Pediatric Organophosphates Toxicity Follow-up
- Author: William Freudenthal, MD; Chief Editor: Timothy E Corden, MD more...
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.
Further Inpatient Care
See the list below:
- 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.
See the list below:
- 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.
Parents sould be educate regarding the following:
- Use of safety lids on accessible containers of pesticides
- Proper storage of chemicals in the home
On a societal level, legislation regarding the sale and storage of dangerous chemicals can be effective in reducing organophosphate poisoning.
Intermediate syndrome can develop 24-96 hours after exposure. A combination of presynaptic and postsynaptic impairment of neuromuscular transmission probably causes the syndrome. Features of intermediate syndrome as as follows:
- The syndrome tends to occur in patients with prolonged exposure before treatment.
- The syndrome is characterized by weakness in the motor cranial nerves, proximal limb muscles, neck flexors, and respiratory muscles.
- 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.[18, 19] Symptoms developed 5 days after exposure and completely resolved after treatment with amantadine
See the list below:
- 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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