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J Korean Soc Emerg Med > Volume 20(4); 2009 > Article
Journal of The Korean Society of Emergency Medicine 2009;20(4): 392-398.
The Variations in Clinical Features According to Intoxicants in High Toxicity Organophosphorus Intoxication
Mu Jin Kim, Byung Kook Lee, Kyung Woon Jeung, Hyun Ho Ryu, Jung Mi Moon
Department of Emergency Medicine, School of Medicine, Chonnam National University, Gwangju, Korea. bbukkuk@hanmail.net
Organophosphorus (OP) pesticides are differentiated into 3 groups according to their toxicity. The differences in chemical composition of each OP pesticide determines its toxicokinetic characteristics. There are few human studies that address the clinical results of poisoning according to the OP pesticide. In this study, we aimed to examine the differences in clinical features among self-poisoning from 4 highly toxic OP pesticides.
The 4 kinds of OP poisonings included 17 cases of Dichlorvos, 17 cases of EPN, 17 cases of methidathion, and 13 cases of phosphamidon. We set primary outcomes as GCS, atropine dose required, duration of patient need for atropine, proportion who required ventilation, duration on ventilation, and the interval from ingestion to ventilation. Secondary outcomes were the proportion of OP-induced delayed neuropathy, duration of ICU stay, and proportion who required additional infusion of pralidoxime chloride (PAM).
The EPN group required the largest amount of atropine, the longest duration of atropine use, the longest duration for support of mechanical ventilation, and the longest ICU stay. Furthermore the proportion who required additional PAM and neuropathy were in the EPN group. However, the EPN group had the longest interval from ingestion to ventilatory support. Meanwhile, the Dichlorvos group exhibited comparatively mild clinical features.
Throughout this study, we found different clinical features to each OP pesticide poisoning. It can be explained by differences in chemical composition, which determined the speed of aging, the reactivation rate of OPenzyme, the metabolism, the fat solubility, and other characteristics of the pesticides.
Key words: Pesticides, Organophosphorus compounds, Poisoning
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