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poisoning,organophosphorus,Update,epidemology,pathophysiolgy,treatment,reveiw of literature

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  • In order for nerve impulses to reach muscles, acetylcholine is released to act as a neurotransmitter at the neuromuscular junction. This allows the nerve impulse to “fire” across the neuromuscular junction. After the acetylcholine has done it’s job, it is critical for it to be deactivated by the enzyme acetylcholinesterase. Otherwise uncontrolled nerve impulses occur. By inhibiting the function of acetylcholinesterase, nerve agents cause various organ systems to be over-stimulated and go “haywire”. The systems most commonly affected include the skeletal muscles, smooth muscles, exocrine glands, and some nerves in both the central nervous system and the ganglia. Once the acetylcholinesterase has been inhibited, the effect cannot be reversed without the medication, Pralidoxime (2-Pam).
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    1. 1. Dr .Anand.M.Tiwari Head of dept. ICU wanowarie Critical care medicine,and emergency physician Ruby hall clinic
    2. 2. Times of India  Confirming the presence of poisonous pesticides in the midday meal, the Forensic Science Laboratory (FSL) said the contaminated food contained monocrotophos, an organophosphate insecticide, after experts examined samples of oil from the container, food remains on the platter and remains of food items in the utensils.
    3. 3. Pesticide regulations ?
    4. 4. introduction Organophosphate-diazinon, chlopyriphos, malathion Carbamate-aldicarb, carbaryl, propoxur nerve gases (sarin, soman, tabun, VX)
    5. 5. Poisons and medicines are often the same substance given with different intents. --Peter Latham (1865)
    6. 6. Reasons--- product mislabeling; label misreading; mistaken identification of unlabeled chemicals; uninformed self-medication; attempted suicide (deliberate self-harm) is the most common reason for intentional exposure
    7. 7. Tokyo subway incidenceIn the Monday morning rush hour of March 20, five cult members boarded different subway trains converging on central Tokyo. Four of them each carried two plastic bags loaded with sarin, and the fifth had three bags. At nearly the same moment, they each dropped the bags to the floor of the jam- packed train and punctured them with a specially sharpened umbrella tip. The cultists then quickly stepped off the trains as they pulled into the next station. Getaway drivers were waiting outside the station for each of them.
    8. 8. 10
    9. 9. O .P . Poisoning Highly lipid soluble Commonly available poison Manifestations due to….M, N,CNS actions “Death due to respiratory failure”
    10. 10. Cholinergic------ SLUDGE-M Nicotinic-- fasciculation Central effects Confusion Seizures,coma
    11. 11. 1-4 DAYS Fention Malthion Diaznion trichorofan
    12. 12. Management---
    13. 13. Decontamination atropine OXIMES Life support Ventilator support FASTHUG Control of seizures
    14. 14. Oximes Have NULL effect or possible harm
    15. 15. Review mcq- All of the following are signs of acetylcholinesterase inhibitor toxicity EXCEPT (A) miosis (B) salivation (C) diarrhea (D) muscle fasciculations (E) anhydrosis
    16. 16. Match the following Poisoning Antidote Paracetamol OPIOIDS ASPIRIN(SALICYLATE) METHANOL TRICYCLIC ANTIDEPRESSANT CYANIDE Amyl nitrate ,sodium nitrite, Sodium thiosulphite FAD BICARBONATES NALOXONE NAC FOMEPIZOLE EHTANOL
    17. 17. Thank you Slides available on  dr.Anand .Tiwari Presentations. Slide share.net. dranandtiwari@gmail.com  In case of help pl contact.=9822545093

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