Tzu Chi Medical Journal
Volume 19, Issue 3 , Pages 159-163, September 2007

Intermediate Syndrome After Organophosphate Ingestion

  • Yen-Ta Huang

      Affiliations

    • Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
    • Department of Emergency Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
    • Institute of Toxicology and Pharmacology, Tzu Chi University, Hualien, Taiwan
    • Corresponding Author InformationCorresponding author. Department of Internal Medicine, Buddhist Tzu Chi General Hospital, 707, Section 3, Chung Yang Road, Hualien, Taiwan
    • ,
  • Pei-Chun Lai

      Affiliations

    • Department of Pediatrics, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
    • Integrative Physiology and Clinical Sciences, Tzu Chi University, Hualien, Taiwan
    • ,
  • Chien-Yu Su

      Affiliations

    • Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
    • ,
  • Yi-Ting Chen

      Affiliations

    • Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
    • ,
  • Chuan-Zhong Cai

      Affiliations

    • Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
    • ,
  • Chih-Hsien Wang

      Affiliations

    • Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
    • Medical Informatics, Tzu Chi University, Hualien, Taiwan

Received 21 December 2006; received in revised form 4 January 2007; accepted 13 February 2007.

Article Outline

Abstract 

Organophosphate poisoning is not uncommon in Taiwan. However, no case of intermediate syndrome (IMS) has been published. We report a case of delayed-onset IMS presenting with abrupt respiratory failure following the acute cholinergic crisis of phenthoate poisoning. Based on electrophysi-ological studies from the literature, IMS results from an excess amount of acetylcholine at neuromuscular junction nicotinic acetylcholine receptors due to prolonged inhibition of acetylcholinesterase. This phenomenon leads to downregulation of the acetylcholine receptor and promotes muscle weakness. There are still no appropriate parameters to predict the development of IMS. Perhaps electrophysiological studies can be applied in the future. Ventilatory support is the most important treatment; the benefits of pra-lidoxime treatment are still controversial. IMS is still a challenging complication of organophosphate poisoning. Physicians should not overlook IMS.

Keywords:  Intermediate syndrome , Organophosphate poisoning , Phenthoate

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PII: S1016-3190(10)60009-2

doi:10.1016/S1016-3190(10)60009-2

Tzu Chi Medical Journal
Volume 19, Issue 3 , Pages 159-163, September 2007

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