Acute demeton poisoning in a child

An acute case of demeton poisoning in a child is described. Intially, typical signs of organophosphate poisoning were not present, and the illness was thought to be aliphatic hydrocarbon (fuel oil) intoxication. When correct diagnosis was first suspected, treatment with pralidoxime chloride and atropine sulfate produced some perilous complications, but was probably life-saving ultimately. Plasma (pseudo) cholinesterase levels 15 to 41 hours after exposure ranged from 0.24 to 0.48 international units (IU). Approximate normal value (2.5 IU) was not reached until 5 1/2 days after exposure. Transdermal poisoning by demeton was confirmed by its presence (15.4 mg/l) in the suspected fuel oil and, at high levels, in several articles of the child's clothing. Verification of expected urinary metabolites helped confirm the diagnosis of demeton poisoning. The availability of rapid blood cholinesterase field tests in hospital laboratories, especially in agricultural areas, is pointed out as an urgent need.