Early management after self-poisoning with an organophosphorus or carbamate pesticide – a treatment protocol for junior doctors

Severe organophosphorus or carbamate pesticide poisoning is an important clinical problem in many countries of the world. Unfortunately, little clinical research has been performed and little evidence exists with which to determine best therapy. A cohort study of acute pesticide poisoned patients was established in Sri Lanka during 2002; so far, more than 2000 pesticide poisoned patients have been treated. A protocol for the early management of severely ill, unconscious organophosphorus/carbamate-poisoned patients was developed for use by newly qualified doctors. It concentrates on the early stabilisation of patients and the individualised administration of atropine. We present it here as a guide for junior doctors in rural parts of the developing world who see the majority of such patients and as a working model around which to base research to improve patient outcome. Improved management of pesticide poisoning will result in a reduced number of suicides globally

The Spectrum of Intermediate Syndrome Following Acute Organophosphate Poisoning: A Prospective Cohort Study from Sri Lanka

Jayawardane and colleagues evaluate a cohort of 78 patients with organophosphate poisoning from Sri Lanka, and identify changes in repetitive nerve stimulation that precede, and may help predict, the onset of intermediate syndrome

Beat it early:putative renoprotective haemodynamic effects of oral hypoglycaemic agents

Diabetic kidney disease represents a considerable burden; around one-third of patients with type 2 diabetes develop chronic kidney disease. In health, the kidneys play an important role in the regulation of glucose homeostasis via glucose utiliza-tion, gluconeogenesis and glucose reabsorption. In patients with diabetes, renal glucose homeostasis is significantly altered with an increase in both gluconeogenesis and renal tubular re-absorption of glucose. Environmental factors, both metabolic (hyperglycaemia, obesity and dyslipidaemia) and haemo-dynamic, together with a genetic susceptibility, lead to the acti-vation of pro-oxidative, pro-inflammatory and pro-fibrotic pathways resulting in kidney damage. Hyperfiltration and its haemodynamic-driven insult to the kidney glomeruli is an im-portant player in proteinuria and progression of kidney diseas

Poisoning

Acute poisoning is one of the most common medical emergencies in the UK, accounting for 10-20% of all acute medical admissions. At least 50% involve more than one drug. with alcohol being the most frequent second agent. Substances involved in poisoning vary widely between different countries (BOX 9.1), In the UK. poisoning wilh paracetamol accounts for 48% of all overdoses, but only 7% of those in Ihe USA, and in Nepal it is very rare. Poisoning with tricyclic antidepressants, selective serotonin (5-hydroxytryprumine, 5-HT) re-uptake inhibilors and drugs of misuse is very common in Ihe UK and USA. Australia has a similar range of ingested toxins to the UK but envenoming wilh snakes. spiders und marine creatures is also very common. In South and South-east Asiua, pesticide ingestion is endemic, and constitutes the most common cause of death by poisoning. The toxicity of available poisons and the paucity of medical facilities in the developing world mean that the mortality rate for self-poisoning is high at 10-20%, compared with 0.5- 1% in most industrialised countries. Reducing deaths from self-harm requires interventions both to lower the incidence of harmful behaviour and to improve the medical management of acute poisoning

Early managment after self-poisioning with an organophosphorus or carbamate pesticide - a treatment protocol for junior doctors

Severe organophosphorus or carbamate pesticide poisoning is an important clinical problem in many countries of the world. Unfortunately, little clinical research has been performed and little evidence exists with which to determine best therapy. A cohor