Pediatric Organophosphates Toxicity Follow-up

Updated: Apr 15, 2018
  • Author: William Freudenthal, MD; Chief Editor: Stephen L Thornton, MD  more...
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Follow-up

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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Further Inpatient Care

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  • 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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Transfer

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  • 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

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.

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Complications

Intermediate syndrome can develop 24-96 hours after exposure. [18, 19] 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. [20]

Shahar et al reported extrapyramidal parkinsonism as a complication of acute organophosphate poisoning. [21, 22] Symptoms developed 5 days after exposure and completely resolved after treatment with amantadine

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Prognosis

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  • 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. [23]

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