Much caution does no harm! Organophosphate poisoning often causes pancreatitis

Area of Science:

• Toxicology
• Gastroenterology
• Critical Care Medicine

Background:

• Organophosphate (OP) poisoning, a neurotoxicological emergency, can rarely lead to pancreatitis.
• This case highlights an unusual presentation of severe acute pancreatitis following malathion ingestion.

Observation:

• A 62-year-old female developed severe acute pancreatitis with lactic acidosis after ingesting 100 ml of malathion.
• Initial management included gastric lavage, activated charcoal, and pralidoxime methiodide (PAM).
• Despite treatment, OP symptoms exacerbated on day 3, requiring atropine, while pancreatitis persisted for over two weeks.

Findings:

• The patient presented with severe acute pancreatitis (Ranson score 6, APACHE II score 14), requiring hemodiafiltration (HDF).
• Unlike generally mild OP-associated pancreatitis, this case demonstrated a prolonged and severe course.
• Aggravated pancreatitis was managed with intensive care, including nafamostat, antibiotics, fluid resuscitation, and HDF.

Implications:

• Organophosphate-associated pancreatitis can be more severe than previously reported, necessitating careful clinical assessment.
• Aggressive supportive care and intensive management strategies are vital for favorable outcomes in severe cases.
• This case underscores the need for vigilance in managing OP poisoning complications, particularly pancreatitis.