Parenteral organophosphorus poisoning in a rural emergency department: a case report

BMC Research Notes

Vivek Dhungana¹  Ajay Yadav³  Shyam Prasad Lohani⁴  Rais Vohra²  Bibhusan Basnet³  Gyanendra Malla³ 

[1] Department of Emergency Medicine, Kathmandu Medical College, Kathmandu, Nepal;Department of Emergency Medicine, UCSF Fresno Medical Center, Fresno, CA, USA;Department of General practice and Emergency Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal;Nepal Drug and Poison Information Centre, Kathmandu, Nepal

关键词: Poisoning;    Parenteral;    Organophosphorus;    Cellulitis;    Chlorpyriphos;   

Others  :  1232487
DOI  :  10.1186/1756-0500-6-524

 received in 2013-04-22, accepted in 2013-12-06,  发布年份 2013

【 摘 要 】

Background

Poisoning is a common presentation in the emergency department. Oral exposures to organophosphorus compounds are especially frequent in rural and agricultural regions of South Asia and throughout the developing world.

Case presentation

Here we report a case of deliberate self-harm with an organophosphorus pesticide via the relatively uncommon parenteral route. A young woman injected herself with chlorpyriphos. Although the cholinergic effects were mild, cellulitis and abscess development were noted as a result.

Conclusion

Resource limited agricultural countries like Nepal present health care workers with numerous challenges in poisoning management. This case represents a rare but potentially morbid method of agrochemical poison exposure.

【 授权许可】

   
2013 Malla et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Goldman L, Tran N: Toxics and poverty: the impact of toxic substances on the poor in developing countries. Washington DC: The World Bank; 2002.
• [2]Ecobichon DJ: Pesticide use in developing countries. Toxicology 2001, 160:27-33.
• [3]Richardson RJ: Assessment of the neurotoxic potential of chlorpyrifos relative to other organophosphorus compounds: A critical review of the literature. J Toxicol Environ Health 1995, 44:135-165.
• [4]Joshi S, Biswas B, Malla G: Management of Organophosphorous poisoning. Update in Anesthesia 2005, 19:1-2.
• [5]World Health Organization/ United Nations Environment Programme: Public health impact of pesticides used in agriculture. Geneva: World Health Organization; 1990. http://apps.who.int/iris/handle/10665/39772 webcite
• [6]Bardin PG, Van Eeden SF: Organophosphates and carbamate poisoning. Arch Intern Med 1994, 154:1433-1441.
• [7]Volk O, Reith S, Saehn C, Haars P, Bach D, Klues HG: Attempted suicide by intravenous injection of metasystox. Anasthesiol Intensivmed Notfallmed Schmerzther 2002, 37:280-283.
• [8]Pandit V, Seshadri S, Rao SN, Samarasing KA, Valsalan R: A case of organophosphate poisoning presenting with seizure and unavailable history of parenteral suicide attempt. J Emerg Trauma Shock 2011, 4:132-134.
• [9]Raina S, Mahesh DM, Sood V, Kaushal SS, Gupta D: Self injection of Dichlorvos, an Organophosphorus compound. Online J Health Allied Sciences 2008, 7:9.
• [10]Roy K, Karmakar KL, Talukdar A, Ghosh K, Pulai S: An unusual presentation of Organophosphorus poisoning in a young female with multiple boils with cellulitis. Indian Journal of Forensic Medicine & Toxicology 2009, 3:9-10.
• [11]Rajapakse BN, Thiermann H, Eyer P, Worek F, Bowe SJ, Dawson AH, Buckley NA: Evaluation of the Test-mate ChE (cholinesterase) field kit in acute organophosphorus poisoning. Ann Emerg Med 2011, 58:559-564. e6
• [12]Eddleston M, Dawson A, Karalliedde L, Dissanayake W, Hittaragw A, Azher S, Buckley NA: Early management after self-poisoning with an organophosphorus or carbamate pesticide – a treatment protocol for junior doctors. Crit Care 2004, 8:R391-R397. BioMed Central Full Text
• [13]Buckley NA, Eddleston M, Li Y, Bevan M, Robertson J: Oximes for acute organophosphate pesticide poisoning. Cochrane Database Syst Rev 2011., 2CD005085
• [14]Brown PD, Ebright JR: Skin and Soft Tissue Infections in Injection Drug Users. Curr Infect Dis Rep 2002, 4:415-419.
• [15]Binswanger IA, Kral AH, Bluthenthal RN, Rybold DJ, Edlin BR: High prevalence of abscesses and cellulitis among community-recruited injection drug users in San Francisco. Clin Infect Dis 2000, 30:579-581.