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Organophosphate Poisoning in a Paediatric Intensive Care Unit: A Retrospective Analysis Based on Ten Years of
Abdullah Yousef1, Waleed Albuali1, Mohammed AlOmari1
1Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
Insights
Organophosphate poisoning is common in children, with skin exposure and accidental ingestion being frequent. Delayed arrival and respiratory failure increase mortality risk in pediatric intensive care unit patients.
Area of Science:
- Pediatric critical care medicine
- Toxicology
- Environmental health
Background:
- Organophosphate (OP) poisoning is a significant cause of poisoning in children.
- Understanding OP toxicity in pediatric populations is crucial for effective management.
Purpose of the Study:
- To analyze the demographic profiles of pediatric patients with OP poisoning.
- To identify clinical features, disease progression, and outcomes in children treated in a pediatric intensive care unit (PICU).
Main Methods:
- Retrospective review of medical records for children (≤14 years) diagnosed with OP poisoning at King Fahad Hospital of the University.
- Inclusion criteria focused on confirmed OP poisoning, excluding cases with co-exposure to other agents or incomplete data.
- Data collected spanned January 2008 to December 2018.
Main Results:
- Thirty-one pediatric patients were included; median age was 2 years, with 61% males.
- Most exposures (68%) involved multiple routes, predominantly skin (84%), and were accidental (90%).
- Bronchorrhea (90%) was the most common symptom; 16% developed ARDS, and 39% required mechanical ventilation.
Conclusions:
- Pediatric organophosphate poisoning presents with diverse clinical manifestations.
- Factors like delayed hospital arrival (>1 hour), inhalational exposure, mechanical ventilation, and elevated lactate levels are associated with increased mortality risk in PICU settings.
Background:
Organophosphate (OP) poisoning is one of the most common etiologies of poisoning in the pediatric age group.
Objective:
This study aimed to evaluate the demographic characteristics, clinical features, clinical course, and outcomes of children with toxicity from organophosphates admitted to the pediatric intensive care unit.
Methods:
A retrospective review of hospital medical records of all children aged 14 years and younger who were admitted to the PICU with a provisional diagnosis of organophosphate poisoning at King Fahad Hospital of the University (KFHU), Alkhobar, Saudi Arabia, between January 1, 2008, and December 31, 2018, was conducted. Patients with incomplete medical record information or with suspicion or evidence of one or more agents other than organophosphate were excluded from the study.
Results:
Thirty-one patients were enrolled in the study. The median age of the study population was 2 years, and 19 (61%) were males. The majority of patients (68%) had more than one route of organophosphate exposure. Skin exposure was reported in 26 patients (84%). Only three patients (10%) had suicidal organophosphate exposure from organophosphates, while the majority (28 patients; 90%) had accidental poisoning. Bronchorrhea was the most prevalent presenting feature, reported in 28 patients (90%). 17 patients (55%) were treated with intravenous atropine and (45%) were used a combination of pralidoxime with atropine for treatment. Five patients (16%) developed acute respiratory distress syndrome. Twelve patients (39%) needed endotracheal intubation and mechanical ventilation secondary to respiratory failure.
Conclusion:
The presenting features of organophosphate poisoning differ widely in children. Risk factors for mortality for PICU patients with organophosphate poisoning include delayed hospital arrival by more than 1 hour, inhalational route of exposure, need for mechanical ventilation, and high lactate levels in the first 24 hours post-exposure.
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