We report two patients who injected themselves a strong organophosphate compound, dichlorvas, and showed the typical clinical picture of organophosphate intoxication. There are very few case reports of parenteral organophosphorous poisoning. With the appropriate therapy, their symptoms disappeared in a few days. The cases are reported because of unusual and interesting way of intoxication

DM, Mahesh

Gupta, Dalip

Kaushal, Satinder Singh

Raina, Sujeet

Sood, Vivek

English

Sujeet Raina

Mahesh DM

Vivek Sood

Satinder Singh Kaushal

Dalip Gupta

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Self injection of Dichlorvos, an Organophosphorus Compound

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Peer Reviewed, Open Access, Free
Published Quarterly
Mangalore, South India
ISSN 0972-5997
Volume 7, Issue 2; Apr-Jun 2008
Self injection of Dichlorvos, an Organophosphorus Compound   
Authors
Sujeet Raina, Senior Resident,
Mahesh DM, PG student
Vivek Sood, PG student
Satinder Singh Kaushal, Professor & Head,
Dalip Gupta, Associate Professor,
Department of Medicine, Indira Gandhi Medical College, Shimla – 171001 (Himachal Pradesh)
Address For Correspondence
Dr Sujeet Raina,
Fire Officers Building,
Stokes Place,,
Shimla (H.P) 171002
E-mail: sujeetrashmishera@yahoo.co.in
Citation
Raina  S,  Mahesh  DM,  Sood  V,  Kaushal  SS, Gupta  D.  Self  injection  of  Dichlorvos,  an  Organophosphorus 
Compound. Online J Health Allied Scs. 2008;7(2):9
URL
http://www.ojhas.org/issue26/2008-2-9.htm
http://ojhas.org 1
OJHAS  Vol 7 Issue 2(9) Raina S, Mahesh DM, Sood V, Kaushal SS, Gupta D. Self injection of Dichlorvos, an Organophosphorus Compound. 
 Case Report
Submitted: April 6, 2008; Accepted: June 20, 2008; Published: July 21, 2008
Abstract:
We report two patients who injected themselves a strong organophosphate compound, dichlorvas, and showed the typical 
clinical picture of organophosphate intoxication. There are very few case reports of parenteral organophosphorous 
poisoning. With the appropriate therapy, their symptoms disappeared in a few days. The cases are reported because of 
unusual and interesting way of intoxication.
Key Words: Dichlorvos, Organophosphorus poisoning, Self injection
Introduction: 
Organophosphorus compounds are routinely used as pesti-
cide in agriculture sector, vector control and domestic pur-
pose. These compounds are an easy access source for sui-
cidal  purpose in India, a predominantly agrarian country. 
Intoxication occurs following the absorption through gas-
trointestinal tract, skin, respiratory tract and rarely by in-
tramuscular  or  intravenous  route.  We are  reporting  two 
cases of organophosphorus poisoning,  in an unusual  way 
of self injection, which is very rare and uncommon, man-
aged  in  our  hospital.  Both  patients  injected  a  strong 
dimethyl organophosphate compound dichlorvos.
Case Report:
Case No: 1
A twenty four year old female health care worker was ad-
mitted  with  alleged  history  of  self  injection  of  Nuvan 
(dichlorvos-76% EC), unknown amount into a left forearm 
vein (Fig-1) and started having typical signs and symptoms 
of  organophosphate intoxication within  thirty  minutes of 
injection. She received a loading dose of atropine followed 
by continous  infusion along with pralidoxime.  Muscarinic 
and nicotinic symptoms persisted for two days. Patient re-
covered  fully  without  any  feature  of  intermediate  syn-
drome or delayed polyneuropathy on follow up. Psychiatric 
evaluation was done and patient was counseled and dis-
charged on antidepressants. 
Figure-1 Picture showing hyperemia at the site of in-
jection in left forearm and elbow
Case No: 2
A twenty six year male, horticulturist was admitted with al-
leged history of self injection of Divax (dichlorvos-76% EC), 
into the left deltoid (Fig-2) three hours back. The patient 
had filled a disposable syringe with 5ml of the compound 
and injected approximately 3ml of the pesticide (Fig-3). At 
admission patient showed muscarinic and nicotinic symp-
toms  like  excessive  salivation,  lacrimation,  miosis  and 
bradycardia. Patient was started on atropine drip and prali-
doxime. The symptoms reversed in two days and patient 
recovered fully without  any feature  of  intermediate  syn-
drome or delayed polyneuropathy on follow up. On psychi-
atric  evaluation it was found to be an impulsive act and 
counseling was done. 
Figure-2 Picture showing site of injection in left deltoid
Figure-3 Picture showing pesticide vial and the dispos-
able syringe used for self injection
Discussion:
Organophosphorus (OP) pesticide poisoning is a worldwide 
problem with deliberate self harm by poisoning reaching 
an  epidemic  proportion  with  an  estimated three  million 
poisonings every year.(1) Fatality rates of 20% are common 
with an estimate of 200,000 deaths worldwide each year 
from pesticide poisoning.(2) India is a predominantly agrar-
ian country with about 60-80% rural population.(3) Primary 
prevention of poisoning is difficult in India because of the 
widespread use of OP pesticides by agricultural communi-
ties. While ingestion with suicidal intent is a common mode 
for OP poisoning worldwide, occupational exposure in agri-
cultural worker engaged in spraying operations in fields is 
http://ojhas.org 2
OJHAS  Vol 7 Issue 2(9) Raina S, Mahesh DM, Sood V, Kaushal SS, Gupta D. Self injection of Dichlorvos, an Organophosphorus Compound. 
an important modality of poisoning in India. There are very 
few case reports of organophosphorus poisoning by intra-
venous  or  intramuscular  route.  In  one  report,  a  patient 
who  injected  himself  a  strong  organophosphate  com-
pound, methamidophos, had shown the features of acute 
cholinergic crisis within 30 min and had satisfactory recov-
ery  with  intermittent  boluses  of  pralidoxime.(4)  Another 
case of attempted suicide in an 80 year old man by intra-
muscular  injection  in  the  thigh  of  an  organophosphate, 
isofenphos is also reported. He developed cholinergic crisis 
five hours after injection and the signs and symptoms last-
ed for 15 days probably due to slow release of OP agent 
into the circulation and he required prolonged hospitaliza-
tion and was given mechanical ventilation and pralidoxime 
therapy.(5) In another case cholinergic crisis was reported 
within 30 min of accidental intravenous monochrotophos 
poisoning in a 32 year male. The patient developed inter-
mediate  syndrome and  was  managed  by  atropine,  prali-
doxime and ventilatory support with full recovery.(6)
Himachal  Pradesh a north Indian state has a huge apple 
producing horticultural belt and organophosphorus based 
pesticide formulations are mainly used to contain pest at-
tack  on  the  apple  fruit.  Thus  organophosphorus  com-
pounds  are  readily  available  in  the  households  of  or-
chardists and can also be easily accessed over the counter 
in the country side. Dichlorvos is a dimethyl organophos-
phorus pesticide compound. The solution used for spraying 
on apple trees is prepared by diluting 0.5 ml of dichlorvas 
in one litre of water. Deliberate self poisoning by pesticides 
as well as accidental exposure is very common in this part 
of the country. There is a need to educate people regard-
ing  careful  use  of  pesticides  and  develop  an  integrated 
pesticide management system.
References:
1. Jeyaratnam J. Acute pesticide poisoning: a major 
global health problem. Wld Hlth Statist Quart  
1990;43:139-44.
2. Eddleston M, Szinicz L, Eyer P, etal. Oximes in acute 
organophosphorus poisoning: a systematic review of 
clinical trials. Q J Med 2002;95:275-83 
3. Bawaskar HS, Joshi SR. Organophosphorus poisoning 
in agricultural India-status in 2005. J Assoc Physcians  
India 2005;53:422-24
4. Guven M, Unluhizarci K, Goktas Z, etal. Intravenous 
organophosphate injection: An unusual way of in-
toxication. Hum Exp Toxicol 1997;16:279-80.
5. Zoppellari R, Borron SW, Chieregato A, etal. Isofen-
phos poisoning: prolonged intoxication after intra-
muscular injection. J Toxicol Clin Toxicol 
1997;35:401-04.
6. Badhe A, Sudhakar S. An intravenous organophos-
phate poisoning with intermediate syndrome: an 
unusual way of intoxication. Indian J Critical Care  
Medicine 2006;10:191-92.
http://ojhas.org 3
OJHAS  Vol 7 Issue 2(9) Raina S, Mahesh DM, Sood V, Kaushal SS, Gupta D. Self injection of Dichlorvos, an Organophosphorus Compound. 


Acute pesticide poisoning: a major global health problem.

An intravenous organophosphate poisoning with intermediate syndrome: an unusual way of intoxication.

Intravenous organophosphate injection: An unusual way of intoxication. Hum Exp Toxicol

Isofenphos poisoning: prolonged intoxication after intramuscular injection.

Organophosphorus poisoning in agricultural India-status in

Oximes in acute organophosphorus poisoning: a systematic review of clinical trials.

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Self injection of Dichlorvos, an Organophosphorus Compound

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