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