Organophosphorous poisoning and opioid intoxication
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ORGANOPHOSPHOROUS POISONING AND OPIOID INTOXICATION . Presenter : Dr. Sunil Moderator : Dr. V. Darlong . www.anaesthesia.co.in [email protected] ORGANOPHOSPHOROUS POISONING . Irreversible anticholinesterases Organo phosphates Carbamates Dyflos Carbaryl

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Organophosphorous poisoning and opioid intoxication

ORGANOPHOSPHOROUS POISONING AND OPIOID INTOXICATION

Presenter : Dr. Sunil

Moderator : Dr. V. Darlong

[email protected]


Organophosphorous poisoning

ORGANOPHOSPHOROUS POISONING


Organophosphorous poisoning and opioid intoxication

Irreversible anticholinesterases

Organo phosphates Carbamates

Dyflos Carbaryl

Echothiophate Propoxur

(Baygon)

Para, Malathion,

Diazinon (TIK 20)

Tabun, serin(Nerve gas)


Absorption

ABSORPTION

  • Inhalational

  • Dermal

  • mucous membrane

  • GIT


Mechanism of action

Mechanism of action


Organophosphorous poisoning and opioid intoxication

  • Suicidal

  • Agricultural exposure

  • nerve gas in bio warfare

    Hydrocarbon solvent


Organophosphorous poisoning and opioid intoxication

SYMPTOMS & SIGNS

  • Muscarinic

  • SLUDGE – Salivation, lacrimation, urination, diarrhoea, gastric upset, emesis

  • Miosis,

  • decreased HR, BP

  • Pulmonary edema, aspiration pneumonia

  • chemical pneumonitis, ARDS

  • Chromolachryorrhoea


Organophosphorous poisoning and opioid intoxication

  • Nicotinic

    • Skeletal Muscle

      • Fasciculation

      • Paralysis

    • Sympathetic Ganglion

      • BP

      •  HR

      • mydriasis


Organophosphorous poisoning and opioid intoxication

SYMPTOMS (Contd…)

  • CNS

  • Slurred speech, delirium, seizure coma, resp depression

  • Other

    • HONK, glucosuria, Hyperamylasemia (pancreatitis)

  • Chronic

    • Peripheral N. memory impair, depression


Organophosphorous poisoning and opioid intoxication

Fatal dose

  • Para (80mg, 175mg) Malathion (1g)

    Fatal period

  • 24 hr, 10 days

    Cause of death

  • Resp. arrest


Organophosphorous poisoning and opioid intoxication

Diagnosis

  • Plasma cholinesterase (40-140-IU/L)

    • Mild :20-50%

    • Moderate: 10-20%

    • Severe: <10 %

  • Clinical improvement preceeds decrease in levels

  • Atropinization (2mg)


Management

MANAGEMENT

  • Supportive

    • ABC, Decontamination

    • Gastric lavage (<1hr) KMnO4 1:10,000

    • Emesis : C/I

    • A:C 25g, 4 hr.ly Thrice

    • ABG, QTc 


Organophosphorous poisoning and opioid intoxication

  • Specific

    • Atropine

      • Benzyl alc

      • 2mg iv. Ev 10 m

      • Atropinizan

      • Taper slowly overs few days

  • Intermediate syndrome


Organophosphorous poisoning and opioid intoxication

  • PAM

    • Started within 24 hrs

    • 1 - 2g 100 ml NS over 30 min

    • 6 - 12 hourly, 12 g / day

    • 500 mg / hr Infusion

    • 20 - 40 mg / kg


Organophosphorous poisoning and opioid intoxication

  • Seizure

    • BZD

    • phenytoin

  • Hemoperfusion

    • Parathion


Opioids classification

Opioids - Classification

  • NaturalSynthetic

    • Morphine Morphinans - Butorphanol

    • Codiene Diphenylpropylamine - methadone

      Benzomorphan- pentazosine

      Phenylpiperidine- meperidine, fentanyl

  • Semi-synthetic

    • Heroin

    • Dihydromorphone


Opioid intoxication

OPIOID INTOXICATION

Accidental, iatrogenic, suicidal, drug abuser, body packer

Symptoms and signs

  • Resp. Depress, Coma, Pinpoint pupil, cyanosis, N/v, seizure

  • Hypotension Bradycardia pulm. Edema

  • Human fatal dose : 250 mg morphine i.m.

  • Cause of death : Resp. fail


Management1

MANAGEMENT

  • ABC, monitoring, ABG

  • Emesis C/I

  • Gastric lavage < 1hr, even injected, KMnO4 1:10,000

  • AC 25 g, 4 hrly, Thrice


Management contd

MANAGEMENT (Contd…)

Naloxone

  • 0.4 mg IV  0.8 after 2 min

  • Rept. Till recovery or total 10 mg

  • S.L. E.T, I.N

  • T ½ (30-45 m)

  • Inf. (2/3 initial dose hrly, Twice i.m. 4-5 /kg/hr)

  • Neonate 10 /kg Rpt. 2 min, 60 /kg

    Naltrexone

  • P.O. Maintenance, 25-30mg/day, T ½ 24 hrs

  • Nal mefene: T ½ 10.8 hrs, 4 mg single dose


Body packers

BODY PACKERS

  • Whole bowel irriga

  • Intestinal obst. Surgery

  • No endoscopic removal

  • ICU, monitoring- R.R. Consciouness level

    (Till all packet passed)

  • Serial CT Scan


Organophosphorous poisoning and opioid intoxication

UROD

  • Anaesthesia assisted

  • Controversial – Sudden deaths , poor supportive evidence

    (O Conner PG, Kosten TR 1998; JAMA)

[email protected]


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