ORGANOPHOSPHOROUS POISONING AND OPIOID INTOXICATION

1
ORGANOPHOSPHOROUS POISONING AND OPIOID
INTOXICATION

• Presenter Dr. Sunil
• Moderator Dr. V. Darlong

www.anaesthesia.co.in anaesthesia.co.in_at_gmail.c
om
2
ORGANOPHOSPHOROUS POISONING
3

• Irreversible anticholinesterases
• Organo phosphates Carbamates
• Dyflos Carbaryl
• Echothiophate Propoxur
• (Baygon)
• Para, Malathion,
• Diazinon (TIK 20)
• Tabun, serin(Nerve gas)

4
ABSORPTION

• Inhalational
• Dermal
• mucous membrane
• GIT

5
Mechanism of action
6

• Suicidal
• Agricultural exposure
• nerve gas in bio warfare
• Hydrocarbon solvent

7
SYMPTOMS SIGNS

• Muscarinic
• SLUDGE Salivation, lacrimation, urination,
  diarrhoea, gastric upset, emesis
• Miosis,
• decreased HR, BP
• Pulmonary edema, aspiration pneumonia
• chemical pneumonitis, ARDS
• Chromolachryorrhoea

8

• Nicotinic
• Skeletal Muscle
• Fasciculation
• Paralysis
• Sympathetic Ganglion
• ?BP
• ? HR
• mydriasis

9
SYMPTOMS (Contd)

• CNS
• Slurred speech, delirium, seizure coma, resp
  depression
• Other
• HONK, glucosuria, Hyperamylasemia (pancreatitis)
• Chronic
• Peripheral N. memory impair, depression

10

• Fatal dose
• Para (80mg, 175mg) Malathion (1g)
• Fatal period
• 24 hr, 10 days
• Cause of death
• Resp. arrest

11

• Diagnosis
• Plasma cholinesterase (40-140-IU/L)
• Mild 20-50
• Moderate 10-20
• Severe lt10
• Clinical improvement preceeds decrease in levels
• Atropinization (2mg)

12
MANAGEMENT

• Supportive
• ABC, Decontamination
• Gastric lavage (lt1hr) KMnO4 110,000
• Emesis C/I
• AC 25g, 4 hr.ly Thrice
• ABG, QTc ?

13

• Specific
• Atropine
• Benzyl alc
• 2mg iv. Ev 10 m
• Atropinizan
• Taper slowly overs few days
• Intermediate syndrome

14

• PAM
• Started within 24 hrs
• 1 - 2g 100 ml NS over 30 min
• 6 - 12 hourly, 12 g / day
• 500 mg / hr Infusion
• 20 - 40 mg / kg

15

• Seizure
• BZD
• phenytoin
• Hemoperfusion
• Parathion

16
Opioids - Classification

• Natural Synthetic
• Morphine Morphinans - Butorphanol
• Codiene Diphenylpropylamine - methadone
• Benzomorphan - pentazosine
• Phenylpiperidine - meperidine, fentanyl
• Semi-synthetic
• Heroin
• Dihydromorphone

17
OPIOID INTOXICATION

• Accidental, iatrogenic, suicidal, drug abuser,
  body packer
• Symptoms and signs
• Resp. Depress, Coma, Pinpoint pupil, cyanosis,
  N/v, seizure
• Hypotension Bradycardia pulm. Edema
• Human fatal dose 250 mg morphine i.m.
• Cause of death Resp. fail

18
MANAGEMENT

• ABC, monitoring, ABG
• Emesis C/I
• Gastric lavage lt 1hr, even injected, KMnO4
  110,000
• AC 25 g, 4 hrly, Thrice

19
MANAGEMENT (Contd)

• Naloxone
• 0.4 mg IV ? 0.8 after 2 min
• Rept. Till recovery or total 10 mg
• S.L. E.T, I.N
• T ½ (30-45 m)
• Inf. (2/3 initial dose hrly, Twice i.m. 4-5
  ?/kg/hr)
• Neonate 10 ?/kg Rpt. 2 min, 60 ?/kg
• Naltrexone
• P.O. Maintenance, 25-30mg/day, T ½ 24 hrs
• Nal mefene T ½ 10.8 hrs, 4 mg single dose

20
BODY PACKERS

• Whole bowel irriga
• Intestinal obst. Surgery
• No endoscopic removal
• ICU, monitoring- R.R. Consciouness level
• (Till all packet passed)
• Serial CT Scan

21
UROD

• Anaesthesia assisted
• Controversial Sudden deaths , poor supportive
  evidence
• (O Conner PG, Kosten TR 1998 JAMA)

www.anaesthesia.co.in anaesthesia.co.in_at_gmail.c
om