o p poisoning - DM SEMINAR August 18, 2006 Organophosphate...

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Organophosphate poisoning: current management strategies. R.SRINIVAS Department of Pulmonary Medicine DM SEMINAR August 18, 2006
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Organophosphate poisoning: Magnitude of problem. WHO estimates acute pesticide poisonings at 3 million cases/ year. I million accidental & 2 million suicidal; likely underestimate 300,000 deaths/ year >99% occur in the developing world. Organophosphate agents commonly used as pesticides. These agents responsible for over 70% of the cases in most of South Asia. Most deaths may occur at home, small towns. Hospital statistics gross underestimate Four fold increase in mortality in the last years. Senananayake. Hum Exp Toxicol 1995; 14: 808-811 Eddleston M. Self poisoning with pesticides. BMJ 2004, 328:42-44
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The case fatality for self-poisoning in the developing world is commonly 10–20%, For particular pesticides it may be as high as 50–70% Contrasts with the less than 0.3% case fatality ratio normally found for self- poisoning from all causes in Western countries. The causes of the high case fatality are multifactorial 1. the high toxicity of locally available poisons, 2. difficulties in transporting patients across long distances to hospital, 3. the paucity of health care workers compared with the large numbers of patients, and 4. the lack of facilities, antidotes, and training for the management of pesticide- poisoned patients A large cohort of 10,000 cases of OP poisoning & carbamate ongoing in north central Sri lanka 6000 already recruited to standardized protocol Eddleston M Critical Care 2004, 8:R391-R397
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PGI emergency data . 15 year data 1990-2004 Unpublished thesis data. . Ongoing retrospective study of number of poisoning admissions to PGIMER Emergency services. Data reflective only of number requiring admissions. EMOPD excluded. Bias toward organophosphate poisoning likely. Also might overestimate mortality data. Total number of poisonings admitted: 1420 Total number of organophosphate poisonings admitted: 557 Admission as percentage of total: 39.2% Outcome Data available for 483 cases. Number alive/discharged: 397( 82.2%) Mortality: 86( 17.8%)
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RICU Data. 8 years data (1998-2005) 1290 admissions. Number of poisonings admitted to RICU: 82 Number of organophosphate poisonings: 52(63%) Number died: 8(15%) Unpublished data Data collected as part of data analysis.
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Forensic autopsy data. A 25 year (1977–2002) autopsy study of 5933 unnatural fatalities Abrupt rise in unnatural deaths (3050; 51.4%) since 1997. 84.2% subjects were between the age group of 16 and 45 Accidental deaths (79.3%) constituted the majority of unnatural fatalities followed by suicidal (13.9%) and homicidal (6%) deaths. Between 1977 and 1987 , poisoning data. Barbiturates (33.3%)
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o p poisoning - DM SEMINAR August 18, 2006 Organophosphate...

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