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Acute poisoning with bromofosmethyl (bromophos)
C Köppel1, T Thomsen, G Heinemeyer
1Universitätsklinikum Rudolf Virchow, Standort Charlottenburg, Freie Universität Berlin, Germany.
Journal of Toxicology. Clinical Toxicology
|January 1, 1991
Summary
This case study details a severe bromophos (organophosphate) poisoning treated with gastric lavage, activated charcoal, atropine, and hemoperfusion. Bromophos poisoning can cause significant cholinergic symptoms, but red blood cell acetylcholinesterase is minimally affected.
Area of Science:
- Toxicology
- Pharmacology
- Clinical Medicine
Background:
- Organophosphate pesticides, such as bromophos, are widely used but pose significant toxicity risks.
- Understanding the specific toxicokinetics and clinical manifestations of bromophos poisoning is crucial for effective management.
Observation:
- A 52-year-old female presented with severe cholinergic symptoms after ingesting a large dose of bromophos.
- Treatment included gastric lavage, activated charcoal, atropine, hemoperfusion with amberlite XAD4, and obidoxime.
- While plasma butyrylcholinesterase was depressed, red blood cell acetylcholinesterase showed minimal depression, unlike in other organophosphate poisonings.
Findings:
- Hemoperfusion demonstrated efficient bromophos clearance (95 mL/min).
- The patient's cholinergic symptoms were managed with atropine, and muscular fibrillation with obidoxime.
- Analysis of 25 reported cases revealed miosis, hyperperistalsis, hypersalivation, agitation, nausea/vomiting, and convulsions as frequent symptoms; nine patients were asymptomatic.
Implications:
- Bromophos poisoning requires aggressive decontamination and supportive care, with hemoperfusion being a viable option for high-dose ingestions.
- The distinct pattern of cholinesterase inhibition by bromophos compared to other organophosphates warrants further investigation.
- Despite its toxicity, bromophos appears less toxic than its derivative, parathion, and some patients may remain asymptomatic even after significant ingestion.