A Study of Clinical Features, Management and Outcome of Organophosphate and Carbamate Poisoning in Children

Introduction: Organophosphates (OP) are commonly used pesticides in rural agricultural regions of Nepal and carbamates are popular household insecticides. Because of poor legislation these poisons are easily accessible and are the most popular suicidal poisons. Materials and Methods: This was a retrospective study done in poisoning cases admitted in PICU of Manipal Teaching Hospital (MTH) over a seven year period. Results: Out of 187 cases of poisoning, 30 (16.04%) were OPs and 4 (2.13%) were Carbamates. The male to female ratio was 56:44 and these poisonings were more common in rural areas (56%). Accidental poisoning (82.4%) was more common but suicidal attempts (17.6%) were also observed. Atropine and pralidoxime were used in 82.4% of the cases. The total atropinizing dose was 0.77±0.6 mg/kg and patients required 56.6±23.7 hours of atropinization. In our study 94.1% of the patients survived and none of them developed any sequel. Children developed muscarinic, nicotinic and CNS symptoms similar to adults. Complications were seen in 41.1% of the children and most common being seizure (85.7%). The most common OP observed in childhood poisoning was Metacid (methyl parathion) seen in 26.4% of the cases. Conclusion: OP and Carbamate poisonings are common in children. Possibility of self-harm poisoning in adolescent females cannot be ignored. Atropine is the mainstay of therapy after initial resuscitation and complications are common in children. With prompt treatment the outcome is good even with complications. The case fatality rate is much less as compared to adults. DOI: http://dx.doi.org/10.3126/jnps.v33i2.7799 J Nepal Paediatr Soc. 2013; 33(2):85-90