Pediatric Organophosphates Toxicity Follow-up

  • Author: William Freudenthal, MD; Chief Editor: Timothy E Corden, MD   more...
 
Updated: Nov 15, 2011
 

Further Inpatient Care

  • Admit patients to the hospital if they require therapy with anticholinergenic agents or 2-PAM. Monitoring, respiratory support, and ventilation may be needed.
  • Consult poison control center personnel for information regarding the specific agent, the length of inpatient treatment, and the duration of likely toxicity.
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Further Outpatient Care

  • Patients with minor or no symptoms of toxicity after organophosphate exposure may be discharged from the emergency department after 6 hours of observation.
  • Discharged patients usually do not require outpatient medications.
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Transfer

  • Transfer pediatric patients with severe life-threatening exposures to a facility with a pediatric intensivist and intensive care unit.
  • Patients should be clinically stable before their transfer.
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Deterrence/Prevention

  • Use of safety lids on accessible containers of pesticides
  • Proper storage of chemicals in the home
  • Legislation regarding the sale and storage of dangerous chemicals
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Complications

  • Intermediate syndrome can develop 24-96 hours after exposure.[13]
    • This syndrome is characterized by weakness in the motor cranial nerves, proximal limb muscles, neck flexors, and respiratory muscles.
    • The syndrome tends to occur in patients with prolonged exposure before treatment.
    • A combination of presynaptic and postsynaptic impairment of neuromuscular transmission probably causes the syndrome.
  • A delayed peripheral neuropathy may develop days to weeks after the exposure.
  • Patients may also have persistent CNS effects, weakness, lethargy, fatigue, and memory impairment.
  • Shahar et al reported extrapyramidal parkinsonism as a complication of acute organophosphate poisoning.[14, 15] Symptoms developed 5 days after exposure and completely resolved after treatment with amantadine.
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Prognosis

  • The prognosis for patients treated early is excellent; most patients fully recover in 7-10 days.
  • Patients with toxicity untreated for more than 24 hours may have a prolonged and severe course with lasting neurologic complications.
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Contributor Information and Disclosures
Author

William Freudenthal, MD  Staff Physician, Department of Emergency Medicine, St. Vincent Hospital Indianapolis, IN

William Freudenthal, MD is a member of the following medical societies: American College of Emergency Physicians and Association of Military Surgeons of the US

Disclosure: Nothing to disclose.

Coauthor(s)

Mark E Ralston, MD, MPH  Staff Pediatrician, Naval Hospital Oak Harbor; Assistant Professor of Pediatrics, F Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences

Mark E Ralston, MD, MPH is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael E Mullins, MD  Assistant Professor, Division of Emergency Medicine, Washington University in St Louis School of Medicine; Attending Physician, Emergency Department, Barnes-Jewish Hospital

Michael E Mullins, MD is a member of the following medical societies: American Academy of Clinical Toxicology and American College of Emergency Physicians

Disclosure: Johnson & Johnson stock ownership None; Savient Pharmaceuticals stock ownership None

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Jeffrey R Tucker, MD  Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut School of Medicine, Connecticut Children's Medical Center

Disclosure: Merck Salary Employment

Daniel Rauch, MD, FAAP  Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine

Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine

Disclosure: Baxter Honoraria Consulting

Chief Editor

Timothy E Corden, MD  Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin

Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, and Wisconsin Medical Society

Disclosure: Nothing to disclose.

References

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  2. Sadaka Y, Broides A, Tzion RL, Lifshitz M. Organophosphate acetylcholine esterase inhibitor poisoning from a home-made shampoo. J Emerg Trauma Shock. Jul 2011;4(3):433-4. [Medline]. [Full Text].

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  8. Lifshitz M, Shahak E, Sofer S. Carbamate and organophosphate poisoning in young children. Pediatr Emerg Care. Apr 1999;15(2):102-3. [Medline].

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  10. Sofer S, Tal A, Shahak E. Carbamate and organophosphate poisoning in early childhood. Pediatr Emerg Care. Dec 1989;5(4):222-5. [Medline].

  11. Mortensen ML. Management of acute childhood poisonings caused by selected insecticides and herbicides. Pediatr Clin North Am. Apr 1986;33(2):421-45. [Medline].

  12. Burillo-Putze G, Hoffman RS, Howland MA, Duenas-Laita A. Late administration of pralidoxime in organophosphate (fenitrothion) poisoning. Am J Emerg Med. Jul 2004;22(4):327-8. [Medline].

  13. De Bleecker JL. The intermediate syndrome in organophosphate poisoning: an overview of experimental and clinical observations. J Toxicol Clin Toxicol. 1995;33(6):683-6. [Medline].

  14. Shahar E, Bentur Y, Bar-Joseph G, et al. Extrapyramidal parkinsonism complicating acute organophosphate insecticide poisoning. Pediatr Neurol. Nov 2005;33(5):378-82.

  15. Shahar E, Bentur Y, Bar-Joseph G, Cahana A, Hershman E. Extrapyramidal parkinsonism complicating acute organophosphate insecticide poisoning. Pediatr Neurol. Nov 2005;33(5):378-82. [Medline].

  16. Brahmi N, Mokline A, Kouraichi N, Ghorbel H, Blel Y, Thabet H. Prognostic value of human erythrocyte acetyl cholinesterase in acute organophosphate poisoning. Am J Emerg Med. Nov 2006;24(7):822-7. [Medline].

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