Hypotension in severe dimethoate self-poisoning.
BACKGROUND
Acute self-poisoning with the organophosphorus (OP) pesticide dimethoate has a human case fatality three-fold higher than poisoning with chlorpyrifos despite similar animal toxicity. The typical clinical presentation of severe dimethoate poisoning is quite distinct from that of chlorpyrifos and other OP pesticides: many patients present with hypotension that progresses to shock and death within 12-48 h post-ingestion. The pathophysiology of this syndrome is not clear.


METHODS
We present here three patients with proven severe dimethoate poisoning. Clinically, all had inappropriate peripheral vasodilatation and profound hypotension on presentation, which progressed despite treatment with atropine, i.v. fluids, pralidoxime chloride, and inotropes. All died 2.5-32 h post-admission. Continuous cardiac monitoring and quantification of troponin T provided little evidence for a primary cardiotoxic effect of dimethoate.


CONCLUSIONS
Severe dimethoate self-poisoning causes a syndrome characterized by marked hypotension with progression to distributive shock and death despite standard treatments. A lack of cardiotoxicity until just before death suggests that the mechanism is of OP-induced low systemic vascular resistance (SVR). Further invasive studies of cardiac function and SVR, and post-mortem histology, are required to better describe this syndrome and to establish the role of vasopressors and high-dose atropine in therapy.
Davies
James
J
Department of Critical Care Medicine, Guy's and St Thomas' Hospital, London, UK.
Roberts
Darren
D
Eyer
Peter
P
Buckley
Nick
N
Eddleston
Michael
M
D000931:Antidotes / Q000627:therapeutic use; D001285:Atropine / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000627:therapeutic use; D004117:Dimethoate / Q000506:poisoning*; D006801:Humans; D007022:Hypotension / Q000139:chemically induced* / Q000503:physiopathology; D007306:Insecticides / Q000506:poisoning*; D008297:Male; D008875:Middle Aged; D011220:Pralidoxime Compounds / Q000627:therapeutic use; D013405:Suicide; D014664:Vasodilation / Q000187:drug effects
D000931:Antidotes; D002316:Cardiotonic Agents; D007306:Insecticides; D011220:Pralidoxime Compounds; D001285:Atropine; C028797:pralidoxime; D004117:Dimethoate