Severe acute organophosphate poisoning managed with two-month prolonged atropine therapy: A case report
Bibhav Bashyal, Alisha Yadav, Anand Kumar Deo, Kirti Kala Kharel, Deepshikha Kharel, Bishal Panthi- General Medicine
- Surgery
Introduction and importance:
Organophosphate poisoning is a common and potentially fatal condition that requires prompt and aggressive treatment with atropine, oximes and supportive care. We report a rare case of organophosphate poisoning that needed high doses of atropine and intensive care for 60 days.
Case presentation:
A 39-year-old male ingested 200 mL of chlorpyriphos, an organophosphate compound, and presented with vomiting and epigastric pain. He received an initial dose of atropine of 60 mL (36 mg, 1ml=0.6 mg), followed by an infusion of 16 mL/hour (9.6 mg/hour). He developed hypoxia, cardiac arrest, delirium, fever and had persistent bronchorrhea. He was intubated, resuscitated, and transferred to ICU where he continued showing signs of organophosphate excess and therefore, he received up to 170 mL/hour (102 mg/hour) of atropine infusion, along with triple inotropes and sedation. He underwent tracheostomy and gradual weaning of atropine. He recovered completely and was discharged in stable condition.
Clinical discussion:
This case demonstrates the need for prolonged monitoring of patients with organophosphate poisoning wherein patient can develop signs of organophosphate excess even after initial atropinisation, effectiveness of multiple doses of atropine in organophosphate poisoning and the importance of monitoring for complications associated with prolonged hospital stay. It also shows the potential need for prolonged atropine therapy and intensive care in organophosphate poisoning.
Conclusion:
Organophosphate poisoning can be life-threatening and requires early and aggressive treatment with atropine, oximes and supportive care. Clinicians should be aware of the potential need for prolonged atropine therapy in organophosphate poisoning cases to improve the chances of survival.