Organophosphate Compound:
Organophosphate compounds belong to the class of irreversible anticholinergic agents. These work by inhibiting the enzyme acetylcholine esterase, which plays a key role in the degradation of acetyl choline in the synapse. Inhibition of the enzyme leads to increased concentration of the neurotransmitter (acetyl choline) in the synapse, this in turn has increased potential to keep the postsynaptic receptors activated and prolongs the effects of the same.
Organophosphate compounds form important constituent of pesticides and insecticides, this being used widely in farms and in the agriculture sector is used as an agent to commit suicide or the workers are affected accidentally (occupational hazard). OP compounds have very high lipid solubility and hence can be absorbed from the skin directly.
Clinical signs and symptoms:
Patient who has consumed OP compound will show the following symptoms:
Muscarinic:
- CNS depression
- Miosis (pinpoint pupil)
- Increased salivation, sweating and lacrymation.
- Emesis and diarrhoea.
- Bradycardia
- Hypotension
- Bronchoconstriction
- Urination
Nicotinic effects:
- Muscle fasciculations.
- Muscle paralysis ( Leads to respiratory paralysis ).
Management of OP poisoning:
1. Maintain :
A - AIRWAY - intubate if necessary.
B - BREATHING - mechanical ventilation must be given if necessary
C - Circulation - CPR if patient has cardiac arrest.
2. Immediately removed clothes contaminated by poison and wash the skin to eliminate poison, OP compounds have very high lipid solubility and hence get absorbed from skin directly.
3. Perform gastric lavage to remove any poison in the stomach.
Definitive treatment:
- Administer 2mg Atropine i/v every 15 minutes once until signs of atropinisation is seen ( Pupil dilates, dry eye and mouth).
- Pralidoxime can be given to reverse the effect of OP compounds on acetyl choline esterase and reactivate the enzyme.
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