N K Sahoo*, C. Banerjee**, S Narain ***
Deptt. of Paediatrics, Bokaro General Hospital, Jharkhand *, Deptt. of Paediatrics, Bokaro General Hospital, Jharkhand **, Deptt. of Paediatrics, Bokaro General Hospital, Jharkhand ***
Organophosphorus Insecticide (OP) inhibits both cholinesterase and pseudo cholinesterase activities resulting in excessive secretions, miosis, bradycardia and respiratory failure with a high mortality. Early diagnosis and prompt management is often life-saving. We report our experience with intensive care management of serious OP poisoning.
To study the clinical profile and outcome of OP poisoning in children.
Retrospective case note analysis of all cases of organophosphate poisoning in children admitted to Paed. Ward from January 2004 to June 2005. Diagnosis was performed with history and consistent clinical findings i.e., miosis, hypersalivation, bradycardia, respiratory failure. Serum and RBC anticholinesterase levels are not done in our institution. Intravenous atropine and oximes were administered as soon as possible. Other measures of treatment were gastric lavage and decontamination. Mechanical ventilation was performed if the patient developed respiratory failure, depressed sensorium or hemodynamic instability. SIMV and pressure support was used ands PEEP was titrated to keep SaO2 above 94% with 40% FiO2 along with pressure support weaning.
A total of 37 patients with OP poisoning were admitted, out of which 35 patients required intensive care. Two patients did not manifest symptoms. Mean age was 14.3 (range 2-16 yrs.). 33 (94.2%) were of deliberate self poisoning and 2 (5.75%) had accidental poisoning (less than 5 yrs). Most frequent signs observed were miosis (94.2%), hypersalivation (91.4%) depressed sensorium (40%), and fasciculation (34.2%). Complications observed were respiratory failure (22.8%), aspiration pneumonia (20%), convulsions (14.2%) and sepsis (8.5%). Intermediate syndrome was observed in 2 (5.7%) cases. Average duration of intensive care stay was 7.8 + - 3 days. Ten patients (28.5%) required mechanical ventilation out of which 5 pts., (50%) died with an overall mortality of 14.2%.
More than 90% had suicidal poisoning in adolescent age group. About one fourth developed respiratory failure requiring mechanical ventilation. Early recognition and prompt treatment is life-saving.
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