Management of exogenous intoxication by carbamates and organophosphates at an emergency unit.

OBJECTIVES to evaluate and indicate the procedure to be followed in the health unit, both for diagnosis and the treatment of acute exogenous intoxications by carbamates or organophosphates. METHODS a descriptive study based on retrospective analysis of the clinical history of patients diagnosed with intoxication by carbamates or organophosphates admitted at the emergency unit of the Hospital de Urgências de Sergipe Governador João Alves (HUSE) between January and December of 2012. Some criteria were evaluated, such as: intoxicating agent; patient's age and gender; place of event, cause, circumstances and severity of the intoxication; as well as signs and symptoms of the muscarinic, nicotinic and neurological effects. RESULTS seventy patients (average age: 25 ± 19.97) formed the study's population. It was observed that 77.14% of them suffered carbamate intoxication. However, organophosphate intoxications were more severe, with 68.75% of patients presenting moderate to severe forms. Suicide attempt was the leading cause of poisoning, with 62 cases (88.57% of total). Atropine administration was an effective therapeutic approach for treating signs and symptoms, which included sialorrhea (p = 0.0006), nausea (p = 0. 0029) and emesis (p < 0.0001). The use of activated charcoal was shown effective, both in combating the signs and symptoms presented by both patient groups (p < 0.0001). CONCLUSION it is concluded that the use of atropine and activated charcoal is highly effective to treat the signs and symptoms developed by patients presenting acute exogenous intoxication by carbamates or organophosphates.

[1]  Eloisa D Caldas,et al.  Intoxicação por agrotóxicos no Distrito Federal, Brasil, de 2004 a 2007 - análise da notificação ao Centro de Informação e Assistência Toxicológica , 2011 .

[2]  S. Hachimi-Idrissi,et al.  Accidental organophosphate insecticide intoxication in children: a reminder , 2011, International journal of emergency medicine.

[3]  Izonete Cristina Guiloski Estudos in vivo e in vitro dos efeitos de pesticidas em peixes nativos , 2010 .

[4]  Mágda Lúcia Félix de Oliveira,et al.  Gravidade das intoxicações por inseticidas inibidores das colinesterases no noroeste do estado do Paraná, Brasil , 2009 .

[5]  D. Pati,et al.  Poisoning severity score, APACHE II and GCS: effective clinical indices for estimating severity and predicting outcome of acute organophosphorus and carbamate poisoning. , 2009, Journal of forensic and legal medicine.

[6]  M. Lifshitz,et al.  Organophosphate and carbamate poisoning: review of the current literature and summary of clinical and laboratory experience in southern Israel. , 2008, The Israel Medical Association journal : IMAJ.

[7]  M. Yonamine,et al.  Organophosphate and carbamate poisonings in the northwest of Paraná state, Brazil from 1994 to 2005: clinical and epidemiological aspects , 2008 .

[8]  James O. J. Davies,et al.  Predicting outcome in acute organophosphorus poisoning with a poison severity score or the Glasgow coma scale. , 2008, QJM : monthly journal of the Association of Physicians.

[9]  V. K. Bhatnagar,et al.  Impairment in Clinical Indices in Acute Organophosphate Insecticide Poisoning Patients in India , 2006 .

[10]  Rosany Bochner Perfil das intoxicações em adolescentes no Brasil no período de 1999 a 2001 , 2006 .

[11]  E. C. E. Baracat,et al.  Exposições tóxicas agudas em crianças: um panorama , 2005 .

[12]  M. Recena,et al.  [Pesticide poisoning in Dourados, Mato Grosso do Sul State, Brazil, 1992/2002]. , 2005, Cadernos de saude publica.

[13]  Rene Donizeti Ribeiro Oliveira,et al.  INTOXICAÇÕES EXÓGENAS EM CLÍNICA MÉDICA , 2003 .

[14]  H. Guven,et al.  Serum Acetylcholinesterase and Prognosis of Acute Organophosphate Poisoning , 2002, Journal of toxicology. Clinical toxicology.

[15]  M. Sungur,et al.  Intensive care management of organophosphate insecticide poisoning , 2001, Critical care.

[16]  L A Fingerhut,et al.  Injury and poisoning episodes and conditions: National Health Interview Survey, 1997. , 2000, Vital and health statistics. Series 10, Data from the National Health Survey.

[17]  Al-Ali,et al.  Cardiac manifestations of acute carbamate and organophosphate poisoning. , 1997, Heart.

[18]  F. Abroug,et al.  Prognostic value of serum cholinesterase in organophosphate poisoning. , 1994, Chest.

[19]  Herlon Saraiva Martins,et al.  Intoxicações Exógenas Agudas , 2016 .

[20]  Clinical Toxicologists Position paper: Single-dose activated charcoal. , 2005 .

[21]  Mirna Albuquerque Frota,et al.  Envenenamento por carbamato em crianças: Estudo descritivo , 2004 .

[22]  Ana Claudia Corrêa Moraes Contribuiçäo para o estudo das intoxicaçöes por carbamatos: o caso do "chumbinho" no Rio de Janeiro , 1999 .

[23]  J. A. Vale,et al.  Position statement: gastric lavage. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists. , 1997, Journal of toxicology. Clinical toxicology.

[24]  P. Chyka,et al.  Position statement: single-dose activated charcoal. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists. , 1997, Journal of toxicology. Clinical toxicology.