Clinical Management of Acute OP Pesticide Poisoning

Chapter

Abstract

Organophosphorus pesticide (OP) poisoning is a worldwide problem. OPs inhibit various enzymes, in particular acetylcholinesterase (AChE) which is considered the key action that induces the clinical features of OP poisoning known as acute cholinergic syndrome. Multisystem clinical features are noted with most cases of OP poisoning but the manifestations can differ between individual OP compounds. Proper medical treatment follows an initial diagnosis, which in turn requires a high index of suspicion. If required, OP exposure can be confirmed by quantifying the blood or plasma cholinesterase activity. Standard resuscitation and supportive care is essential in the management of the exposed patient. This is accompanied by rapid administration and dose titration of antagonists of muscarinic cholinergic receptors (anti-muscarinics, notably atropine). A detailed risk assessment should be conducted so that adverse outcomes can be anticipated and treated, where possible. The risk of secondary poisoning in staff providing health care to patients is anticipated to be low if standard precautions are exercised. Other treatments are available but their role is more controversial; indeed, use varies across the world. For example, oximes such as pralidoxime and obidoxime appear to have the ability to reverse AChE inhibition in patients. However, clinical trials have yielded conflicting results (both benefit and harm), so their role in routine clinical practice is not confirmed. The role of oximes and other treatments such as magnesium, bicarbonate, clonidine, nicotinic antagonists, and extracorporeal blood purification modalities are the areas of research interest. Careful monitoring and development of a discharge plan are also necessary to optimise outcomes.

Keywords

Organophosphorus Organophosphate Pesticide Poisoning Cholinesterase AChE Mortality Atropine Pralidoxime Obidoxime Clonidine Magnesium Bicarbonate Developing country Acetylcholinesterase–inhibition Acetylcholinesterase- reactivation Activated charcoal Acute cholinergic syndrome Acute cholinergic syndrome or crisis Acute Physiology and Chronic Health Evaluation (APACHE) Ageing Alcohol- ethanol Alkalinisation Anticholinergic medicines Antidotes Arrhythmias Aspiration pneumonitis and pneumonia Atropine- antidote Atropine- diagnostic test Autonomic nervous system Benzodiazepines Bicarbonate Bioscavengers Bradycardia Bronchorrhoea Bronchospasm Butyrylcholinesterase Carbamate Case fatality- acute poisoning Catecholamine Chlorpyrifos Clinical scoring tools Clonidine Coformulants Concentration- OP in plasma Concentration- OP in the product Cyclohexanone CYP450 Decontamination- dermal Decontamination- gastrointestinal Diagnosis-acute poisoning Diaphoresis Diarrhoea Diazepam Diazinon Differential diagnosis-acute poisoning Dimethoate DUMBELS Electrophysiology- peripheral Emesis-forced (treatment) Emesis-symptom Enhanced elimination Epidemiology- acute poisoning Erythrocyte cholinesterase Ethanol-alcohol European Association of Poison Control Centres and Clinical Toxicologists Exposure-amount Exposure-dermal  Exposure-inhalation Exposure-oral Extracorporeal blood purification Fasciculations Fenthion Formulation-concentration and solvent Fresh frozen plasma Gastric lavage Glasgow Coma Score Glycopyrrolate Haemodialysis Healthcare workers- protection HI-6 Hyoscine Hypertension Hypotension Intentional self-poisoning Intermediate Syndrome International Program on Chemical Safety (IPCS) IPCS (International Program on Chemical Safety) Lacrimation LD50 Magnesium Malathion Management-acute poisoning Miosis Mixing study Mydriasis Nerve conduction study Neuropathy target esterase Nicotinic antagonists Obidoxime OP-diethyl OP-dimethyl OP-induced delayed polyneuropathy OP-induced neuropsychiatric Outcomes- age Oxime therapy-ageing Oxime therapy-clinical endpoints Oxime therapy- clinical evidence Oxime therapy- principles Oxime- dose-equivalents Oxon Pancuronium Paralysis Paraoxonase Pesticide Phosphoryl-oxime compound (POX) Pilocarpine Plasma cholinesterase Pralidoxime Prognosis- acute poisoning Profenofos Pseudocholinesterase Randomised controlled trials RBC cholinesterase Regulations Respiratory failure Resuscitation Risk Assessment- acute poisoning Salivation Secondary contamination Seizures Simplified Acute Physiology Score (SAPS) Solvent Spirometry Succinyl choline Suxamethonium Tachycardia Thion Toxicogenomics Urination WHO- classification 

References

  1. Abdollahi M, Karami-Mohajeri S (2012) A comprehensive review on experimental and clinical findings in intermediate syndrome caused by organophosphate poisoning. Toxicol Appl Pharmacol 258:309–314PubMedCrossRefGoogle Scholar
  2. Abedin MJ, Sayeed AA, Basher A, Maude RJ, Hoque G, Faiz MA (2012) Open-label randomized clinical trial of atropine bolus injection versus incremental boluses plus infusion for organophosphate poisoning in Bangladesh. J Med Toxicol 8:108–117PubMedCentralPubMedCrossRefGoogle Scholar
  3. Afshari R, Mohammadi M, Balali-Mood M (2010) Therapeutic effects of sodium bicarbonate in organophosphate poisoning in man is pH dependent: a randomized clinical trial. Toxicol Lett 196S:S84–S85CrossRefGoogle Scholar
  4. Akdur O, Durukan P, Ozkan S, Avsarogullari L, Vardar A, Kavalci C, Ikizceli I (2010) Poisoning severity score, Glasgow coma scale, corrected QT interval in acute organophosphate poisoning. Hum Exp Toxicol 29:419–425PubMedCrossRefGoogle Scholar
  5. Asari Y, Kamijyo Y, Soma K (2004) Changes in the hemodynamic state of patients with acute lethal organophosphate poisoning. Vet Hum Toxicol 46:5–9PubMedGoogle Scholar
  6. Avasthi G, Singh G (2000) Serial neuro-electrophysiological studies in acute organophosphate poisoning—correlation with clinical findings, serum cholinesterase levels and atropine dosages. J Assoc Physicians India 48:794–799PubMedGoogle Scholar
  7. Balali-Mood M, Balali-Mood K (2008) Neurotoxic disorders of organophosphorus compounds and their management. Arch Iranian Med 11:65–89Google Scholar
  8. Balali-Mood M, Shariat M (1998) Treatment of organophosphate poisoning. Experience of nerve agents and acute pesticide poisoning on the effects of oximes. J Physiol Paris 92:375–378PubMedCrossRefGoogle Scholar
  9. Balali-Mood M, Ayati MH, Ali-Akbarian H (2005) Effect of high doses of sodium bicarbonate in acute organophosphorus pesticide poisoning. Clin Toxicol 43:571–574CrossRefGoogle Scholar
  10. Balali-Mood M, Afshari R, Kahrom M, Ayati MH, Ali-Akbarian H, Zare G (2007) Use of high doses of sodium bicarbonate in acute organophosphorus pesticide poisoning is advancing. Clin Toxicol 45:92–93CrossRefGoogle Scholar
  11. Basher A, Rahman SH, Ghose A, Arif SM, Faiz MA, Dawson AH (2013) Phase II study of magnesium sulfate in acute organophosphate pesticide poisoning. Clin Toxicol (Phila) 51:35–40CrossRefGoogle Scholar
  12. Bateman DN, Sandilands E (2009) Poisoning in special patient groups: the elderly. Clin Toxicol 47:436–437CrossRefGoogle Scholar
  13. Besser R, Gutmann L (1995) A quantitative study of the pancuronium antagonism at the motor endplate in human organophosphorus intoxication. Muscle Nerv 18:956–960CrossRefGoogle Scholar
  14. Bilgin TE, Camdeviren H, Yapici D, Doruk N, Altunkan AA, Altunkan Z, Oral U (2005) The comparison of the efficacy of scoring systems in organophosphate poisoning. Toxicol Ind Health 21:141–146PubMedCrossRefGoogle Scholar
  15. Buckley NA, Dawson AH, Whyte IM (1994) Organophosphate poisoning: peripheral vascular resistance–a measure of adequate atropinization. J Toxicol Clin Toxicol 32:61–68PubMedCrossRefGoogle Scholar
  16. Buckley NA, Eddleston M, Li Y, Bevan M, Robertson J (2011) Oximes for acute organophosphate pesticide poisoning. Cochrane Database Syst Rev CD005085Google Scholar
  17. Cherian AM, Peter JV, Samuel J, Jaydevan R, Peter S, Joel S, Jeyaseelan L, Thomas K (1997) Effectiveness of 2-PAM (pralidoxime) in the treatment of organophosphorus poisoning (OPP): a randomised double blind placebo controlled trial. J Assoc Phys India 45:22–24Google Scholar
  18. Cordoba D, Cadavid S, Angulo D, Ramos I (1983) Organophosphate poisoning: modifications in acid base equilibrium and use of sodium bicarbonate as an aid in the treatment of toxicity in dogs. Vet Hum Toxicol 25:1–3PubMedGoogle Scholar
  19. Costa LG, Cole TB, Vitalone A, Furlong CE (2005) Measurement of paraoxonase (PON1) status as a potential biomarker of susceptibility to organophosphate toxicity. Clin Chim Acta 352:37–47PubMedCrossRefGoogle Scholar
  20. Dagli AJ, Shaikh WA (1983) Pancreatic involvement in malathion–anticholinesterase insecticide intoxication. A study of 75 cases. Br J Clin Pract 37:270–272PubMedGoogle Scholar
  21. Daly FFS, Little M, Murray L (2006) A risk assessment based approach to the management of acute poisoning. Emerg Med J 23:396–399PubMedCrossRefGoogle Scholar
  22. Dassanayake T, Weerasinghe V, Dangahadeniya U, Kularatne K, Dawson A, Karalliedde L, Senanayake N (2007) Cognitive processing of visual stimuli in patients with organophosphate insecticide poisoning. Neurology 68:2027–2030PubMedCrossRefGoogle Scholar
  23. Dassanayake T, Weerasinghe V, Dangahadeniya U, Kularatne K, Dawson A, Karalliedde L, Senanayake N (2008) Long-term event-related potential changes following organophosphorus insecticide poisoning. Clin Neurophysiol 119:144–150PubMedCentralPubMedCrossRefGoogle Scholar
  24. Davies J, Roberts D, Eyer P, Buckley N, Eddleston M (2008a) Hypotension in severe dimethoate self-poisoning. Clin Toxicol 46:880–884CrossRefGoogle Scholar
  25. Davies JOJ, Eddleston M, Buckley NA (2008b) Predicting outcome in acute organophosphorus poisoning with a poison severity score or the Glasgow coma scale. Q J Med 101:371–379CrossRefGoogle Scholar
  26. Dawson A, Buckley N, Whyte I (1997) What target pralidoxime concentration? J Toxicol Clin Toxicol 35:227–230PubMedCrossRefGoogle Scholar
  27. Dawson AH, Eddleston M, Senarathna L, Mohamed F, Gawarammana I, Bowe SJ, Manuweera G, Buckley NA (2010) Acute human lethal toxicity of agricultural pesticides: a prospective cohort study. PLoS Med 7:e1000357PubMedCentralPubMedCrossRefGoogle Scholar
  28. de Silva HJ, Wijewickrema R, Senanayake N (1992) Does pralidoxime affect outcome of management in acute organophosphorus poisoning? Lancet 339:1136–1168PubMedCrossRefGoogle Scholar
  29. Dickson EW, Bird SB, Gaspari RJ, Boyer EW, Ferris CF (2003) Diazepam inhibits organophosphate-induced central respiratory depression. Acad Emerg Med 10:1303–1306PubMedCrossRefGoogle Scholar
  30. Eddleston M (2000) Patterns and problems of deliberate self-poisoning in the developing world. Q J Med 93:715–731CrossRefGoogle Scholar
  31. Eddleston M, Szinicz L, Eyer P, Buckley N (2002) Oximes in acute organophosphorus pesticide poisoning: a systematic review of clinical trials. Q J Med 95:275–283CrossRefGoogle Scholar
  32. Eddleston M, Buckley NA, Checketts H, Senarathna L, Mohamed F, Sheriff MHR, Dawson A (2004a) Speed of initial atropinisation in significant organophosphorus pesticide poisoning—a systematic comparison of recommended regimens. J Toxicol Clin Toxicol 42:865–875CrossRefGoogle Scholar
  33. Eddleston M, Dawson A, Karalliedde L, Dissanayake W, Hittarage A, Azher S, Buckley NA (2004b) Early management after self-poisoning with an organophosphorus or carbamate pesticide—a treatment protocol for junior doctors. Crit Care 8:R391–R397CrossRefGoogle Scholar
  34. Eddleston M, Eyer P, Worek F, Mohamed F, Senarathna L, von Meyer L, Juszczak E, Hittarage A, Azhar S, Dissanayake W, Sheriff MHR, Szinicz L, Dawson AH, Buckley NA (2005) Differences between organophosphorus insecticides in human self-poisoning: a prospective cohort study. Lancet 366:1452–1459PubMedCrossRefGoogle Scholar
  35. Eddleston M, Mohamed F, Davies JOJ, Eyer P, Worek F, Sheriff MHR, Buckley NA (2006) Respiratory failure in acute organophosphorus pesticide self-poisoning. Q J Med 99:513–522CrossRefGoogle Scholar
  36. Eddleston M, Buckley NA, Eyer P, Dawson AH (2007) Management of acute organophosphorus pesticide poisoning. Lancet, pre-publication online; final publication in 2008Google Scholar
  37. Eddleston M, Buckley NA, Eyer P, Dawson AH (2008a) Management of acute organophosphorus pesticide poisoning. Lancet 371:597–607CrossRefGoogle Scholar
  38. Eddleston M, Eyer P, Worek F, Sheriff MH, Buckley NA (2008b) Predicting outcome using butyrylcholinesterase activity in organophosphorus pesticide self-poisoning. QJM 101:467–474CrossRefGoogle Scholar
  39. Eddleston M, Juszczak E, Buckley NA, Senarathna L, Mohamed F, Dissanayake W, Hittarage A, Azher S, Jeganathan K, Jayamanne S, Sheriff MHR, Warrell DA, Ox-Col PStudyC (2008c) Multiple-dose activated charcoal in acute self-poisoning: a randomised controlled trial. Lancet 371:583–539Google Scholar
  40. Eddleston M, Eyer P, Worek F, Juszczak E, Alder N, Mohamed F, Senarathna L, Hittarage A, Azher S, Jeganathan K, Jayamanne S, von Meyer L, Dawson AH, Rezvi Sheriff MH, Buckley NA (2009a) Pralidoxime in acute organophosphorus insecticide poisoning—a randomised controlled trial. PLoS Med 6:e1000104CrossRefGoogle Scholar
  41. Eddleston M, Gunnell D, von Meyer L, Eyer P (2009b) Relationship between blood alcohol concentration on admission and outcome in dimethoate organophosphorus self-poisoning. Br J Clin Pharm 68:916–919CrossRefGoogle Scholar
  42. Eddleston M, Worek F, Eyer P, Thiermann H, von Meyer L, Jeganathan K, Sheriff MHR, Dawson AH, Buckley NA (2009c) Poisoning with the S-Alkyl organophosphorus insecticides profenofos and prothiofos. Q J Med 102:785–792CrossRefGoogle Scholar
  43. Eddleston M, Street JM, Self I, Thompson A, King T, Williams N, Naredo G, Dissanayake K, Yu LM, Worek F, John H, Smith S, Thiermann H, Harris JB, Eddie Clutton R (2012) A role for solvents in the toxicity of agricultural organophosphorus pesticides. Toxicology 294:94–103PubMedCentralPubMedCrossRefGoogle Scholar
  44. Eyer P (2003) The role of oximes in the management of organophosphorus pesticide poisoning. Toxicol Rev 22:165–190PubMedCrossRefGoogle Scholar
  45. Eyer F, Meischner V, Kiderlen D, Thiermann H, Worek F, Haberkorn M, Felgenhauer N, Zilker T, Eyer P (2003) Human parathion poisoning: a toxicokinetic analysis. Toxicol Rev 22:143–163PubMedCrossRefGoogle Scholar
  46. Eyer P, Worek F, Thiermann H, Eddleston M (2010) Paradox findings may challenge orthodox reasoning in acute organophosphate poisoning. Chem Biol Interact 187:270–278PubMedCrossRefGoogle Scholar
  47. Feldmann RJ, Maibach HI (1970) Absorption of some organic compounds through the skin in man. J Invest Dermatol 54:399–404PubMedCrossRefGoogle Scholar
  48. Garcia-Repetto R, Martinez D, Repetto M (1994) The influence of pH on the degradation kinetics of some organophosphorous pesticides in aqueous solutions. Vet Hum Toxicol 36:202–204PubMedGoogle Scholar
  49. Griffin P, Mason H, Heywood K, Cocker J (1999) Oral and dermal absorption of chlorpyrifos: a human volunteer study. Occup Environ Med 56:10–13PubMedCrossRefGoogle Scholar
  50. Grmec S, Mally S, Klemen P (2004) Glasgow coma scale score and QTc interval in the prognosis of organophosphate poisoning. Acad Emerg Med 11:925–930PubMedCrossRefGoogle Scholar
  51. Gunnell D, Eddleston M, Phillips MR, Konradsen F (2007) The global distribution of fatal pesticide self-poisoning: systematic review. BMC Public Health 7:357PubMedCentralPubMedCrossRefGoogle Scholar
  52. Guven M, Sungur M, Eser B, Sari I, Altuntas F (2004) The effects of fresh frozen plasma on cholinesterase levels and outcomes in patients with organophosphate poisoning. J Toxicol Clin Toxicol 42:617–623PubMedCrossRefGoogle Scholar
  53. Hayes GR Jr, Funckes AJ, Hartwell WV (1964) Dermal exposure of human volunteers to parathion. Arch Environ Health 8:829–833PubMedCrossRefGoogle Scholar
  54. IPCS (2002) The WHO recommended classification of pesticides by hazard and guidelines to classification 2000–2002. World Health OrganisationGoogle Scholar
  55. Jalali N, Balali-Mood M, Jalali I, Shakeri MT (2011) Electrophysiological changes in patients with acute organophosphorous pesticide poisoning. Basic Clin Pharmacol Toxicol 108:251–255PubMedCrossRefGoogle Scholar
  56. Jayawardane P, Dawson A, Senanayake N, Weerasinghe V, Buckley N (2007) Progression of electrophysiological abnormalities in acute organophosphate poisoning and the intermediate syndrome. Clin Toxicol 45:370–371Google Scholar
  57. Jayawardane P, Dawson AH, Weerasinghe V, Karalliedde L, Buckley NA, Senanayake N (2008) The spectrum of intermediate syndrome following acute organophosphate poisoning: a prospective cohort study from Sri Lanka. PLoS Med 5:e147PubMedCentralPubMedCrossRefGoogle Scholar
  58. Jayawardane P, Senanayake N, Buckley NA, Dawson AH (2012) Electrophysiological correlates of respiratory failure in acute organophosphate poisoning: evidence for differential roles of muscarinic and nicotinic stimulation. Clin Toxicol (Phila) 50:250–253CrossRefGoogle Scholar
  59. John M, Oommen A, Zachariah A (2003) Muscle injury in organophosphorous poisoning and its role in the development of intermediate syndrome. Neurotoxicology 24:43–53PubMedCrossRefGoogle Scholar
  60. Johnson MK, Vale JA, Marrs TC, Meredith TJ (1992) Pralidoxime for organophosphorus poisoning. Lancet 340:64PubMedCrossRefGoogle Scholar
  61. Johnson S, Peter JV, Thomas K, Jeyaseelan L, Cherian AM (1996) Evaluation of two treatment regimens of pralidoxime (1 gm single bolus dose vs 12 gm infusion) in the management of organophosphorus poisoning. J Assoc Physician India 44:529–531Google Scholar
  62. Johnson MK, Jacobsen D, Meredith TJ, Eyer P, Heath AJ, Ligtenstein DA, Marrs TC, Szinicz L, Vale JA, Haines JA IPCS (2000) Evaluation of antidotes for poisoning by organophosphorus pesticides. Emerg Med 12:22–37CrossRefGoogle Scholar
  63. Kamijo Y, Soma K, Uchimiya H, Asari Y, Ohwada T (1999) A case of serious organophosphate poisoning treated by percutaneus cardiopulmonary support. Vet Hum Toxicol 41:326–328PubMedGoogle Scholar
  64. Karalliedde L, Baker D, Marrs TC (2006) Organophosphate-induced intermediate syndrome: aetiology and relationships with myopathy. Toxicol Rev 25:1–14PubMedCrossRefGoogle Scholar
  65. Lee P, Tai DYH (2001) Clinical features of patients with acute organophosphate poisoning requiring intensive care. Intensive Care Med 27:694–699PubMedCrossRefGoogle Scholar
  66. Li Y, Tse ML, Gawarammana I, Buckley N, Eddleston M (2009) Systematic review of controlled clinical trials of gastric lavage in acute organophosphorus pesticide poisoning. Clin Toxicol 47:179–192CrossRefGoogle Scholar
  67. Little M, Murray L (2004) Consensus statement: risk of nosocomial organophosphate poisoning in emergency departments. EMA Emerg Med Australas 16:456–458CrossRefGoogle Scholar
  68. Liu WF (1991) A symptomatological assessment of organophosphate-induced lethality in mice: comparison of atropine and clonidine protection. Toxicol Lett 56:19–32PubMedCrossRefGoogle Scholar
  69. Lotti M, Moretto A (2005) Organophosphate-induced delayed polyneuropathy. Toxicol Rev 24:37–49PubMedCrossRefGoogle Scholar
  70. Morgan JP, Penovich P (1978) Jamaica ginger paralysis. Forty-seven-year follow-up. Arch Neurol 35:530–532PubMedCrossRefGoogle Scholar
  71. Moshiri M, Darchini-Maragheh E, Balali-Mood M (2012) Advances in toxicology and medical treatment of chemical warfare nerve agents. Daru 20:81PubMedCentralPubMedCrossRefGoogle Scholar
  72. Muldoon SR, Hodgson MJ (1992) Risk factors for nonoccupational organophosphate pesticide poisoning. J Occup Med 34:38–41PubMedGoogle Scholar
  73. Namba T, Nolte CT, Jackrel J, Grob D (1971) Poisoning due to organophosphate insecticides. Acute and chronic manifestations. Am J Med 50:475–492PubMedCrossRefGoogle Scholar
  74. Nissen LM, Wong KH, Jones A, Roberts DM (2010) Availability of antidotes for the treatment of acute poisoning in Queensland public hospitals. Aust J Rural Health 18:78–84PubMedCrossRefGoogle Scholar
  75. Pajoumand A, Shadnia S, Rezaie A, Abdi M, Abdollahi M (2004) Benefits of magnesium sulfate in the management of acute human poisoning by organophosphorus insecticides. Hum Exp Toxicol 23:565–569PubMedCrossRefGoogle Scholar
  76. Pati S, Goodfellow JA, Iyadurai S, Hilton-Jones D (2008) Approach to critical illness polyneuropathy and myopathy. Postgrad Med J 84:354–360PubMedCrossRefGoogle Scholar
  77. Pawar KS, Bhoite RR, Pillay CP, Chavan SC, Malshikare DS, Garad SG (2006) Continuous pralidoxime infusion versus repeated bolus injection to treat organophosphorus pesticide poisoning: a randomised controlled trial. Lancet 368:2136–2141PubMedCrossRefGoogle Scholar
  78. Peng A, Zhu K, Li X, Li C, Buckley NA, Roberts DM (2006) Extracorporeal blood purication for organophosphorus pesticide poisoning [Protocol]. Cochrane Database Syst Rev Art No CD006253. doi:10.1002/14651858.CD006253Google Scholar
  79. Peng Y, Zhang Q, Snyder GL, Zhu H, Yao W, Tomesch J, Papke RL, O’Callaghan JP, Welsh WJ, Wennogle LP (2010) Discovery of novel alpha7 nicotinic receptor antagonists. Bioorg Med Chem Lett 20:4825–4830PubMedCentralPubMedCrossRefGoogle Scholar
  80. Perera PMS, Jayamanna SF, Hettiarachchi R, Abeysinghe C, Karunatilake H, Dawson AH, Buckley NA (2009) A phase II clinical trial to assess the safety of clonidine in acute organophosphorus pesticide poisoning. Trials 10:73PubMedCentralPubMedCrossRefGoogle Scholar
  81. Pichamuthu K, Jerobin J, Nair A, John G, Kamalesh J, Thomas K, Jose A, Fleming JJ, Zachariah A, David SS, Daniel D, Peter JV (2010) Bioscavenger therapy for organophosphate poisoning—an open-labeled pilot randomized trial comparing fresh frozen plasma or albumin with saline in acute organophosphate poisoning in humans. Clin Toxicol (Phila) 48:813–819CrossRefGoogle Scholar
  82. Rehiman S, Lohani SP, Bhattarai MD (2008) Correlation of serum cholinesterase level, clinical score of presentation and severity of organophosphorus poisoning. JNMA 47:47–52Google Scholar
  83. Roberts DM (2008) Kinetics and dynamics in acute poisoning. Doctor of Philosophy, Australian National UniversityGoogle Scholar
  84. Roberts DM, Aaron CK (2007) Managing acute organophosphorus pesticide poisoning. Br Med J 334:629–634CrossRefGoogle Scholar
  85. Roberts D, Buckley NA (2005) Alkalinisation for organophosphorus pesticide poisoning. Cochrane Database Syst Rev CD004897Google Scholar
  86. Roberts D, Senarathna L (2004) Secondary contamination in organophosphate poisoning. Q J Med 97:697–698CrossRefGoogle Scholar
  87. Roberts DM, Fraser JF, Buckley NA, Venkatesh B (2005) Experiences of anticholinesterase pesticide poisonings in an Australian Tertiary Hospital. Anaesth Intensive Care 33:469–476PubMedGoogle Scholar
  88. Roberts DM, Ai P, Kaiyuan Z, Buckley NA (2007a) Extracorporeal blood purification for acute organophosphorus pesticide poisoning. J Intensive Care Med 22:124–126CrossRefGoogle Scholar
  89. Roberts DM, Dawson AH, Hittarage A, Jeganathan K, Sheriff MHR, Buckley NA (2007b) Plasma alkalinization for acute organophosphorus poisoning—is it a reality in the developing world? Clin Toxicol 45:90–91CrossRefGoogle Scholar
  90. Sahin I, Onbasi K, Sahin H, Karakaya C, Ustun Y, Noyan T (2002) The prevalence of pancreatitis in organophosphate poisonings. Hum Exp Toxicol 21:175–177PubMedCrossRefGoogle Scholar
  91. Sam KG, Kondabolu K, Pati D, Kamath A, Pradeep Kumar G, Rao PGM (2009) Poisoning severity score, APACHE II and GCS: effective clinical indices for estimating severity and predicting outcome of acute organophosphorus and carbamate poisoning. J Forensic Leg Med 16:239–247PubMedCrossRefGoogle Scholar
  92. Senanayake N, Karalliedde L (1987) Neurotoxic effects of organophosphorus insecticides. An intermediate syndrome. N Engl J Med 316:761–763PubMedCrossRefGoogle Scholar
  93. Shadnia S, Darabi D, Pajoumand A, Salimi A, Abdollahi M (2007) A simplified acute physiology score in the prediction of acute organophosphate poisoning outcome in an intensive care unit. Hum Exp Toxicol 26:623–627PubMedCrossRefGoogle Scholar
  94. Shih DM, Gu L, Xia YR, Navab M, Li WF, Hama S, Castellani LW, Furlong CE, Costa LG, Fogelman AM, Lusis AJ (1998) Mice lacking serum paraoxonase are susceptible to organophosphate toxicity and atherosclerosis. Nature 394:284–287PubMedCrossRefGoogle Scholar
  95. Singh G, Avasthi G, Khurana D, Whig J, Mahajan R (1998) Neurophysiological monitoring of pharmacological manipulation in acute organophosphate (OP) poisoning. The effects of pralidoxime, magnesium sulphate and pancuronium. Electroencephalogr Clin Neurophysiol 107:140–148PubMedCrossRefGoogle Scholar
  96. Sivilotti MLA, Bird SB, Lo JCY, Dickson EW (2005) Multiple centrally-acting antidotes protect against severe organophosphate toxicity. Clin Toxicol 43:693–694Google Scholar
  97. Sungur M, Güven M (2001) Intensive care management of organophosphate insecticide poisoning. Crit Care 5:211–215PubMedCrossRefGoogle Scholar
  98. Sungurtekin H, Gurses E, Balci C 2006. Evaluation of several clinical scoring tools in organophosphate poisoned patients. Clin Toxicol (Phila) 44:121–126CrossRefGoogle Scholar
  99. Thiermann H, Szinicz L, Eyer F, Worek F, Eyer P, Felgenhauer N, Zilker T (1999) Modern strategies in therapy of organophosphate poisoning. Toxicol Lett 107:233–239PubMedCrossRefGoogle Scholar
  100. Thiermann H, Szinicz L, Eyer P, Zilker T, Worek F (2005) Correlation between red blood cell acetylcholinesterase activity and neuromuscular transmission in organophosphate poisoning. Chem Biol Interact 157–158:345–347Google Scholar
  101. Valiyaveettil M, Alamneh Y, Rezk P, Biggemann L, Perkins MW, Sciuto AM, Doctor BP, Nambiar MP (2011) Protective efficacy of catalytic bioscavenger, paraoxonase 1 against sarin and soman exposure in guinea pigs. Biochem Pharmacol 81:800–809PubMedCrossRefGoogle Scholar
  102. Wadia RS, Sadagopan C, Amin RB, Sardesai HV (1974) Neurological manifestations of organophosphorous insecticide poisoning. J Neurol Neurosurg Psychiatry 37:841–847PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2014

Authors and Affiliations

  1. 1.Burns, Trauma and Critical Care Research CentreRoyal Brisbane and Women’s Hospital, University of QueenslandSt LuciaAustralia
  2. 2.Department of Renal MedicineAddenbrooke’s HospitalCambridgeUK
  3. 3.Department of Drug HealthRoyal Prince Alfred HospitalSydneyAustralia

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