title: A mixture of organophosphate and pyrethroid intoxication requiring intensive care unit admission: a diagnostic dilemma and therapeutic approach.
abstract: The illegal mixing of organophosphates and pyrethroids in marketed agriculture insecticides is becoming prevalent in developing countries. Over a 12-mo period, 8 patients were admitted to the emergency department of a university hospital in Dharan, Nepal after ingestion of such a mixture with suicidal intent. All patients presented with a combination of miosis, bradycardia, tachypnea, and unconsciousness. The occurrence of both pupillary dilation after a small-dose infusion of atropine (0.08 to 0.2 mg/kg in 1-3 h) and seizures raised the possibility of pyrethroid poisoning. In each case, an examination of the insecticide container confirmed that it contained a mixture of organophosphate and pyrethroid. After seizure control, gastric lavage, respiratory support, hemodynamic stabilization and diuresis, seven of the patients recovered without neurological deficit. One patient suffered aspiration pneumonia and died. The early clinical picture after this mixed poisoning is based on the toxicity of organophosphates rather than pyrethroids. Because the patients responded to a small dose of atropine with mydriasis and tachycardia, it suggested a mixed poisoning. Early suspicion of mixed poisoning may have a significant prognostic impact.
authors.affiliation: Department of Anesthesiology and Critical Care, BP Koirala Institute of Health Sciences, Dharan, Nepal. mukesh_tripathi@yahoo.com
authors.forename: Mukesh
authors.initials: M
authors.lastname: Tripathi
authors.forename: Rajesh
authors.initials: R
authors.lastname: Pandey
authors.forename: Sushil P
authors.initials: SP
authors.lastname: Ambesh
authors.forename: Mamta
authors.initials: M
authors.lastname: Pandey
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007306:Insecticides / Q000506:poisoning*; D007362:Intensive Care Units; D008297:Male; D008743:Methyl Parathion / Q000506:poisoning*; D008875:Middle Aged; D009570:Nitriles / Q000506:poisoning*; D011041:Poisoning / Q000175:diagnosis / Q000628:therapy; D011722:Pyrethrins / Q000506:poisoning*
chemical_list: D007306:Insecticides; D009570:Nitriles; D011722:Pyrethrins; D008743:Methyl Parathion; C037304:cyhalothrin