[Acute voluntary poisoning by carbamate].

Area of Science:

• Toxicology
• Clinical Pharmacology

Background:

• Organophosphate and carbamate poisonings inhibit cholinesterases, leading to a cholinergic syndrome.
• Severe complications including cardiorespiratory failure, coma, and death can occur without prompt management.

Observation:

• A case of voluntary poisoning by aldicarb, a potent carbamate, highlights diagnostic challenges.
• The initial presentation was subtle, delaying diagnosis and emphasizing the need for early symptomatic treatment.

Findings:

• Cholinergic syndrome is the hallmark clinical presentation, confirmable by plasma cholinesterase levels.
• Atropine is the primary antidote for these poisonings, particularly at high doses.
• Pralidoxime is recommended for organophosphate poisoning but its role in carbamate poisoning is debated.

Implications:

• Early recognition and symptomatic care are critical for improving outcomes in organophosphate and carbamate poisoning.
• Understanding the specific roles of atropine and pralidoxime guides therapeutic decisions.
• This case underscores the importance of considering toxicological differentials in patients with unexplained neurological symptoms.