Clinical findings and cholinesterase levels in children of organophosphates and carbamates poisoning.
BACKGROUND
Exposure to organophosphate and carbamate insecticides inhibits cholinesterase activity and interferes with synaptic transmission both centrally and peripherally at muscarinic receptors and nicotinic receptors. The study reported the usefulness of plasma cholinesterase ChE activity assays for diagnosis and the management of organophosphate and carbamate toxicity in children.


METHODS
A retrospective study was conducted on children with organophosphate and carbamate poisoning. Forty-seven patients were included. The diagnosis was confirmed by measuring plasma cholinesterase levels. Atropine was given intravenous (0.02 mg/kg) and repeated until secretions were controlled. Obidoxime chloride was administered as 4-8 mg/kg/dose for children with organophosphate poisoning and to those in whom the ingested material was unidentified on admission.


CONCLUSIONS
Most of the patients showed marked reactivation in plasma ChE within several hours and recovered completely within 24 h of admission. Complications were observed in 17 patients (36%). Mechanical ventilatory support was required in six patients. The duration intensive care stay was 3 +/- 2.4 days.


CONCLUSIONS
Low plasma ChE levels support the diagnosis of insecticides poisoning, but no significant association is present between the severity of poisoning and plasma ChE levels. Atropine should be used as soon as possible to counteract the muscarinic effects. Appropriate management and early recognition of the complications may decrease the mortality rate.
El-Naggar
Abd El-Rahman
Ael-R
National Center for Clinical and Environmental Toxicology, Faculty of Medicine, Cairo University, Cairo, Egypt.
Abdalla
Mohammed Shehata
MS
El-Sebaey
Alaa S
AS
Badawy
Sayed M
SM
D000293:Adolescent; D001285:Atropine / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D002219:Carbamates / Q000506:poisoning*; D002648:Child; D002675:Child, Preschool; D002801:Cholinesterase Reactivators / Q000627:therapeutic use; D002802:Cholinesterases / Q000097:blood*; D042241:Early Diagnosis; D004534:Egypt / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D007306:Insecticides / Q000506:poisoning*; D008297:Male; D009768:Obidoxime Chloride / Q000627:therapeutic use; D062025:Organophosphate Poisoning; D011041:Poisoning / Q000150:complications / Q000175:diagnosis / Q000401:mortality; D011237:Predictive Value of Tests; D012121:Respiration, Artificial; D012189:Retrospective Studies
D015415:Biomarkers; D002219:Carbamates; D002801:Cholinesterase Reactivators; D007306:Insecticides; D009768:Obidoxime Chloride; D001285:Atropine; D002802:Cholinesterases