Tushar Patil
Associate Professor Dept. of Neurology Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences Sawangi (Meghe) Wardha
Harshal Rathod
Associate Professor Dept. of Neurology Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences Sawangi (Meghe) Wardha
Abstract
Background: Organophosphate (OP) based pesticides are widely used and have emerged as the Major contributor to ill health associated with pesticides worldwide.Though accidental Poisoning can occur following exposure or inhalation, serious poisoning often follows Suicidal ingestion
Aims and Objectives:The present study was undertaken to identify the factors, which help in predicting the neuromuscular weakness in acute organophosphate poisoning, to identify the clinical parameters which help in early identification of patients who may develop respiratory failure due to neuromuscular weakness.
Material and Methods: The diagnosis of organophosphate was made on the basis of definite history of OP poisoning by patients or attendants. For each patient enrolled in the study a detailed clinical history was taken. A detailed clinical examination was carried out in each patient as per Proforma. The patients were divided into two groups. The first group had patients who developed neuromuscular weakness.. The second group had patients who did not develop neuromuscular weakness. The various factors were studied which help in early prediction of respiratory failure
Results: 100 patients of OP poisoning were studied. The patients were divided into two groups the first group with neuromuscular weakness and the second without neuromuscular weakness. Thesymptoms in the present study was vomiting(95%), increased secretions (79%), diarrhea (24%), abdominal pain (23%), diminished vision (12%) and convulsions (8%).The frequently observed signs were miosis( 82%), secretions (79%), fasciculations (76%) bradycardia( 52%), typical odor( 50%), hypotension(22%).The youngest patient was 14 years and oldest was 70 years. The maximum number of patients belonged to age group of 21 to 30. On multivariate analysis the identified predictors included Time lag in receiving treatment (p = 0.012), Presence of convulsions (p=0.000); Grade of poisoning (p=0.000); Presence of fasciculation (p=0.000); G.C.S. score on admission (p=0.000); Pupillary size on admission (p=0.010)
Conclusions: The predictors of neuromuscular weakness in acute organophosphate poisoning are severe clinical grade of poisoning on admission; increased duration of time elapsed prior to treatment; level of sensorium on admission; presence of fasciculations on admission; pupil’s size on admission and presence of convulsions on admission.
Keywords: diarrhea, abdominal pain, diminished vision, bradycardia, typical odor, fasciculations