[Severe accidental poisoning by the organothiophosphate insecticide "Sugovan"]

Early diagnoses of poisoning by organothiophosphate insecticide enables us to offer the appropriate treatment, which is in most cases crucial for the outcome of the poisoning. Our case was the serious accidental poisoning of a five year-old child, at home with organothiophosphate insecticide, which was packed in an attractively wrapped juice bottle, and within reach of the child. The history, general condition of the patient and the level of pseudoholinesterasis of 0.62 U/ml (reference limits are 7-10 U/nml) showed the severe nature of the poisoning. After emergency measures and several administrations of atropine with a total dosage of 1mg, we attained hyperatropinisation (or full atropinisation), and after two doses of the specific antagonist pralidoxim (whose "use by" date had expired three years earlier) every four hours, there was an increase in the level of pseudoholinesterasis to 1.66 Ulml. On the eighth day of hospitalization our patient was discharged in good health and his level of pseudoholinesterasis was 6.60 U/ml. Examination of the antidote pralidoxim (Neopam), was performed later and showed that its activityin relation to the standard substance was 90 9, which is good for safe treatment and adequate treatment efficacy. In conclusion, it should be emphasized that through measures of prevention, poisoning of children can be stopped, and in the case of poisoning, what is most important is prompt diagnosis and the appropriate administration of two extremely effective antidotes: atropine sulfates and pralidoxim. There should be no legal barriers to purchasing these antidotes, because the possibility of poisoning with very toxic substances such as organothiophosphate insecticides cannot be excluded.