Related Experiment Videos
Organophosphate and carbamate poisoning in infants and children
1Department of Pediatrics, University of Texas Health Science, Dallas.
Insights
Organophosphate and carbamate poisoning in children, often from pesticides, caused symptoms like miosis and weakness. Prompt treatment with atropine and pralidoxime led to recovery in most cases, with no deaths.
Area of Science:
- Toxicology
- Pediatrics
- Environmental Health
Background:
- Organophosphate and carbamate pesticides pose significant risks to children.
- Accidental ingestion and environmental exposure are common routes of intoxication.
- Accurate diagnosis and timely management are crucial for favorable outcomes.
Purpose of the Study:
- To describe the clinical and laboratory features of organophosphate and carbamate toxicity in pediatric patients.
- To evaluate the effectiveness of treatment interventions.
- To identify common exposure routes and diagnostic challenges.
Main Methods:
- Retrospective review of 37 infants and children with moderate to severe organophosphate and carbamate toxicity.
- Analysis of clinical signs, laboratory findings (cholinesterase activity), and treatment outcomes.
- Assessment of exposure routes, including ingestion and environmental contact.
Main Results:
- The most common exposure route was ingestion of liquid pesticides (76%).
- Common clinical signs included miosis (73%), excessive salivation (70%), muscle weakness (68%), and lethargy (54%).
- Respiratory insufficiency occurred in 38%, requiring mechanical ventilation; 22% experienced seizures. No deaths were reported.
Conclusions:
- Organophosphate and carbamate toxicity in children presents with diverse neurological and systemic symptoms.
- Early recognition and treatment with atropine and pralidoxime are effective.
- Environmental exposure, including from improperly stored pesticides and home spraying, is a significant concern.
Abstract:
The clinical and laboratory features of moderate to severe organophosphate and carbamate toxicity in 37 infants and children are presented. Ingestion of an improperly stored liquid pesticide was the most common route of intoxication (76% of patients); five (14%) children became intoxicated after playing on carpets and floors of homes that had been sprayed or fogged by unlicensed exterminators. The transfer diagnoses were incorrect for 16 or 20 patients who were transferred to our center from another institution. Miosis (73%), excessive salivation (70%), muscle weakness (68%), and lethargy (54%) were the most common abnormal signs; 49% and 22% of patients had tachycardia and seizures, respectively, and 38% of children had respiratory insufficiency that required endotracheal intubation and mechanical ventilation. The results of erythrocyte and serum cholinesterase activity assays were concordant in 83% of patients. Thirty-four (92%) patients were treated with atropine and/or pralidoxime; three patients required only supportive care. Most patients had a prompt response to therapy; however, two patients with organophosphate toxicity required multiple doses of atropine during a 24-hour period; in both instances, the doses of atropine were subtherapeutic. There were no deaths. Pneumonitis and/or atelectasis developed in ten patients, including six who had ingested a petroleum distillate-containing insecticide.