Key Clinical Message
Organophosphate (OP) poisoning is the common form of poisoning accounting for approximately 0.9-1.0% of the patient admissions to hospital emergency departments in Nepal. Most cases of unintentional organophosphate poisoning occur in farmers due to unsafe handling and storage of insecticides. Although OP compounds are widely used as insecticide, a few cases of hospital admission after unintentional dermal exposure have been reported so far. The case fatality rate of treated OP poisoning is appropriately 7.4% in Nepal and 5-20% in developing countries of Asia. The severity and onset of the symptoms depends on the amount of poison ingested, route of absorption, and rate of metabolic breakdown of the insecticide. The most common symptoms of OP poisoning are altered level of consciousness, vomiting, sweating, hypersalivation and lacrimation. Diagnosis of OP poisoning is primarily based on the history, the clinical signs and symptoms, smell of insecticides or solvents involved, and reduced levels of red blood cell or plasma acetylcholine esterase (AchE). We reported a case of a 23-year-old male presented with a history of unintentional chlorpyrifos (CPS) poisoning after dermal exposure with bouts of vomiting and severe epigastric pain. Prompt recognition of signs and symptoms, and immediate decontamination followed by intravenous (IV) atropine and IV fluids with careful monitoring of vitals led to patient’s survival without any neurologic sequelae.
Keywords: Organophosphate, Insecticide, Acetylcholine esterase, Chlorpyrifos, Decontamination