INTENSIVE CARE MANAGEMENT OF ORGANOPHOSPHATE INSECTICIDE POISONING: A RETROSPECTIVE STUDY

Abstract

Background: Organophosphate (OP) insecticide poisoning is a major cause of preventable morbidity and mortality in developing countries, particularly in agrarian regions like the Kashmir valley. Both suicidal and accidental exposures are common due to the widespread availability of these compounds. Organophosphates inhibit acetylcholinesterase, leading to excessive cholinergic activity manifested as muscarinic, nicotinic, and central nervous system effects. Management in the intensive care unit (ICU) focuses on rapid decontamination, administration of antidotes such as atropine and pralidoxime, ventilatory support, and meticulous hemodynamic stabilization. Despite advances in critical care, outcomes depend heavily on early recognition and timely intervention. Aim: The present retrospective study was undertaken to assess the clinical profile, management strategies, and outcomes of patients admitted with organophosphate insecticide poisoning at Government Medical College Srinagar over a two-year period.

Methods: A retrospective observational study was carried out on 42 patients diagnosed with organophosphate poisoning between January 2023 and December 2024. Data were collected from ICU records regarding demographic details, route and intent of exposure, clinical features, laboratory findings, atropine and pralidoxime dosages, need for ventilatory support, ICU stay duration, and outcomes. Data analysis was performed using SPSS version 25.0, with results expressed as mean ± standard deviation for continuous variables and percentage for categorical variables. Results:  A total of 42 patients were included, with 16 males (38.1%) and 26 females (61.9%), and a mean age of 36.5 ± 11.8 years. Suicidal ingestion accounted for most exposures (85.7 percent), and the mean time to hospital arrival was 6.4 ± 3.1 hours. The most common clinical features were miosis (90.4%), excessive salivation (76.1%), fasciculations (61.9%), respiratory distress (55.9%), and bradycardia (95.2%). Atropine was administered to 40 patients, and pralidoxime was given to all 42 patients. Mechanical ventilation was required in 19 patients (45.2%), with a mean duration of 7.4 ± 3.6 days, while the mean ICU stay was 9.6 ± 4.8 days. Respiratory failure (47.6%) and aspiration pneumonia (16.7%) were the most frequent complications. Overall survival was 81.0 percent, whereas mortality was 19.0%, with a higher death rate among those presenting more than 6 hours after ingestion. Conclusion: Organophosphate poisoning remains a significant medical emergency requiring prompt ICU-based management. Early atropinization, adequate oxime therapy, and timely ventilatory support significantly improve survival outcomes. The study highlights the need for early referral, better community awareness about pesticide hazards, and stringent control over organophosphate distribution to minimize poisoning incidents.