Risk Factors, Clinical Features, Diagnosis, and Management of Organophosphorus Poisoning

Introduction

Organophosphorus (OP) poisoning is a critical medical condition that results from exposure to organophosphate compounds commonly found in pesticides, nerve agents, and industrial chemicals.

Risk Factors

• Occupational exposure (agriculture, pest control)
• Accidental ingestion
• Intentional ingestion (suicide attempts)
• Environmental contamination

Clinical Manifestations

Signs and Symptoms

OP poisoning affects the nervous system by inhibiting acetylcholinesterase activity, leading to excessive cholinergic activity.

• Muscarinic effects: Salivation, lacrimation, urination, diarrhea, bronchospasm
• Nicotinic effects: Muscle fasciculations, weakness, paralysis
• CNS effects: Anxiety, confusion, convulsions, coma

Diagnosis

Diagnosis is based on clinical presentation, exposure history, and laboratory tests:

• Serum cholinesterase levels
• Urinary metabolites
• Clinical scoring systems (e.g., Peradeniya Organophosphorus Poisoning scale)

Management

Immediate Care

• Decontamination (removal of contaminated clothing, washing skin)
• Airway management and oxygenation

Pharmacologic Treatment

• Atropine: Counters muscarinic symptoms
• Pralidoxime (2-PAM): Reactivates acetylcholinesterase
• Diazepam: Manages seizures

Conclusion

Early recognition and appropriate management are crucial in reducing morbidity and mortality associated with OP poisoning.