Severe organophosphate (demeton-S-methyl) poisoning in a two-year-old child

A previously healthy 2-y-old boy was admitted to the hospital 30 min after the ingestion of 10 ml of demeton-S-methyl (META-SYSTOX). Treatment consisted of gastric decontamination, atropine, reactivator (obidoxime) and supportive therapy. Atropine was given to control the muscarinic features. Assisted ventilation was required for 6 h; however, this treatment was able to be discontinued following the second injection of obidoxime 11.5 h after the ingestion. Excess salivation and slight bradycardia were easily controlled with small doses of atropine for 5 d following admission to Ullevaal Hospital. Further course was uneventful, and the patient was discharged on the 8th d without any sequelae. Plasma cholinesterase levels were initially low (<400 U/l), but returned to reference values upon discharge. In this case, adequate supportive therapy and the rapid administration of both atropine and obidoxime were clearly associated with a favorable outcomes