Rapid responses are electronic letters to the editor. They enable our users to debate issues raised in articles published on thebmj.com. Although a selection of rapid responses will be included online and in print as readers' letters, their first appearance online means that they are published articles. If you need the url (web address) of an individual response, perhaps for citation purposes, simply click on the response headline and copy the url from the browser window. Letters are indexed in PubMed.
These cases of organophosphate poisoning outbreak were not given the
proper care, probably because the diagnosis was not considered. These
cases required urgent confirmation of the diagnosis by a simple test that
is true or even pseudocholinesterase. Clinical picture missed the full
cholinergic picture. The following features were not observed; tremors,
fasciculations, bradycardia, muscarinic syndrome - wheezes,
hypersalivation, pin pointed pupils. A simple bedside test - in my
experience - is the atropine resistance in which the patient will tolerate
a large dose of atropine - 1-2 mg without having his pupils dilated or
developing dryness of secretions or developing tachycardia. Mechanical
ventilation would not be beneficial if the patient is not given a proper
dose of atropine sufficient enough to relax bronchoconstricion and releive
the high airway pressure, hence allow proper oxygenation.
Botulism would not be considered as loss of consciousness and cholinergic
features as sweating are inconsistent features.
Treatment should have included large amount of atropine. Patient should
have been atropinised several days thereafter. At the same time
pralidoxime or obidoxime should have been given for the first 3 days
especially when some patients rapidly developed respiratory failure. It is
well known that rapid sufficient therapy with cholinesterase reactivators
prevent the development of the intermediate syndrome.
Treatment of acute poisoning - Organophosphates - Markers of poisoning
No competing interests
21 October 2006
Mohy K El Masry
Professor of Clinical Toxicology
Poison Control Center - Faculty of Medicine - Ain Shams University - Cairo - Egypt