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Intermediate syndrome after exposure to chlorpyrifos in a 16-month-old girl
Jason E Mattingly1, Janice E Sullivan, Henry A Spiller
1Department of Emergency Medicine, University of Louisville, Louisville, Kentucky 40202, USA.
Insights
A toddler developed Intermediate Syndrome from chlorpyrifos poisoning, experiencing delayed paralysis despite continuous pralidoxime treatment. This case highlights unusual pediatric toxicity and treatment challenges with organophosphate pesticides.
Area of Science:
- Toxicology
- Pediatric Emergency Medicine
Background:
- Organophosphate pesticides, like chlorpyrifos, pose significant risks, particularly to children.
- Intermediate Syndrome (IMS) is a delayed neuromuscular complication following organophosphate poisoning.
Observation:
- A 16-month-old girl ingested chlorpyrifos, developing initial toxicity including lethargy, tachycardia, and pulmonary edema requiring mechanical ventilation.
- Despite prompt and continuous pralidoxime infusion, the child experienced a delayed onset of flaccid paralysis, bradycardia, and apnea approximately 27.5 hours post-ingestion.
Findings:
- This case represents a rare occurrence of Intermediate Syndrome in a toddler due to chlorpyrifos exposure.
- The development of IMS despite adequate oxime therapy underscores the complex and unpredictable nature of organophosphate toxicity in pediatric patients.
Implications:
- This case highlights the critical need for vigilant monitoring in pediatric organophosphate poisoning, even with continuous oxime treatment.
- Further research into the pathophysiology and management of Intermediate Syndrome in children is warranted to improve patient outcomes.
Abstract:
We describe a case of intermediate syndrome after chlorpyrifos ingestion in a toddler, despite a continuous pralidoxime infusion. A 16-month-old girl ingested a pesticide containing chlorpyrifos. She was brought to an Emergency Department where she became lethargic and tachycardic, and subsequently developed pulmonary edema requiring mechanical ventilation. Pralidoxime 150 mg i.v. was administered twice, and an infusion begun at 15 mg/kg/h. At 24.5 h post-ingestion the child had a normal neurologic examination, showed no signs of cholinergic excess, and was extubated successfully. At 27.5 h post-ingestion the child became flaccid, bradycardic and apneic. She was emergently re-intubated. The child's delayed onset of respiratory arrest and flaccid paralysis after an asymptomatic period is consistent with Intermediate Syndrome. This is an unusual case in that it occurred in a young child, was related to chlorpyrifos, and occurred despite continuous and adequate oxime therapy.
