She also had increased bronchial secretions and lacrimation. She was reacting to painful stimuli, light reflexes were +/+, and her respiratory rate was 32/minute. Her pupils were myotic in “pin point” shape. Her orientation to time, place and person was impaired. The aim of this study is to discuss a patient who developed atropine-induced delirium during treatment for organophosphate intoxication at intensive care unit (ICU).Ī twenty-year old female who ingested pesticide (Diazinon 60 EC®) during a suicide attempt was not conscious at time of her first examination at the emergency care unit. Majority of the cases can survive if appropriate first aids or intensive care treatments are initiated on time. Death due to organophosphate intoxication occurs most prominently between five minutes and 24 hours. Intoxication may have a very severe manifestation and has a high mortality if the response is delayed. Respiratory insufficiency arising from central respiratory depression, weakness of respiratory muscles, bronchospasm and increased bronchial secretions is a common cause of death. A combination of increased lacrimation, salivation, urination, myosis, nausea-vomiting, increased pulmonary secretion and weakness in muscles lead to a diagnosis of organophosphate intoxication. It may also cause seizures and depression in respiration center. Increased acetylcholine concentration in the CNS may lead to various symptoms ranging from headache, dizziness, anxiety, confusion to coma. Such intoxications are generally diagnosed based on the clinic manifestations and patient’s medical history. Intoxication results from overexistence of acetylcholine and it affects muscarinic, and nicotinic receptors and also central nervous system (CNS). Their oral ingestion may result in severe intoxication also intoxications of various degrees may result from their absorption through skin, mucosal membranes, conjunctiva or their uptake by inhalation. Organophosphates are among irreversible inhibitors of acetylcholinesterases and lead to acetylcholine accumulation in cholinergic receptors.ĭue to the ease of access, organophosphates are commonly used to commit suicide. They are widely used chemical agents throughout the world for agricultural purposes in order to eradicate harmful microorganisms and other plant-threatening creatures. Their structure mostly involves a paraoxon or parathion ring. Organophosphates frequently exist in herbicides and insecticides in the form of organophosphorus or carbamate. On the following day, her clinical picture completely recovered and the patient was discharged on the 6th day of admission. But her clinical condition did not improve and haloperidol drops were augmented with quetiapine tablets. She was diagnosed to have delirium and haloperidol(Norodol®, 2 mg/mL) oral drops were started. However, she was uncooperative and agitated so psychiatry department was consulted. At day 3, patient had an improvement in her general condition and therefore was extubated. At day 2, sedation was terminated and weaning protocol from mechanical ventilator was started. Activated charcoal, atropine and pralidoxim were administered intravenously. As she had a poor general condition and was suffering from respiratory distress, she was hospitalized at intensive care unit, intubated and mechanical ventilation was initiated. A twenty-year old female patient was brought to the emergency department of our hospital since she had attempted suicide by drinking pesticide. Respiratory insufficiency is a common cause of death in these patients. When there is excessive accumulation of acetylcholine, patients develope symptoms such as central respiratory depression, weakness in respiratory muscles, broncospasm, increase in bronchial secretion, and dyspnea. Organophosphates are irreversible inhibitors of acetylcholinesterases and they lead to acetylcholine accumulation in cholinergic receptors.
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