Unintentional organophosphate intoxication in children

To describe the demographic characteristics, clinical course, and outcome of children with acute organophosphate (OP) poisoning admitted to a regional medical center.

The clinical charts of all children admitted to the pediatric wards in Hadassah University Hospital with a diagnosis of acute OP intoxication were reviewed.

During the study period (1989-2003), 31 children, mean age 5.6 +/- 3.9 years, presented with manifestations of acute OP poisoning. In 71% of the patients, it was possible to identify the toxin, most commonly parathion and diazinone. The most common route of exposure was ingestion of agricultural products treated with OPs (71%). The major clinical manifestation was neurological, with most of the patients presenting with coma and/or seizures (71%). The classic muscarinic and nicotinic signs of intoxication including increased secretions, bradycardia, fasciculations, and miosis were less common in our patient population. Treatment included decontamination, administration of antidote, and supportive care. Most patients responded well to treatment, but 2 patients (6.4%) died.

The manifestations of OP poisoning in children are different from those of adults. Pediatricians should be aware of these differences because in some cases, a history of OP exposure is not obtained.