title: Organophosphate poisoning presenting with muscular weakness and abdominal pain--a case report.
abstract: BACKGROUND
  Organophosphate (OP) poisoning is the most common cause (27.64%) and has the highest death rate (13.88%) of poisoning in Bangladesh. It leads to three main syndromes notably acute cholinergic syndrome, intermediate syndrome, and delayed polyneuropathy. It rarely causes cardiac arrhythmia, pancreatitis and hepatic dysfunction. We present the case of a middle-aged Asian woman suffering from organophosphate poisoning with dual complications.
  
  
  METHODS
  A middle aged Asian woman with depression was brought to emergency attention after drinking of 60 milliliter of organophosphate insecticide in a suicidal attempt. She had vomiting, excessive retching, diarrhoea, miosis, hypersalivation and bilateral crepitation on chest during admission. After immediate resuscitation, atropinization was done and it required total of 36 milligram. The patient also received pralidoxime. While on maintenance, features of toxicity re-appeared and she again required atropine in bolus dose. On the fifth day of management she complained of generalized weakness, inability to control her neck and to sit or stand without support. But there was no respiratory muscle involvement and all deep tendon reflexes were normal. On the same day the patient also developed severe upper abdominal pain along with nausea and vomiting. Investigations revealed neutrophilic leucocytosis (30,000/cubic millimeter; 86%) with high serum lipase (770 Unit/Liter) and alanine transaminase (379 Unit/Liter) and low serum potassium (3.0 millimol/Liter). On the basis of above mentioned features organophosphate induced intermediate syndrome and pancreatitis was diagnosed. The patient recovered completely with appropriate management.
  
  
  CONCLUSIONS
  Organophosphate poisonings causes up to 25% mortality worldwide. A major contributing factor for that are different complications. Awareness of these complications can reduce both mortality and morbidity. Early diagnosis of complications and timely therapeutic measures can improve prognosis.
authors.affiliation: Department of Medicine, Sylhet MAG Osmani Medical College, Sylhet, Bangladesh. mastershakil@hotmail.com.
authors.forename: Fazle Rabbi
authors.initials: FR
authors.lastname: Chowdhury
authors.forename: Md Shafiqul
authors.initials: MS
authors.lastname: Bari
authors.forename: M M Jahangir
authors.initials: MM
authors.lastname: Alam
authors.forename: Md Mustafezur
authors.initials: MM
authors.lastname: Rahman
authors.forename: Binayak
authors.initials: B
authors.lastname: Bhattacharjee
authors.forename: Junaid Abdul
authors.initials: JA
authors.lastname: Qayyum
authors.forename: Md Sohel
authors.initials: MS
authors.lastname: Mridha
mesh_terms: D015746:Abdominal Pain / Q000209:etiology*; D000328:Adult; D005260:Female; D006801:Humans; D007306:Insecticides / Q000506:poisoning*; D018908:Muscle Weakness / Q000209:etiology*; D062025:Organophosphate Poisoning / Q000150:complications* / Q000628:therapy; D013406:Suicide, Attempted; D016896:Treatment Outcome
chemical_list: D007306:Insecticides