642-650
Organophosphorus
pesticide poisoning causes tens of thousands of deaths each year across the
world. Poisoning includes acute cholinergic crisis as a result of AChE
inhibition, intermediate syndrome (IMS) due to neuromuscular necrosis and
organophosphate-induced delayed neuropathy (OPIDN) due to inhibition of
neuropathy target esterase (NTE). Standard treatment for acute poisoning
involves administration of intravenous atropine, oxime 2-PAM to counter AChE
inhibition and diazepam for CNS protection. However clinical trials showed
ineffectiveness of the standard therapy regimen. Although new oximes that can
reactivate both peripheral and cerebral AChE and other prophylactic agents such
as human serum butyrylcholinesterase (Hu BChE), sodium bicarbonate, huperzine A (a reversible ChE inhibitor) with imidazenil
(a GABAA receptor modulator) have been proved effective in animal models,
systematic clinical trials in patients are warranted. For IMS which is
non-responsive to standard therapy, supportive therapy specifically artificial
respiration followed by recovery is indicated. For OPIDN
which has a different target (NTE) than AChE, standard therapy is ineffective.
However neuroprotective drugs such as corticosteroids proved partially
effective. Pretreatment with protease inhibitor PMSF has been shown to protect
the aging of NTE and prevent the development of delayed symptoms in hens. Since
the biology of NTE is being explored, new pharmacological agents should be
developed in future. OP pesticide poisoning is a serious condition that needs
rapid diagnosis and treatment. Since respiratory failure is the major reason
for mortality, artificial respiration, careful monitoring, appropriate
treatment and early recognition of OP pesticide poisoning may decrease the
mortality rate among these patients.
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