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Several episodes of mass poisoning by organophosphates (OPs) have been reported from the developing countries. The diagnosis of OP-poisoning is mainly based on the characteristic clinical features and history of exposure to a known OP compound. Estimation of serum and red blood cell (RBC) cholinesterase activities are helpful in confirming the diagnosis. However, there is controversy regarding a definite relationship between serum cholinesterase activity and the severity of clinical manifestations and prognosis. This report describes an episode of mass monocrotophos poisoning that occurred due to accidental ingestion of monocrotophos-contaminated millet (so called bavta) flour involving eight severely poisoned persons. Clinical presentation included severe abdominal pain, diarrhoea, vomiting, pupil narrowing, and difficulty breathing. On hospital admission, plasma cholinesterase (PChE) and especially RBC acetylcholinesterase (AChE) activities correlated well with clinical symptoms presented by the patients. This case study highlights the need for clinicians to be aware of OP-pesticide poisoning from food sources and the need to look for depressed PChE and AChE activities that may point to OP exposure, so that OP-poisoning can be identified immediately and patients can receive specific treatment, rather than general treatment for food poisoning.
KEY WORDS: abdominal pain, acetylcholinesterase, acute OP poisoning, blood cholinesterase, diarrhoea, difficulty breathing, organophosphate pesticides, plasma cholinesterase, pupil narrowing, vomiting
KLJUCNE RIJECI: acetilkolinesteraza, akutno trovanje organofosfatima, bolovi u trbuhu, dijareja, kolinesteraza u plazmi, pesticidi, poteskoce u disanju, povracanje, suzavanje zjenica
Organophosphate (OP) pesticides continue to be the most common type of pesticides involved in acute poisoning in countries like India and Sri Lanka (1, 2). A large number of them, including monocrotophos, are registered for use in India. Despite structural differences, the mechanism by which they elicit their toxicity is identical and is associated with the inhibition of the nervous tissue acetyl cholinesterase. Morbidity and mortality from OP pesticides remains especially high in rural settings where facilities for intensive care are either absent or very limited. The World Health Organization (WHO) has estimated that each year more than 200,000 people in the world die from pesticide poisoning (3). Most of the poisonings occur in Asia and at least 50 % are OP-related (1, 3). Episodes of mass poisoning due to OP pesticides have been reported from developing countries like Pakistan and India (4, 5); the...