Acute Organophosphate Intoxication

Overview

The author presents a view of date from the literature concerning organophosphate intoxications which belong to the prognosticallymost serious poisons and are still associated with a high mortality. In addition to the clinical picture a decisive part forestablishment of the diagnosis during the first hours of the intoxication is played by the AChE activity in erythrocytes. The authoremphasizes also the danger of incorrect interpretation of latent symptom-free periods (in particular during parathion intoxication)which must not be the reason for premature termination of treatment. Treatment of respiratory manifestations of the intoxication isthe first most important provision.Atropine administration should be started already during the prehospitalization stage. Monitoring of oxygen saturation andcardiovascular monitoring must be continuous, analysis of blood gases should be done repeatedly at regular intervals. After oralingestion irrigation of the stomach with warm water is essential (it should be done repeatedly for several hours or days). Theeffectiveness of forced diuresis is controversial. There is only limited experience with extracorporeal provisions: haemoperfusion ismore effective than haemodialysis (the majority of organophosphates are lipophil).

Key words:
acetylcholine, acetylcholine esterase, atropine, haemoperfusion, haemodialysis, obidoxime chloride, pralidoxime chloride,pseudoacetylcholine esterase, organophosphates