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Carbamate and organophosphate poisoning in young children
M Lifshitz1, E Shahak, S Sofer
1Toxicology Unit, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Insights
Pediatric carbamate and organophosphate poisoning presents differently than in adults, often with central nervous system depression. Classic muscarinic symptoms may be absent, but poisoning is still possible in children.
Area of Science:
- Toxicology
- Pediatric Medicine
- Environmental Health
Background:
- Carbamate and organophosphate pesticides are common causes of poisoning globally.
- Young children are particularly vulnerable to pesticide toxicity due to their developing physiology.
- Understanding the specific clinical manifestations in children is crucial for timely diagnosis and treatment.
Purpose of the Study:
- To retrospectively evaluate the clinical course of carbamate and organophosphate poisoning in young children.
- To compare the clinical presentation in pediatric patients with that described in adult populations.
- To identify key diagnostic indicators for cholinesterase inhibitor poisoning in children.
Main Methods:
- Retrospective review of medical records for 52 children (2-8 years old) with carbamate or organophosphate poisoning.
- Analysis of clinical signs, symptoms, interventions, and outcomes.
- Identification of specific carbamate (methomyl, aldicarb) and organophosphate (parathion, fenthion, malathion, diazinon) agents.
Main Results:
- Central nervous system depression and severe hypotonia were the predominant symptoms.
- Classic muscarinic effects like miosis, diarrhea, and salivation were less frequent.
- Pulmonary edema occurred in some organophosphate poisoning cases; one fatality was reported, while others recovered.
Conclusions:
- The clinical presentation of carbamate and organophosphate poisoning in young children differs from adults.
- Absence of classic muscarinic signs does not rule out cholinesterase inhibitor poisoning in children presenting with CNS depression.
- Early recognition and appropriate management are vital for favorable outcomes in pediatric pesticide poisoning.
Objective:
Retrospective evaluation of the clinical course of carbamate and organophosphate poisoning in young children.
Design:
The records of 36 children intoxicated with carbamate and 16 children intoxicated with organophosphate (age range: 2 to 8 years, median: 2.8 years) were examined retrospectively. The carbamate agents were identified as methomyl or aldicarb, and the organophosphate as parathion, fenthion, malathion, and diazinon. The causes of poisoning were accidental ingestion in 46 children and inhalation in six children.
Clinical Setting:
Pediatric Intensive Care Unit of a teaching hospital.
Interventions:
Gastric lavage was performed, and activated charcoal was administered to all children who had ingested poisonous pesticides. Atropine sulphate was administered intravenously in repeated doses to all children with bradycardia, diarrhea, salivation, and miosis. Obidoxime chloride was administered to patients with organophosphate poisoning and to those in whom the ingested material was unidentified on admission.
Results:
Predominant symptoms were related to central nervous system depression and severe hypotonia. Other clinical signs such as miosis, diarrhea, salivation, bradycardia, and fasciculation were less frequent, while tearing and diaphoresis were not observed. Pulmonary edema developed in six patients with organophosphte poisoning. Three children required mechanical ventilation for several hours. One child (organophosphate poisoning) died shortly after arrival at the emergency department. All other children recovered completely.
Conclusion:
Based on a relatively large group of young pediatric patients with carbamate and organophosphate poisoning, it is concluded that the clinical presentation differed from those described in adults. Absence of classic muscarinic effects does not exclude the possibility of cholinesterase inhibitor agents poisoning in young children with central nervous system depression.