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"The Toxic Depot": Parenteral Insecticide Injection.
Jerry Jacob1, Ch Karthik Reddy1, Jobin James1
1Department of Emergency Medicine, St John's Medical College Hospital, Bengaluru, Karnataka, India.
Summary
A patient self-injecting organophosphorus (OP) pesticide developed severe poisoning. Surgical removal of the toxic depot was crucial for recovery when antidotes failed, highlighting a rare route of OP exposure.
Area of Science:
- Toxicology
- Clinical Medicine
- Pharmacology
Background:
- Organophosphorus (OP) pesticides are widely used globally.
- Poisoning typically results from occupational, accidental, or suicidal exposures.
- Parenteral injection of OP compounds is an extremely rare route of exposure.
Observation:
- A patient self-administered Dichlorvos (76% OP compound) via injection into a leg swelling.
- Initial symptoms included gastrointestinal distress and excessive secretions, progressing to neuromuscular weakness.
- Standard OP antidotes (atropine, pralidoxime) were ineffective due to a formed toxic depot.
Findings:
- Surgical excision of the injected swelling led to a rapid improvement in the patient's condition.
- Biopsy revealed granuloma and fungal hyphae within the excised tissue.
- The patient experienced intermediate syndrome during intensive care unit stay.
Implications:
- This case underscores the critical importance of considering unusual exposure routes in organophosphorus poisoning.
- Surgical intervention may be necessary to manage toxicity from localized, depot-forming OP injections.
- Fungal infection may complicate parenteral OP compound administration.
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