2. Organophosphate poisoning
(Ops)
A CASE AND ARTICLE PRESENTATION ON

6. Examples
Examples of organophosphates include:
- insecticides (malathion, parathion, diazinon,
fenthion, dichlorvos, chlorpyrifos, ethion)
- nerve gases (soman, sarin, tabun, VX)
- ophthalmic agents (echothiophate,
isoflurophate)
- antihelmintics (trichlorfon).
- Herbicides (tribufos [DEF], merphos) are
tricresyl phosphate–containing industrial
chemicals.

7. Frequency

8. Organophosphate compounds were first
synthesized in the early 1800 when Lassaigne
reacted alcohol with phosphoric acid.
Shortly thereafter in 1854, Philip de Clermount
described the synthesis of tetraethyl
pyrophosphate at a meeting of the French
Academy of Sciences.
Eighty years later, Lange, in Berlin, and,
Schrader, a chemist at Bayer AG, Germany,
investigated the use of organophosphates as
insecticides.
History

9. COVALENT BOND
AGING
MECHANISM OF ACTION OF
ORGANOPHOSPATE POISONING
9

11. PHYSIOLOGY REVISITED
11

12. Inhalation
• Cough
• Difficulty in breathing
• Bronchitis
• Pneumonia
Eye contact
• Irritation
• Pain
• Lacrimation
• Miosis
• Blurring vision
• Photophobia
clinical features
depends on route of entry
ingestion inhalation eye contact

13. GASTRIC LAVAGE ACTIVATED CHARCOAL
OROPHARYNGEAL AIRWAY USED AMBU VENTILATION & ET TUBE
MANAGEMENT OF OP POISONING

16. NAME: Mr.Krishna reddy.
GENDER: MALE
AGE: 33 years
DEPARTMENT: General Medicine (male medical (IV)
DATE OF ADMISSION: 05-02-2015.
CHIEF COMPLAINTS:
Vomiting present – 5 episodes.
Burning sensation of throat and abdomen.
HISTORY OF PRESENT ILLNESS: No h/o swelling neck and micturation
present
DEMOGRAPHIC DETAILS

17. FAMILY HISTORY: Not relevant
GENERAL EXAMINATION:
PHYSICAL EXAMINATION:
Conscious and oriented
TEMP : Afebrile
BP : 130/90 mm Hg
PULSE : 124 bpm
SYSTEMS EXAMINATION:
CVS : S1, S2 (+)
CNS : pupils-NSRL+
RS : BLAE +
RR :16 cpm.
P/A : soft.

18. PAST MEDICAL HISTORY:
not a K/c/o Diabetic, Hypertensive, Epileptic, TB.
PERSONAL HISTORY AND HABITS:
known alcoholic, and not a smoker.
FAMILY HISTORY:
Nothing is relevant.
PAST SURGICAL HISTORY:
No h/o previous surgery.

19. PROVISIONAL DIAGNOSIS: An alleged case of
op poisoning @
7.30p.m near Badvel.
ASSESSMENT
ORGANOPHOSPHORUS COMPOUND POISONING

20. DRUG CHART
S.no DRUGS GENERIC NAME INDICATION DOSE ROA FREQUENCY DURATION
1. Inj. Atropine Atropine Antidote(anti
cholinergic)
2mg
(amp)
IV TID 5/2/115 to
12/2/15
2. Inj. PAM Pralidoxime Antidote 1 gm
(amp)
IV BD 5/2/15 to
12/2/15
3. IVF Intravenous
fluids
Electrolyte
balance
2 NS
2 RL
IV INFUSION
OD
9/2/15 to
12/2/15
4. Inj. Pantop Pantaprazole Anti ulcerative 40 mg IV BD 5/2/15 to
12/2/15
5. Inj. Ceftriaxone Ceftriaxone Antibacterial 1 g IV BD 5/2/15 to
9/2/15

21. Progress chart
PROGNOSIS TREATMENT
Day 1,
O/E, Pt-unconscious,vomiting BP-
130/90mmHg,PR-110bpm,RS-
BLAE+, P/A-soft, CNS-NSRL+
Rx, Inj. Atropine 2 amp-IV TID in 1 NS
Inj. Pantop 40mg IV BD
Inj. PAM 1gm IV BD
Inj. Ceftriaxone 1 gm IV BD
Inj. Ondansetron 4mg IV BD
Day 2, O/E, vomiting
Pt is conscious, coherent, pupils-
NSRL+
Rx, CST
stop Inj ondansetron
Day 3,O/E
Pt-c/c, BP-130/80mm/Hg, PR-
110bpm
Rx, CST

22. Progress chart….
Day 4 , O/E,
Pt- c/c, irritable, burning sensation,
pupils-B/L dilated, reacting to
light,BP-130/90mm Hg,PR-94bpm,
Rx, CST
Day 5,
Pt-c/c, ↓ irritability,BP-
110/70mmHg,pupils dilated, PR-
92bpm,
Rx, CST
IVF 2DNS, 1RL, 1NS
Day 6,
Pt-general condition is fair ,C/O
body pains , headache
Rx, CST
T.PCT 500mg BD
T. Cefixime 200 mg- P/O- BD
Day 7,
Pt- symptomatically, BP- 120/80
mm HG, PR-90bpm, CNS-NAD, RS-
Clear
Rx, CST

23. Progress chart…
Discharge medication:
Patient general condition is symptomatically better,
Rx,
T. B-Complex OD
T. Rantac 150mg BD
T. Amoxiclav 625mg BD
T.PCT 500mg TID
Asked to review after 1 week.

24. PHARMACIST INTERVENTIONS
Possible drug- drug interactions: No specific drug interactions
were observed.
Possible ADRs are:
Atropine:
Dry mouth, dysphagia, constipation, flushing, dryness of skin,
palpitations
Ceftriaxone:
super infection, rash, fever, pruritis, nephrotoxicity
Amoxyclav:
GI disturbances, anaphylactic shock, pruritis, skin rashes

25. PATIENT COUNSELING
REGARDING DISEASE CONDITION :
Organophosphorus compound poisoning is a lethal one
if not treated with antidote immediately. The compound
may cause respiratory depression, bradycardia,
hypotension,
sweating(cholinergic),unconsciousness…etc
REGARDING DRUGS MEDICATION PROFILE:
Inj. Atropine: Anti cholinergic drug which act as
antidote for the poisoning
Inj. PAM (Pralidoxime): it is an antidote.
Inj. Ceftriaxone: antibacterial to treat hospital acquired
infections.

26. REGARDING LIFE STYLE MODIFICATIONS
 Advised family to support the patient by any means
 After knowing that poisoning occur ,water with mustard
or water with excess salt is given and vomiting should be
induced.
 Referred and counseled given by psychiatrist:
 The causes for suicidal attempts is to be analyzed based
on that counseling is done.
 To do meditation or yoga to relieve stress and to relax
well
 Advised him if any suicidal tendencies are seen in him, to
consult a psychiatrist immediately

28. TITLE
“ INCIDENCE AND ASSESSMENT OF ANTIDOTES IN OP
POISONING AT TERTIARY CARE HOSPITAL,
SOUTH INDIA”
Corresponding author:
Daghari Zakieh Jasem,
Nikitha,
Rajeswari Ramaswamy,
Arpan Dutta Roy,
Dr. Anjani M. Reddy

29. OP compounds and other pesticides are commonly used for
suicide.
 Globally, OP Poisoning is a major problem though its types
varies in different countries.
Organophosphate (OP) poisoning is always having high
morbidity and mortality rates, both in poor and in well-
developed countries.
INTRODUCTION
OP POISONING

30. Major cause of morbidity and mortality is due to self-
poisoning and because of their easy availability.
The causes of poisoning are many-civilian, industrial,
accidental & deliberate.
Since the exact causative agents is not known there is a
greater need for understanding the clinical characteristics of OP
Poisonings.

31. In the majority of situations there is a lack of analytical
assistance in most of the primary health care systems.
The physicians mostly depend on clinical signs and
symptoms for diagnosis.
 However, the toxicity might become irreversible or even
fatal because onset of symptoms may take some time to
develop.
The Purpose of the study was to find out the incidence of
OP (Organo Phosphate) poisoning cases in the ED (Emergency
Department), and to assess the antidotes.

32. METHODOLOGY
 Study design : A Prospective observational study.
 Study site :MVJ Medical College and Research Hospital,Bangalore.
 Study duration : The study carried out over for 6 months.
 Sample size : 90 op poisoning patients.
 Inclusion criteria : OP poisoning cases in Emergency Department
including casualty and ICU are included in the study.
 Exclusion criteria : All other poisoning, other than OP cases, were
excluded from the study.

33. METHODOLOGY………
STUDY MATERIALS:
 Patient demographic data collection form.
 Patient informed consent form.
 Case Report Form (CRF).

34. ANALYSIS
STATISTICAL ANALYSIS
All the cases included in the study, were analyzed for the reason
for Poisoning; appropriateness of gastric lavage, selection and
rational use of antidotes by the investigators, using Micromedex
database.
DATA ANALYSIS
The data including demographic information (age, sex), toxic
substances involved, type of poisoning, clinical symptoms,
laboratory tests and patient outcome were evaluated.
Necessary steps were taken to determine the impact of clinical
pharmacist involvement in poison management.

35. RESULTS AND DISCUSSION

39. CONCLUSION
There are considerable variations in the practice of gastric lavage
and antidote utilization in practicing clinicians in the study site.
In many cases the dosing interval was wrong which lead to
problems like Atropine induce Psychosis.
This Study would help in prompt and appropriate poisoning
treatment, and prevent the prolonged hospitalization & better
patient outcome.