Unexpected Diagnosis in the Metropolis: Organophosphate Poisoning

Abstract

We aimed to point out that organophosphate poisoning is rarely seen in the metropolis and therefore diagnosis and treatment of these poisonings can be delayed. A 62 year old woman with a history of diabetes type II and ischemic cerebrovascular disease was admitted to the Emergency Department of Cerrahpasa Faculty of Medicine with diarrhea. During a 24-h follow-up, dysphagia, bronchorrhea and myosis were established. The patient was investigated for cholinergic symptoms due to intoxication. Toxicologic analysis was made and atropine treatment begun in the emergency room, and the patient was followed up for 10 days at the intensive care unit (ICU) without intubation. After the muscarinic symptoms improved, atropine treatment was terminated. The patient was discharged from the ICU and followed up in the service because of continual hypoxia. At the service follow-up, intermediated syndrome manifested as paralysis and respiratory distress. Hence the patient was intubated and mechanical ventilation was begun at the ICU. After the treatment, she was discharged without any sequel. In unintentional organophosphate poisoning cases, diagnosis and the treatment can be delayed because it is rare in large cities, so that the patient and their relatives are not aware of the poisoning.