Agricultural Intoxications. Industrial Allergens. Acute Occupational Poisoning

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Agricultural Intoxications. Industrial
Allergens. Acute Occupational Poisoning

• AKANYA VICTORIA NINMA
• GROUP 501
• CRIMEA STATE MEDICAL UNIVERSITY

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ORGANOPHOSPHATE POISONING

• Organophosphates organic compound phosphate
  group
• Uses
• Agricultural insecticides
• Fungicides
• Household garden spray
• Herbicides

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TYPES OF ORGANOPHOSPHATES INSECTICIDES
INSECTICIDES NEVRE GASES ANTIHELMIN-THIC AGENTS HERBICIDES
Malathion Soman Trichloforn Tribufos
Parathion Sarin Merphos
Diazinon Tabun
Fenthion VX
Dichlorvos
Chlorprifos
Ethion
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EXPOSURE
Home exposure Occupational exposure Other
Accidental ingestion Farm/ farm worker Dietary exposure residue in crops
Lawn/ garden use Pesticide applicator Leaching from the soil to ground water
Insect control Manufacturer community exposure
Food supply Mixing and handing Airborne drift from commercial application
Water supply Landscapers Contaminated water
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• ROUTE cutaneous
• ingestion (accidental/suicidal
  )
• inhalation
• ingestion
• Manifestation of early symptom depend on
• Concentration
• Route of exposure
• Rate of metabolic degradation

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PATHOGENESIS

• OP
  
• Acetyl cholinesterase
• 
  CNS, PNS, RBCs
• Overstimulation of
  muscarininc and nicotinic receptors
  

This enzyme helps to degrade Ach to choline and
acetic acid
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SIGNS AND MANIFESTATIONS

• MUSCARINE EFFECT
• CVS- bradycardia, hypotension
• Resp- rhinorrhea, bronchospasm, bronchorrhea,
  cough severe respiratory distress.
• GIT- hypersalivation, nausea, vomiting, abdominal
  pain, diarrhea.
• UT- incontinence
• Ocular- blurred vision, miosis
• Glands- increased lacrimation, diaphoresis

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• NICOTINIC EFFECT
• Muscle fasiculation, cramps, weakness,
  hypertension, tachycardia, mydriasis, pallor,
  diaphragmatic failure.
• CNS EFFECT
• Anxiety, restlessness, confusion, ataxia,
  seizures, coma,
• Extrapyramidal effect
• Dystonia, cogwheel rigidity, parkinsonian
  features (lesions of basal ganglia), Gullian
  Barre syndrome

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DIAGNOSIS

• Complains
• Anamnesis of occupation
• Laboratory analysis
• confirmation of cholinesterase
  activity in blood
• Blood analysis leucocytosis, hemoconcentration,
  metabolic-respiratory acidosis, hyperglycemia,
  decrease of K, Mg 2, increase of amylase and
  liver function, abnormal levels of creatinine and
  urea.
• Chest X- ray Pulmonary edema
• ECG prolonged Q interval, increase ST segment,
  extrasystole, atrial fibrillation and ventricular
  tachycardia.

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TREATMENT

• Clean airway
• Oxygenation and proper ventilation
• Removal of soiled clothes
• Wash skin to prevent further absorption
• Administer antidote therapy
• IV Atropine 2mg every 15min till signs of
  atropinization are been seen. Add paralidoxine.
• Gastric lavage within half hour followed by
  administration of charcoal via nasogastric tube.

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• PAM
• Nuclophillic agent that reactivates the
  phosphorylated AchE by binding to the OP
  molecule.
• 1-2g(20-40mg/kg) IV in 100ml every 15-30mins
• Magnesium (decreases Ach release)- 4g/day
• Benzodiazepine/Diazepam to facilitate inhibitory
  GABA neurotransmission 5-15mg IV Q 5-10mins.

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