Organophosphorus insecticide poisoning by absorption through the skin of the head: report of two patients [Article in Croatian]

Abstract

A common cause of acute poisoning, particularly among young children, is unintentional exposure to pesticides. Organophosphates inhibit acetylcholinesterase in cholinergic synapses and on the red-cell membrane, which results in accumulation of acetylcholine. Children with severe organophosphorus poisoning have pinpoint pupils, excessive sweating, reduced consciousness and poor respiration, with possible respiratory insufficiency. Diagnosis is made on the basis of a high dose of suspicion, clinical signs, a characteristic smell and cholinesterase level in red-cell or in blood. Treatment of organophosphorus poisoning includes breathing and circulation support, use of atropine and oximes, decontamination of skin and mucous membranes, and supportive care. Our two patients had signs of acute cholinergic crisis. The older sister, in spite of therapy with atropine and obidoxime, developed malignant tachyarrhythmia. Although she was treated with antiarrhythmics and electroconversion, there was no improvement and death occurred. The younger sister responded to atropine therapy which was prerequisite for a good outcome.