title: Intermediate syndrome after exposure to chlorpyrifos in a 16-month-old girl.
abstract: We describe a case of intermediate syndrome after chlorpyrifos ingestion in a toddler, despite a continuous pralidoxime infusion. A 16-month-old girl ingested a pesticide containing chlorpyrifos. She was brought to an Emergency Department where she became lethargic and tachycardic, and subsequently developed pulmonary edema requiring mechanical ventilation. Pralidoxime 150 mg i.v. was administered twice, and an infusion begun at 15 mg/kg/h. At 24.5 h post-ingestion the child had a normal neurologic examination, showed no signs of cholinergic excess, and was extubated successfully. At 27.5 h post-ingestion the child became flaccid, bradycardic and apneic. She was emergently re-intubated. The child's delayed onset of respiratory arrest and flaccid paralysis after an asymptomatic period is consistent with Intermediate Syndrome. This is an unusual case in that it occurred in a young child, was related to chlorpyrifos, and occurred despite continuous and adequate oxime therapy.
authors.affiliation: Department of Emergency Medicine, University of Louisville, Louisville, Kentucky 40202, USA.
authors.forename: Jason E
authors.initials: JE
authors.lastname: Mattingly
authors.forename: Janice E
authors.initials: JE
authors.lastname: Sullivan
authors.forename: Henry A
authors.initials: HA
authors.lastname: Spiller
authors.forename: George M
authors.initials: GM
authors.lastname: Bosse
mesh_terms: D004390:Chlorpyrifos / Q000506:poisoning*; D002800:Cholinesterase Inhibitors / Q000506:poisoning; D002801:Cholinesterase Reactivators / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007223:Infant; D007306:Insecticides / Q000506:poisoning*; D010243:Paralysis / Q000209:etiology*; D011041:Poisoning / Q000150:complications / Q000628:therapy; D011220:Pralidoxime Compounds / Q000627:therapeutic use; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000209:etiology*
chemical_list: D002800:Cholinesterase Inhibitors; D002801:Cholinesterase Reactivators; D007306:Insecticides; D011220:Pralidoxime Compounds; D004390:Chlorpyrifos; C028797:pralidoxime