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Presentation and outcome of severe anticholinesterase insecticide poisoning
L Verhulst1, Z Waggie, M Hatherill
1Paediatric Intensive Care Unit, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
Insights
Severe anticholinesterase insecticide poisoning in children is a serious condition. Cardiac arrhythmias and respiratory failure are key indicators of a poor prognosis in pediatric intensive care patients.
Area of Science:
- Pediatric Intensive Care Medicine
- Toxicology
- Environmental Health
Background:
- Anticholinesterase insecticides pose a significant poisoning risk to children.
- Understanding the presentation and outcomes of severe poisoning is crucial for effective management.
Purpose of the Study:
- To document the patterns of presentation and outcome of severe anticholinesterase insecticide poisoning in children admitted to a pediatric intensive care unit (PICU).
Main Methods:
- Retrospective case note review of 5541 children admitted to PICU over 10 years.
- Identified 54 children with anticholinesterase insecticide poisoning.
- Analyzed presenting features, exposure routes, treatment, complications, and mortality using statistical tests.
Main Results:
- Most poisoned children were from rural areas, with enteral exposure being most common.
- Complications included coma, seizures, shock, arrhythmias, and respiratory failure.
- Mortality (7%) was associated with cardiac arrhythmia and respiratory failure, not route of exposure or decontamination delay.
Conclusions:
- The prognosis of severe anticholinesterase insecticide poisoning in children is not linked to exposure route or decontamination timing.
- Cardiac arrhythmias and respiratory failure are significant predictors of poor outcomes in pediatric poisoning cases.
Aims:
To document the patterns of presentation and outcome of severe anticholinesterase insecticide poisoning in children requiring intensive care.
Methods:
Retrospective case note review of all 5541 children admitted to the paediatric intensive care unit (PICU) of a university hospital during the 10 years from January 1990 to May 2000. Fifty four children (1%) with anticholinesterase insecticide poisoning were identified. Presenting features, route of exposure, treatment, complications, and mortality were recorded. Data were analysed by the Fisher's exact and Mann-Whitney tests.
Results:
More children than expected were from a rural area (46% versus 25%). Decontamination occurred in 50% of children prior to PICU admission. Enteral exposure was most common (n = 27; 50%). Median pseudocholinesterase level was 185 IU/l (range 75-7404). Median total dose of atropine required to maintain mydriasis was 0.3 mg/kg (range 0.03-16.7) over a median of 10 hours (range 1-160). Complications included coma (31%), seizures (30%), shock (9%), arrhythmias (9%), and respiratory failure requiring ventilation (35%). No significant differences were detected in incidence of seizures, cardiac arrhythmias, respiratory failure, mortality, duration of ventilation, or PICU stay, according to route of exposure, or state of decontamination. Four children died (7%). Mortality was associated with the presence of a cardiac arrhythmia (likelihood ratio 8.3) and respiratory failure (likelihood ratio 3.3).
Conclusion:
The mortality and morbidity of severe anticholinesterase insecticide poisoning in childhood is not related to route of exposure, or to delay in decontamination. However, the presence of either a cardiac arrhythmia or respiratory failure is associated with a poor prognosis.