Organophosphate Toxicity Follow-up

Updated: Sep 05, 2017
  • Author: Kenneth D Katz, MD, FAAEM, ABMT; Chief Editor: Sage W Wiener, MD  more...
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Follow-up

Further Inpatient Care

Because of risks of respiratory compromise or recurrent symptoms, hospitalizing all symptomatic patients for at least 48 hours in a high acuity setting is recommended. Patients who are asymptomatic 12 hours after organophosphate exposure can be discharged since symptom onset should usually occur within this time frame.

Optimal recommendations are made on a case-by-case scenario. Consider discussing each case with a medical toxicologist or the regional poison center (1-800-222-1222).

Following occupational exposure, patients should not be allowed to return to work with organophosphates until serum cholinesterase activity returns to 75% of the known baseline level. Also, establishing baseline cholinesterase levels for workers with known organophosphate exposure is recommended. [29]

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Deterrence/Prevention

Health care providers must avoid contaminating themselves while handling patients poisoned by organophosphates. The potential for cross-contamination is highest in treating patients after massive dermal exposure.

Use personal protective equipment, such as neoprene or nitrile gloves and gowns, when decontaminating patients because hydrocarbons can penetrate nonpolar substances such as latex and vinyl. Use charcoal cartridge masks for respiratory protection when caring for patients with significant contamination.

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Patient Education

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Prognosis

In a study of acute organophosphate insecticide poisoning in which 12 of the 71 patients died, multivariate logistic regression analysis identified the following as independent factors indicating a poor prognosis [30] :

  • High 6-hour post-admission blood lactate levels
  • Low blood pH
  • Low post-admission 6-hour lactate clearance rates
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