Organophosphates Follow-up

Updated: Nov 29, 2016
  • Author: Frances M Dyro, MD; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Follow-up

Further Outpatient Care

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  • 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.
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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).

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Inpatient & Outpatient Medications

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

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Transfer

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

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Deterrence/Prevention

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  • 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.
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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.

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Prognosis

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  • 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.
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Patient Education

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  • 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.
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