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OJHAS Vol. 7, Issue 2: (2008
Apr-Jun) |
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| Self injection of
Dichlorvos, an Organophosphorus Compound |
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Sujeet Raina, Senior Resident,
Mahesh DM, PG student
Vivek Sood, PG student
Satinder Singh Kaushal,
Professor &
Head,
Dalip Gupta, Associate Professor,
Department of Medicine, Indira Gandhi Medical College,
Shimla – 171001 (Himachal Pradesh) |
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Address For Correspondence |
Fire Officers Building,
Stokes Place,,
Shimla (H.P) 171002
E-mail:
sujeetrashmishera@yahoo.co.in |
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Raina S, Mahesh DM, Sood V, Kaushal SS, Gupta D. Self injection of
Dichlorvos, an Organophosphorus Compound. Online J Health Allied Scs.
2008;7(2):9 |
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Submitted: April 6, 2008; Accepted:
June 20, 2008; Published: July 21, 2008 |
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| Abstract: |
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We report two patients who injected themselves
a strong organophosphate compound, dichlorvas, and showed the typical
clinical picture of organophosphate intoxication. There are very few
case reports of parenteral organophosphorous poisoning. With the appropriate
therapy, their symptoms disappeared in a few days. The cases are reported
because of unusual and interesting way of intoxication.
Key Words:
Dichlorvos, Organophosphorus poisoning, Self injection |
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Organophosphorus compounds are routinely used as pesticide in agriculture
sector, vector control and domestic purpose. These compounds are an
easy access source for suicidal purpose in India, a predominantly agrarian
country. Intoxication occurs following the absorption through gastrointestinal
tract, skin, respiratory tract and rarely by intramuscular or intravenous
route. We are reporting two cases of organophosphorus poisoning, in
an unusual way of self injection, which
is very rare and uncommon,
managed in our hospital. Both patients injected a strong dimethyl organophosphate
compound dichlorvos.
Case No: 1
A twenty four year old female health care worker was admitted with alleged
history of self injection of Nuvan (dichlorvos-76% EC), unknown amount
into a left forearm vein (Fig-1) and started having typical signs and
symptoms of organophosphate intoxication within thirty minutes of injection.
She received a loading dose of atropine followed by continous infusion
along with pralidoxime. Muscarinic and nicotinic symptoms persisted
for two days. Patient recovered fully without any feature of intermediate
syndrome or delayed polyneuropathy on follow up. Psychiatric evaluation
was done and patient was counseled and discharged on antidepressants.
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Figure-1 Picture
showing hyperemia at the site of injection in left forearm and elbow |
Case No:
2
A twenty six year male, horticulturist was admitted with alleged history
of self injection of Divax (dichlorvos-76% EC), into the left deltoid
(Fig-2) three hours back. The patient had filled a disposable syringe
with 5ml of the compound and injected approximately 3ml of the pesticide
(Fig-3). At admission patient showed muscarinic and nicotinic symptoms
like excessive salivation, lacrimation, miosis and bradycardia. Patient
was started on atropine drip and pralidoxime. The symptoms reversed
in two days and patient recovered fully without any feature of intermediate
syndrome or delayed polyneuropathy on follow up. On psychiatric evaluation
it was found to be an impulsive act and counseling was done.
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Figure-2 Picture
showing site of injection in left deltoid |
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Figure-3 Picture
showing pesticide vial and the disposable syringe used for self injection |
Organophosphorus (OP) pesticide poisoning is a worldwide problem with
deliberate self harm by poisoning reaching an epidemic proportion with
an estimated three million poisonings every year.(1)
Fatality rates of 20% are common with an estimate of 200,000 deaths
worldwide each year from pesticide poisoning.(2) India is a predominantly
agrarian country with about 60-80% rural population.(3)
Primary prevention of poisoning is difficult in India because of the
widespread use of OP pesticides by agricultural communities. While
ingestion with suicidal intent is a common mode for OP poisoning worldwide,
occupational exposure in agricultural worker engaged in spraying operations
in fields is an important modality of poisoning in India. There are
very few case reports of organophosphorus poisoning by intravenous or
intramuscular route. In one report, a patient who injected himself a
strong organophosphate compound, methamidophos, had shown the features
of acute cholinergic crisis within 30 min and had satisfactory recovery
with intermittent boluses of pralidoxime.(4) Another case of attempted
suicide in an 80 year old man by intramuscular injection in the thigh
of an organophosphate, isofenphos is also reported. He developed cholinergic
crisis five hours after injection and the signs and symptoms lasted
for 15 days probably due to slow release of OP agent into the circulation
and he required prolonged hospitalization and was given mechanical ventilation
and pralidoxime therapy.(5) In another case cholinergic crisis was
reported within 30 min of accidental intravenous monochrotophos poisoning
in a 32 year male. The patient developed intermediate syndrome and was
managed by atropine, pralidoxime and ventilatory support with full recovery.(6)
Himachal Pradesh a north Indian state has a huge apple producing horticultural
belt and organophosphorus based pesticide formulations are mainly used
to contain pest attack on the apple fruit. Thus organophosphorus compounds
are readily available in the households of orchardists and can also
be easily accessed over the counter in the country side. Dichlorvos
is a dimethyl organophosphorus pesticide compound. The solution used
for spraying on apple trees is prepared by diluting 0.5 ml of dichlorvas
in one litre of water. Deliberate self poisoning by pesticides as well
as accidental exposure is very common in this part of the country. There
is a need to educate people regarding careful use of pesticides and
develop an integrated pesticide management system.
- Jeyaratnam J. Acute
pesticide poisoning: a major global health problem. Wld Hlth Statist
Quart 1990;43:139-44.
- Eddleston M, Szinicz
L, Eyer P, etal. Oximes in acute organophosphorus poisoning: a systematic
review of clinical trials. Q J Med 2002;95:275-83
- Bawaskar HS, Joshi
SR. Organophosphorus poisoning in agricultural India-status in 2005.
J Assoc Physcians India 2005;53:422-24
- Guven M, Unluhizarci
K, Goktas Z, etal. Intravenous organophosphate injection: An unusual
way of intoxication. Hum Exp Toxicol 1997;16:279-80.
- Zoppellari R, Borron
SW, Chieregato A, etal. Isofenphos poisoning: prolonged intoxication
after intramuscular injection. J Toxicol Clin Toxicol 1997;35:401-04.
- Badhe A, Sudhakar
S. An intravenous organophosphate poisoning with intermediate syndrome:
an unusual way of intoxication. Indian J Critical Care Medicine 2006;10:191-92.
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