Abstract | BACKGROUND: AIM: DESIGN: We set up a prospective cohort of patients with acute profenofos or prothiofos self- poisoning admitted to acute medical wards in two Sri Lankan district hospitals. Clinical observation was carried out throughout their inpatient stay; blood samples were taken in a subgroup for assay of cholinesterases and insecticide. RESULTS: Ninety-five patients poisoned with profenofos and 12 with prothiofos were recruited over 5 years. Median time to admission was 4 (IQR 3-7) h. Eleven patients poisoned with profenofos died (11/95; 11.6%, 95% CI 5.9-20); one prothiofos patient died (1/12; 8.3%, 95% CI 0.2-38). Thirteen patients poisoned with profenofos required intubation for respiratory failure (13/95; 13.7%, 95% CI 7.5-22); two prothiofos-poisoned patients required intubation. Both intubations and death occurred late compared with other OP insecticides. Prolonged ventilation was needed in those who survived-a median of 310 (IQR 154-349) h. Unexpectedly, red cell AChE activity on admission did not correlate with clinical severity-all patients had severe AChE inhibition (about 1% of normal) but most had only mild cholinergic features, were conscious, and did not require ventilatory support. CONCLUSION: Compared with other commonly used OP insecticides, profenofos and prothiofos are of moderately severe toxicity, causing relatively delayed respiratory failure and death. There was no apparent response to oxime therapy. The lack of correlation between red cell AChE activity and clinical features suggests that this parameter may not always be a useful marker of synaptic AChE activity and severity after OP pesticide poisoning.
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Authors | M Eddleston, F Worek, P Eyer, H Thiermann, L Von Meyer, K Jeganathan, M H R Sheriff, A H Dawson, N A Buckley |
Journal | QJM : monthly journal of the Association of Physicians
(QJM)
Vol. 102
Issue 11
Pg. 785-92
(Nov 2009)
ISSN: 1460-2393 [Electronic] England |
PMID | 19737786
(Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
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Chemical References |
- Biomarkers
- Insecticides
- Organophosphorus Compounds
- Organothiophosphates
- profenofos
- Cholinesterases
- prothiophos
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Topics |
- Adult
- Biomarkers
(blood)
- Cause of Death
- Cholinesterases
(blood)
- Female
- Humans
- Insecticides
(blood, poisoning)
- Male
- Middle Aged
- Organophosphate Poisoning
- Organophosphorus Compounds
(blood)
- Organothiophosphates
(blood)
- Prospective Studies
- Sri Lanka
- Young Adult
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