OP Poisoning Pondering

Global suicide rates may be reduced if the management of organophosphate pesticide poisoning (OPP) were improved, according to a review in an online edition of The Lancet.  Dr. Michael Eddleston, Scottish Poisons Information Bureau, New Royal Infirmary, Edinburgh, Scotland, and team examined published articles on OPP during the period 1960-2006.  They explained “Organophosphorous pesticide self-poisoning is a major clinical health problem across much of rural Asia.  Of the estimated 500,000 deaths from self-harm in the region each year, about 60 percent are due to pesticide poisoning.”  Furthermore, they say that about 200,000 deaths, two-thirds of the total pesticide poisonings, are specifically due to OPP.  Deaths as a result of accidental OPP are much less common, and seem to take place only in regions where the most toxic organophosphate pesticides are accessible.  Symptoms of OPP, caused by the over-stimulation of autonomous nerve receptors in the body include vomiting, diarrhea, sweating, confusion, agitation, coma, respiratory failure, and paralysis. 

There is still a great deal of uncertainty about the best use of common treatments for OPP, even though these treatments have been around for over 50 years.  Commonly used treatments, such as atropine, oximes and diazepam have different levels of effectiveness, depending on which specific poison is affecting the patient.  “However, consensus exists that early resuscitation with atropine, oxygen, respiratory support, and fluids are needed to improve oxygen delivery to tissues,” the authors say.  The authors believe larger trials are needed to see how effective magnesium sulphate might be and they suggest patients may benefit greatly from it.  Gastric lavage (stomach pumping), a commonly used procedure for OPP, is only effective right at the beginning of the onset of symptoms.  As the onset of symptoms is rapid the authors wonder how effective gastric lavage might be.  “Medical management of OPP is difficult, especially in resource poor locations where most of these patients come in for treatment.  (Medical News Today, 8/17/07).