Organo-Phosphorus and Carbamate Compounds Poisoning

• Remove poison by irrigating eye or washing skin (if in eye or on skin).
• Give activated charcoal if ingested and within 1 hour of the ingestion.
• Do not induce vomiting because most pesticides are in petrol-based solvents.
• In a serious ingestion where activated charcoal cannot be given, consider careful aspiration of stomach contents by NG tube (the airway should be protected).
• Auscultate the chest for signs of respiratory secretions and monitor respiratory rate, heart rate and coma score (if appropriate)
• Give oxygen if oxygen saturation is less than 90%

• Pharmacological

If there are signs of excess parasympathetic activation (see above) give:

Atropine, boluses of 5mg IV

o Repeat every 10minutes until satisfactory atropinization (i.e. no chest signs of secretions, HR>80b/min, Systolic BP >80mmHg, pupils no longer pinpoint, Dry axillae)
o Paediatric patient can start at 0.05mg/kg, then double the dose every five minutes, stop doubling the dose when parameters have improved
Obidoxime (a cholinestarase activator) 5mg/kg IV if <24 hours. It may be given 5minutes after the first dose of atropine, if available.

If muscle weakness gives:

Pralidoxime (cholinesterase reactivator) 50mg/kg diluted with 15 ml water for injection by IV infusion over 30 minutes

o Repeated once to twice
o Followed by 10–20 mg/kg/hour, as necessary.

Prevention

Educate the patient on Dos and Don’ts of poisoning prevention.

Do’s

• Keep medicines and poison in proper containers and out of reach of children
• Use containers with child resistant caps
• Keep all products in their original container
• Read medicine labels carefully to avoid mistake

Don’ts

• Leave container open
• Transfer products from their origin
• Remove labels from the medicine products
• Put tablets into another containers such as purse or envelope
• Medicine/tablets as sweet
• Take your medicine in front of children as they often copy

References

1. STG