Intermediate syndrome secondary to ingestion of chlorpiriphos

A rural-area resident male patient deliberately ingested chlorpiriphos, an organophosphate insecticide. Although presented with cholinergic symptoms initially, he suffered general condition deterioration after 4 d characterized by muscular weakness, hypotonia, arreflexia and recumbent dyspnea requiring ventilatory support. These clinical manifestations occur from liposoluble organophosphates or metabolites with long-lasting half time, causeing delayed inhibition of acetylcholinesterase and subsequent burn out of the neuromuscular junction from acetylcholine overstimulation.