A farmer with pinpoint pupils, increased secretions and urination. What is the most likely diagnosis?
Organophosphate poisoning
Opioid poisoning
Alcohol poisoning
Atropine poisoning
The above clinical findings are suggestive of OPC poisoning. Organophosphate poisoning (OPC poisoning) - OPC compounds - Parathion (follidol) Methyl parathion Malathion HETP, TEPP Diazinon (Tik 20) Smell - Kerosene like (due to presence of Aromax) MOA - Inhibits Acetylcholinesterase enzyme Clinical features - Muscarinic Nicotinic 'SLUDGE BBB' Monday - Mydriasis S - Salivation Tuesday - Tachycardia L - Lacrimation (Red tears) Wednesday - Weakness of muscles U - | Urination Thursday - Hypeension D - Diarrhoea Friday - Fasciculations G - GIT upset E - Emesis B - Bronchospasm B - Blurring of vision (Constricted pupil) B - Bradycardia Diagnosis - Check the Cholinesterase enzyme levels - True Cholinesterase (RBC) Pseudocholinesterase - Correlates with Clinical features - Sensitive 2. Para nitrophenol test - Done for Parathion poisoning Rx - Decontamination Atropine i.v (Blocks the muscarinic effects) Oximes (Acetylcholinesterase enzyme reactivator) - Pralidoxime Suppoive Rx
FMGE 2019