Anticholinesterase Substances Poisoning

Abstract

İntroduction: Acute anticholinesterase pesticide poisoning is an important global public health problem. Approximately 350,000–440,000 annual suicides by means of deliberate pesticide poisoning have been estimated to occur worldwide. The numbers of victims of non-fatal pesticide poisoning are assumed to be much greater. However, pesticide poisoning can be prevented and minimized by proper interventions such as regulatory legislation, safety education and improving patient care.
Methodology: The aim of this retrospective study is to present data regarding the epidemiology and clinical management of anticholinesterase substances poisoning admitted to the Clinical Toxicology Center (CTC), that we collected during the 12 years period (2009-2020).
Results: In the study period 26,132 patients were hospitalized at the CTC, and there were 23,233 patients treated for poisoning by various toxic agents, and among them 562 cases (2.4%) due to organophosphate pesticides intoxication (OPI). In this period, 68.7% of OPI treated in the CTC were suicidal by intention, while others were due to accidental or occupational ingestion or inhalation. The most common clinical signs of poisoning in patients exposed to anticholinesterase pesticides were miosis (99%), bradycardia (92%) and bronchorrhoea (89%). There were 97 (17,2%) most severely poisoned patients with convulsions, respiratory failure and coma required intubation and controlled ventilation.
Besides general supportive measures (decontamination, respiratory support), specific pharmacological treatment (atropine and diazepam) was applied. Oximes were not applying due to their unavailability in Azerbaijan
The highest total administered dose of atropine at CTC was 1000 mg. However, the most patients received total doses of atropine up to 200 mg.
Conclusion: Acute poisoning with anticholinesterase pesticides is not frequent in Azerbaijan, however, it represents important clinical feature due to severity, possible complications and their impact on duration and costs of hospitalization. The Clinical Toxicology Centre in Baku, in addition to treatment of acute poisonings, continuously performs toxicovigilance actions to identification, investigation and evaluation of various toxic risks in the community, developing and implementation of measures aimed at racing public awareness about the prevention of pesticide poisoning