do Organophosphates work?  Inactivate Acetylcholinesterase Choline  Increase  Acetic acid Acetylcholine level ACh is found in the central and peripheral nervous system, neuromuscular junctions, and red blood cells (RBCs)
  3. 3. Increased Ach levels result in overstimulation of muscarinic and nicotinic receptors
  4. 4. Overview of muscarinic receptors
  5. 5. Overview of muscarinic receptors contd…
  6. 6. Overview of nicotinic receptors
  7. 7. Routes of absorption Organophosphates absorbed ingested  inhaled injected  can be cutaneously
  8. 8. Although most patients rapidly become symptomatic, the Onset and Severity of symptoms depend on specific compound amount route rate of exposure and of metabolic degradation
  9. 9.  Signs and symptoms of organophosphate poisoning can be divided into 3 broad categories 1. muscarinic 2. nicotinic 3. CNS effects effects effects
  10. 10. MUSCARINIC effects SLUDGE salivation, lacrimation, urination, diarrhea, GI upset, emesis DUMBELS diaphoresis and diarrhea urination miosis bradycardia, bronchospasm, bronchorrhea emesis excess lacrimation salivation
  11. 11. Muscarinic effects by organ systems include the following: Cardiovascular - Bradycardia, hypotension Respiratory - Rhinorrhea, bronchorrhea, bronchospasm, cough, severe respiratory distress Gastrointestinal - Hypersalivation, nausea and vomiting, abdominal pain, diarrhea, fecal incontinence Genitourinary - Incontinence Ocular - Blurred vision, miosis Glands - Increased lacrimation, diaphoresis
  12. 12. NICOTINIC effects  muscle fasciculations  cramping  Weakness and  diaphragmatic failure Autonomic nicotinic effects include  Hypertension  Tachycardia  Mydriasis  Pallor
  13. 13. CNS effects  anxiety  emotional liability  restlessness  confusion  ataxia  tremors  seizures  coma
  14. 14. ORGANOCHLORINES  Organic chlorines are strongly lipid soluble and sequester in body tissues with high lipid content, such as the brain and liver  Consequently, blood levels tend to be much lower than fatty tissue levels  The lipophilic tendency of organochlorines accounts for prolonged systemic effects in overdose
  15. 15. Routes of absorption  Ingestion  Skin absorption or inhalation  Chronic exposure
  16. 16. Ingestion produces the following manifestations: Nausea and vomiting Confusion, tremor, myoclonus, coma, and seizures Respiratory depression or failure Unusual odor
  17. 17. Skin absorption or inhalation produces the following manifestations: Ear, nose, and throat irritation Blurred vision Cough Acute lung injury (ALI) Dermatitis
  18. 18. Long-term occupational exposure to organochlorine pesticides may result in various nonspecific symptoms - headaches, nausea, fatigue, muscle twitching, and visual disturbances In addition, chronic exposure to these agents may be associated with the development of blood dyscrasias, including aplastic anemia and leukemia Other manifestations of chronic exposure are as follows: Anorexia Hepatotoxicity Renal CNS toxicity disturbances
  19. 19. Presentation  Onset – abrupt   CNS excitation and depression are the primary effects observed in acute organochlorine toxicity - The patient may appear agitated, lethargic, intoxicated, or may even be unconscious  Initial euphoria with auditory or visual hallucinations and perceptual disturbances are common in the setting of acute toxicity.
  20. 20. Peradeniya Organophosphorus Poisoning (POP) scale  Laboratory estimation of blood cholinesterase and OP levels are not available in many developing countries  POP score can assess severity without laboratory investigation  Also patient co-ordination not required The score is given when the patient first presents in the hospital Nimal Senanayake, H.J. de Silva Kaealliedeand Laxman Karalleidde (Department of Medicine, Faculty of Medicine, University of Perdeniya, Sri Lanka and Queen Elizabeth Military Hospital, London, UK)
  21. 21. Parameter Pupil size >2mm 0 Pupil size <=2mm 1 Pinpoint pupil 2 None 1. Score 0 Miosis 2. Fasciculation Present but not generalized or continuous 1 Generalised and continuous 2 Respiratory rate <=20/min 0 Respiratory rate >20/min 1 Respirator rate >20/min with central cyanosis 2 3. Respiration 4. Bradycardia Pulse rate >60/min 0 Pulse rate 41-60/min 1 Pulse rate <=40/min 2 Conscious and rational 0 Impaired, responds to verbal command 1 Impaired, no response to verbal command 2 If convulsions present, add 1 TOTAL 11 5.Level of consciousness
  22. 22.  POP score 0-3 : Mild  POP score 4-7 : Moderate  POP score 8-11 : Severe Based on results from the initial study, severe intoxications (score of 8 to 11) have a higher mortality rate Require greater need for ventilatory support, and higher dose of atropine in the first 24 hours.
  23. 23. THANK YOU
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