Organo-phosphorus compound (OPC) poisoning

Written by Dr.Md.Redwanul Huq (Masum)
Tuesday, 22 January 2013 08:26

Clinical features:

Type of manifestation Affected organ/system Effects


MuscarinicManifestation Pupils Constriction of pupils (Miosis)
GI tract Anorexia, nausea, vomiting, diarrhea, abdominal cramp, tenesmus, faecal incontinence
Lacrimal gland Increased Lacrimation
CVS Bradycardia, hypotension
Salivary gland Increased salivation
Sweat gland Increased sweating
Respiratory system Bronchospasm, increased bronchial secretion, dyspnoea, cyanosis, pulmonary edema
Urinary bladder Incontinence of urine
NicotinicManifestation Skeletal muscle Fasciculation, muscle cramp, weakness, loss of reflexes, muscle paralysis
Sympathetic ganglia Hypertension, tachycardia
CNSManifestation Early excitation Headache, restlessness, emotional liability, tremor
Late depression Drowsiness, confusion, depression of respiratory and cardiovascular centers, coma

Management of OPC poisoning:

I. Immediate management of OPC poisoning

a) Airway clearance
b) Ensuring breathing
c) Maintenance of circulation

II. General measurements of OPC poisoning:

a) Prevention of absorption and also elimination of poison

i) Removal of clothing
ii) Skin wash with soap water
iii) Stomach wash with KMnO4
vi) Whole bowel irrigation
vii) Haemoperfusion

b) Supportive management

i) Aspiration of secretions
ii) O2 therapy
iii) IV infusion
iv) Artificial ventilation if needed

c) Inactivation of the absorbed poison

i) Antidote: Pralidoxime 30 mg /Kg IV (not more than 500 mg/min) and repeated every 30 min as necessary
ii) Antagonist: Atropin sulphate 2-4 mg IV. If no effect, the dose may be doubled at 5-10 min intervals up to atropinization

e) Symptomatic treatment

i) Antipyretics
ii) Antibiotics to prevent pulmonary infection
iii) Anticonvulsant e.g. Benzodiazepines or Barbiturates

f) Maintenance of nutrition– oral (if possible) or parenteral

g) Follow up of the patient to prevent any complication of OPC poisoning.

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