Management of Common Poisoning, Insecticide Toxicity, and Animal/Insect Bites

Specific Management of Organophosphate and Pesticide Poisoning

Organophosphate poisoning is a serious medical emergency that results from exposure to insecticides commonly used in agriculture. These compounds inhibit acetylcholinesterase, leading to excessive accumulation of acetylcholine and subsequent cholinergic crisis.

Clinical Presentation

• Muscarinic Effects: Salivation, lacrimation, urination, diarrhea, gastrointestinal distress, emesis (SLUDGE syndrome).
• Nicotinic Effects: Muscle weakness, fasciculations, respiratory failure.
• CNS Effects: Confusion, seizures, coma.

Diagnosis

Diagnosis is primarily clinical, supported by history of exposure and characteristic symptoms. Laboratory tests include:

• Plasma and RBC cholinesterase levels (reduced in poisoning).
• Atropine challenge test.

Management

Immediate Steps

• Decontamination: Remove contaminated clothing, wash skin thoroughly.
• Airway and Breathing: Provide oxygen, intubate if necessary.
• Circulation: Monitor vital signs and provide IV fluids.

Specific Antidotes

• Atropine: Blocks muscarinic effects; given IV in titrated doses.
• Pralidoxime (2-PAM): Reactivates acetylcholinesterase; most effective if given early.

Supportive Care

• Seizure management with benzodiazepines.
• Continuous monitoring for respiratory failure.
• ICU admission for severe cases.

Prevention

• Use protective equipment when handling pesticides.
• Educate workers on safe pesticide usage.
• Implement strict regulations on pesticide exposure.

Early recognition and prompt treatment are crucial in managing organophosphate poisoning effectively.