In this presentation we look at the common organophosphate compounds in our set up, how they lead to poisoning and how possibly we can manage the poisoned patient

Organophosphate poisoning

1. Organophosphate Poisoning Common Household Compounds in Kenya & Management Prepared by Benedict Otieno Ogola

2. Common Organophosphates in Kenya - Chlorpyrifos (Dursban, Pyrinex) - Diazinon (Basudin) - Malathion (Malix, Fyfanon) - Dimethoate (Rogor) - Dichlorvos (DDVP, Nuvan) - Phosmet (Prolate) - Fenitrothion (Sumithion)

3. Mechanism of Toxicity - Inhibits acetylcholinesterase → Accumulation of acetylcholine - Leads to overstimulation of muscarinic, nicotinic, and CNS receptors - Results in cholinergic crisis (SLUDGE symptoms)

4. Clinical Features of OP Poisoning **Muscarinic Effects (SLUDGE-BBB):** - Salivation, Lacrimation, Urination, Diarrhea, GI upset, Emesis - Bronchospasm, Bradycardia, Blurred vision **Nicotinic Effects:** - Muscle fasciculations, Weakness, Hypertension **CNS Effects:** - Anxiety, Seizures, Coma, Respiratory depression

5. Diagnosis of OP Poisoning - History of exposure (pesticides, insecticides, fumigants) - Clinical presentation (SLUDGE symptoms, seizures, respiratory failure) - Decreased serum cholinesterase levels - Garlic-like odor from breath (specific for OPs)

6. Management of OP Poisoning - **Airway, Breathing, Circulation (ABC)** - **Atropine:** 1-2 mg IV every 5-15 minutes until secretions dry - **Pralidoxime (2-PAM):** 30 mg/kg IV over 30 minutes - **Benzodiazepines:** For seizures - **Activated charcoal:** If ingestion was <1 hour ago - **Supportive care:** Oxygen, fluids, ventilation if needed

7. Prevention & Public Health Concerns - Safe storage of pesticides away from children - Use of personal protective equipment (PPE) during handling - Proper disposal of OP containers - Awareness programs on OP toxicity - Regulation & banning of highly toxic OPs