Poisoning due to
organophosphate pesticides is an important cause of morbidity and mortality worldwide. Although standard treatments involving the administration of
atropine and
oximes have been used, there remain many controversial areas concerning
organophosphate poisoning (
OPP). Herein, we present our 10 years of experience in assessing the severity of
OPP in southern Taiwan. A retrospective study was performed on patients admitted with
OPP. A total of 75 patients (50 males and 25 females) were studied between January 1996 and December 2005. Diagnosis was based on a clinical assessment and serum
acetylcholinesterase (AChE) level at the time of hospital admission. The severity of
OPP was assessed using the grading system of Bardin et al. The duration and dosage of
atropine and palidroxime were recorded. All the biochemical data were analyzed. Sixty-one of the patients had attempted suicide and 14 patients had accidental exposure. The overall mortality rate was 8%.
Muscarinic effects were observed in 66 (88%) of the
OPP patients and the most frequent symptom was bronchial hypersecretion (52%). Among these three different severity groups, prolonged
length of stay, higher
infection rates, and higher mortality were found in the life-threatened group. The initial serum
C-reactive protein (CRP) level was strongly correlated to the severity grading of the
OPP. Nearly half of the patients were admitted to the intensive care unit (ICU) and, of this, 21 patients developed
respiratory failure within 72 hours. Low serum AChE levels support the diagnosis of
OPP, but no significant association was found between the severity of
OPP and serum AChE levels. The grading system of Bardin et al is very helpful for physicians to facilitate the recognition of seriously poisoned subjects, and to permit their early admission to an ICU. Initial serum CRP, an
acute phase reactant, had significant value in assessing the severity of the
OPP. Although the management of acute
OPP is supportive and the recovery rate is high,
anti-cholinergic therapy should be used as soon as possible to counteract
muscarinic effects. Physicians must be aware of the potential dangers of
respiratory failure, which could occur within 72 hours of
OPP.