Organophosphates Follow-up

  • Author: Frances M Dyro, MD; Chief Editor: Stephen A Berman, MD, PhD, MBA   more...
 
Updated: Jan 23, 2012
 

Further Inpatient Care

Following treatment of the acute manifestations of organophosphate poisoning, patients may develop tremor, cognitive deficits, and general debility; they may need treatment of these secondary consequences of organophosphate toxicity. In the case of the patient exposed to large amounts of diazinon, the effects initially were thought to be seizures but were in fact related to generalized nervous system hyperexcitability, which the author treated with tizanidine (Zanaflex).

Next

Further Outpatient Care

  • Generally, after the treatment of acute effects of organophosphate exposure, no additional treatment is needed. Occasionally, the patient has residual neurophysiologic and neuropsychological sequelae.
  • Patients exposed to an agent suspected of producing neuropathy require monitoring and electrodiagnostic studies several weeks following acute toxicity.
  • Neuropsychological assessment on a periodic basis is recommended for workers with long-term exposure.
  • Testing should be done for patients with complaints of memory problems and cognitive deficits.
Previous
Next

Inpatient & Outpatient Medications

Generally, no medications are prescribed for the patient at discharge.

Previous
Next

Transfer

Transfer to a rehabilitation facility may be indicated for the patient who develops late neuropathic sequelae.

Previous
Next

Deterrence/Prevention

  • Use of pesticides in enclosed spaces generally results in exposure to organophosphates. Use of proper ventilation and avoidance of cutaneous exposure reduces toxic events. Many of the more toxic substances are being phased out of production. Carbamate pesticides, for example, while not totally benign, cause a less severe type of toxicity. The carbamates are cholinesterase inhibitors with a blockade time of about 6 hours. They do not cross the blood-brain barrier well and affect primarily the peripheral receptors.
  • Care must be taken by those who use organophosphate pesticides commercially (eg, crop dusters, farmers); a healthy respect for the substances will help reduce cases of acute toxicity.
  • Children should be kept from areas where pesticides have been applied.
Previous
Next

Complications

Complications generally are seen during the period of hospitalization and involve respiratory difficulty, requiring intubation and ventilatory assistance. Seizures occurring during the acute phase should be treated with diazepam.

Previous
Next

Prognosis

  • Promptly treated organophosphate toxicity carries a favorable prognosis.
  • Individuals with long-term exposure need to be monitored for the late complication of neuropathy and development of cognitive abnormalities.
Previous
Next

Patient Education

  • Pesticides can be dangerous substances if used improperly. They must be kept in a safe place and away from children. People using pesticides should be educated in the fact that the chemicals can enter the body by several routes and to use gloves, protective clothing, and even respiratory protection. After cutaneous exposure, immediate washing is a must.
  • Patients exposed to pesticides at home should be cautious concerning the potential for repeat exposure. Individuals need to have proper ventilation and to use personal protective equipment such as plastic gloves and clothing that can be removed and laundered immediately after spraying is completed.
  • Employers are required to provide protective equipment and to instruct their workers to avoid undue exposure by not applying pesticides downwind on a windy day.
Previous
 
Contributor Information and Disclosures
Author

Frances M Dyro, MD  Associate Professor of Neurology, New York Medical College; Neuromuscular Section, Department of Neurology, Westchester Medical Center

Frances M Dyro, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, and Muscular Dystrophy Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Jonathan S Rutchik, MD, MPH  Clinical Professor, Division of Occupational Medicine, Department of Neurology, Environmental and Occupational Medicine, University of California, San Francisco, School of Medicine

Jonathan S Rutchik, MD, MPH is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Occupational and Environmental Medicine, and Society of Toxicology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Neil A Busis, MD  Chief, Division of Neurology, Department of Medicine, Head, Clinical Neurophysiology Laboratory, University of Pittsburgh Medical Center-Shadyside

Neil A Busis, MD is a member of the following medical societies: American Academy of Neurology and American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Selim R Benbadis, MD  Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association

Disclosure: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Honoraria Speaking, consulting

Chief Editor

Stephen A Berman, MD, PhD, MBA  Professor of Neurology, University of Central Florida College of Medicine

Stephen A Berman, MD, PhD, MBA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, and Phi Beta Kappa

Disclosure: Nothing to disclose.

References

  1. Lotti M, Becker CE, Aminoff MJ. Organophosphate polyneuropathy: pathogenesis and prevention. Neurology. May 1984;34(5):658-62. [Medline].

  2. Sung JJ, Kim SJ, Lee HB, et al. Anticholinesterase induces nicotinic receptor modulation. Muscle Nerve. Sep 1998;21(9):1135-44. [Medline].

  3. Trojan DA, Collet JP, Shapiro S, et al. A multicenter, randomized, double-blinded trial of pyridostigmine in postpolio syndrome. Neurology. Oct 12 1999;53(6):1225-33. [Medline].

  4. Abou-Donia MB. Organophosphorus ester-induced chronic neurotoxicity. Arch Environ Health. Aug 2003;58(8):484-97. [Medline].

  5. Eddleston M, Buckley NA, Eyer P, Dawson AH. Management of acute organophosphorus pesticide poisoning. Lancet. Feb 16 2008;371(9612):597-607. [Medline].

  6. Compston JE, Vedi S, Stephen AB, et al. Reduced bone formation after exposure to organophosphates. Lancet. Nov 20 1999;354(9192):1791-2. [Medline].

  7. Alavanja MC, Hoppin JA, Kamel F. Health effects of chronic pesticide exposure: cancer and neurotoxicity. Annu Rev Public Health. 2004;25:155-97. [Medline].

  8. Eskenazi B, Maizlish NA. Effects of Occupational Exposure to Chemicals on Neurobehavioral Functioning. In: Tarter RE, Thiel DHV, Edwards KL, eds. Medical Neuropsychology: The Impact of Disease on Behavior. New York, NY: Plenum Press; 1988.

  9. Rosenstock L, Keifer M, Daniell WE, et al. Chronic central nervous system effects of acute organophosphate pesticide intoxication. The Pesticide Health Effects Study Group. Lancet. Jul 27 1991;338(8761):223-7. [Medline].

  10. Menegon A, Board PG, Blackburn AC, Mellick GD, Le Couteur DG. Parkinson's disease, pesticides, and glutathione transferase polymorphisms. Lancet. Oct 24 1998;352(9137):1344-6. [Medline].

  11. Bhatt MH, Elias MA, Mankodi AK. Acute and reversible parkinsonism due to organophosphate pesticide intoxication: five cases. Neurology. Apr 22 1999;52(7):1467-71. [Medline].

  12. Himuro K, Murayama S, Nishiyama K, et al. Distal sensory axonopathy after sarin intoxication. Neurology. Oct 1998;51(4):1195-7. [Medline].

  13. Senanayake N, Jeyaratnam J. Toxic polyneuropathy due to gingili oil contaminated with tri-cresyl phosphate affecting adolescent girls in Sri Lanka. Lancet. Jan 10 1981;1(8211):88-9. [Medline].

  14. Senanayake N, Karalliedde L. Neurotoxic effects of organophosphorus insecticides. An intermediate syndrome. N Engl J Med. Mar 26 1987;316(13):761-3. [Medline].

  15. Morgan JP, Penovich P. Jamaica ginger paralysis. Forty-seven-year follow-up. Arch Neurol. Aug 1978;35(8):530-2. [Medline].

  16. Rajapakse BN, Thiermann H, Eyer P, Worek F, Bowe SJ, Dawson AH, et al. Evaluation of the Test-mate ChE (cholinesterase) field kit in acute organophosphorus poisoning. Ann Emerg Med. Dec 2011;58(6):559-564.e6. [Medline].

  17. Maselli RA, Soliven BC. Analysis of the organophosphate-induced electromyographic response to repetitive nerve stimulation: paradoxical response to edrophonium and D-tubocurarine. Muscle Nerve. Dec 1991;14(12):1182-8. [Medline].

  18. Rutchik JS, Rutkove SB. Effect of temperature on motor responses in organophosphate intoxication. Muscle Nerve. Jul 1998;21(7):958-60. [Medline].

  19. De Luca CJ, Buccafusco JJ, Roy SH, et al. The electromyographic signal as a presymptomatic indicator of organophosphates in the body. Muscle Nerve. 2006;33(3):369-76. [Medline].

  20. Singh G, Sidhu UP, Mahajan R, et al. Phrenic nerve conduction studies in acute organophosphate poisoning. Muscle Nerve. Apr 2000;23(4):627-32. [Medline].

  21. Pawar KS, Bhoite RR, Pillay CP, Chavan SC, Malshikare DS, Garad SG. Continuous pralidoxime infusion versus repeated bolus injection to treat organophosphorus pesticide poisoning: a randomised controlled trial. Lancet. Dec 16 2006;368(9553):2136-41. [Medline].

  22. Feldman RG. Organophosphates. In: Occupational and Environmental Neurotoxicology. Philadelphia, Pa: Lippincott-Raven; 1998.

  23. Grandjean P, Landrigan PJ. Developmental neurotoxicity of industrial chemicals. Lancet. Dec 16 2006;368(9553):2167-78. [Medline].

  24. Kamel F, Engel LS, Gladen BC, et al. Neurologic symptoms in licensed private pesticide applicators in the agricultural health study. Environ Health Perspect. Jul 2005;113(7):877-82. [Medline].

  25. Ludomirsky A, Klein HO, Sarelli P, et al. Q-T prolongation and polymorphous ("torsade de pointes") ventricular arrhythmias associated with organophosphorus insecticide poisoning. Am J Cardiol. May 1982;49(7):1654-8. [Medline].

  26. Maddy KT, Edmiston S, Richmond D. Illness, injuries, and deaths from pesticide exposures in California 1949-1988. Rev Environ Contam Toxicol. 1990;114:57-123. [Medline].

  27. Savage EP, Keefe TJ, Mounce LM, et al. Chronic neurological sequelae of acute organophosphate pesticide poisoning. Arch Environ Health. Jan-Feb 1988;43(1):38-45. [Medline].

  28. Taylor P. Development of acetylcholinesterase inhibitors in the therapy of Alzheimer's disease. Neurology. Jul 1998;51(1 Suppl 1):S30-5; discussion S65-7. [Medline].

  29. Tune LE, Damlouji NF, Holland A, et al. Association of postoperative delirium with raised serum levels of anticholinergic drugs. Lancet. Sep 26 1981;2(8248):651-3. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.