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 ,Revised 4 January 2007 ,Accepted 13 February 2007.

References 

  1. Lin CL , Yang CT , Pan KY , Huang CC . Most common intoxication in nephrology ward organophosphate poisoning . Ren Fail . 2004;26:349–354
  2. Lee WC , Yang CC , Deng JF , et al.   The clinical significance of hyperamylasemia in organophosphate poisoning . J Toxicol Clin Toxicol . 1998;36:673–681
  3. Karalliedde L . Organophosphorus poisoning and anaesthesia . Anaesthesia . 1999;54:1073–1088
  4. Satoh T , Hosokawa M . Organophosphates and their impact on the global environment . Neurotoxicology . 2000;21:223–227
  5. Dharmani C , Jaga K . Epidemiology of acute organophosphate poisoning in hospital emergency room patients . Rev Environ Health . 2005;20:215–232
  6. Venkatesh S , Kavitha ML , Zachariah A , Oommen A . Progression of type I to type II paralysis in acute organophosphorous poisoning: is oxidative stress significant? . Arch Toxicol . 2006;80:354–361
  7. Senanayake N , Karalliedde L . Neurotoxic effects of organophosphorus insecticides. An intermediate syndrome . N Engl J Med . 1987;316:761–763
  8. Karalliedde L , Baker D , Marrs TC . Organophosphate-induced intermediate syndrome: aetiology and relationships with myopathy . Toxicol Rev . 2006;25:1–14
  9. Leon-S FE , Pradilla G , Vesga E . Neurological effects of organophosphate pesticides . BMJ . 1996;313:690–691
  10. Hsieh BH , Deng JF , Ger J , Tsai WJ . Acetylcholinesterase inhibition and the extrapyramidal syndrome: a review of the neurotoxicity of organophosphate . Neurotoxicology . 2001;22:423–427
  11. Mahieu P , Hassoun A , Van Binst R , Lauwerys R , Deheneffe Y . Severe and prolonged poisoning by fenthion. Significance of the determination of the anticholinesterase capacity of plasma . J Toxicol Clin Toxicol . 1982;19:425–432
  12. Gadoth N , Fisher A . Late onset of neuromuscular block in organophosphorus poisoning . Ann Intern Med . 1978;88:654–655
  13. Gutmann L , Besser R . Organophosphate intoxication: pharmacologic, neurophysiologic, clinical, and therapeutic considerations . Semin Neurol . 1990;10:46–51
  14. Smith AP . Long-term effects of the anticholinesterases sarin and soman on latencies of muscle action potentials in mouse diaphragm muscle . J Pharm Pharmacol . 1993;45:176–181
  15. De Bleecker J , Van den Abeele K , De Reuck J . Electromyography in relation to end-plate acetylcholinesterase in rats poisoned by different organophosphates . Neurotoxicology . 1994;15:331–340
  16. De Wilde V , Vogelaers D , Colardyn F , et al.   Postsynaptic neuromuscular dysfunction in organophosphate induced intermediate syndrome . Klin Wochenschr . 1991;69:177–183
  17. Shailesh KK , Pais P , Vengamma B , Muthane U . Clinical and electrophysiological study of intermediate syndrome in patients with organophosphorous poisoning . J Assoc Physicians India . 1994;42:451–453
  18. Avasthi G , Singh G . Serial neuron-electrophysiological studies in acute organophosphate poisoning–correlation with clinical findings, serum cholinesterase levels and atropine dosages . J Assoc Physicians India . 2000;48:794–799
  19. Aygun D, Doganay Z, Altintop L, Guven H, Onar M, Deniz T, et al. Serum acetylcholinesterase and prognosis of acute organophosphate poisoning . J Toxicol Clin Toxicol . 2002;40:903–910
  20. Bissbort SH , Vermaak WJ , Elias J , Bester MJ , Dhatt GS , Pum JK . Novel test and its automation for the determination of erythrocyte acetylcholinesterase and its application to organophosphate exposure . Clin Chim Acta . 2001;303:139–145
  21. Thiermann H , Szinicz L , Eyer P , Zilker T , Worek F . Correlation between red blood cell acetylcholineste rase activity and neuromuscular transmission in organo phosphate poisoning . Chem Biol Interact . 2005;157–158:345–347
  22. du Toit PW , Muller FO , van Tonder WM , Ungerer MJ . Experience with the intensive care management of organophosphate insecticide poisoning . S Afr Med J . 1981;60:227–229
  23. Aygun D . Diagnosis in an acute organophosphate poisoning: report of three interesting cases and review of the literature . Eur J Emerg Med . 2004;11:55–58
  24. Worek F , Kirchner T , Backer M , Szinicz L . Reactivation by various oximes of human erythrocyte acetylcholinesterase inhibited by different organophosphorus compounds . Arch Toxicol . 1996;70:497–503
  25. Kassa J , Cabal J . A comparison of the efficacy of a new asymmetric bispyridinium oxime BI–6 with presently used oximes and H oximes against sarin by in vitro and in vivo methods . Hum Exp Toxicol . 1999;18:560–565
  26. Willems JL , De Bisschop HC , Verstraete AG , et al.   Cholinesterase reactivation in organophosphorus poisoned patients depends on the plasma concentrations of the oxime pralidoxime methylsulphate and of the organophosphate . Arch Toxicol . 1993;67:79–84
  27. Sudakin DL , Mullins ME , Horowitz BZ , Abshier V , Letzig L . Intermediate syndrome after malathion ingestion despite continuous infusion of pralidoxime . J Toxicol Clin Toxicol . 2000;38:47–50
  28. De Bleecker J , Van den Neucker K , Colardyn F . Intermediate syndrome in organophosphorus poisoning: a prospective study . Crit Care Med . 1993;21:1706–1711
  29. Uehara S , Hiromori T , Suzuki T , Kato T , Miyamoto J . Studies on the therapeutic effect of 2-pyridine aldoxime methiodide (2-PAM) in mammals following organophosphorus compound (OP)-poisoning (report II): aging of OP-inhibited mammalian cholinesterase . J Toxicol Sci . 1993;18:179–183
  30. Eddleston M , Szinicz L , Eyer P , Buckley N . Oximes in acute organophosphorus pesticide poisoning: a systematic review of clinical trials . QJM . 2002;95:275–283
  31. Peter JV , Moran JL , Graham P . Oxime therapy and outcomes in human organophosphate poisoning: an evaluation using meta-analytic techniques . Crit Care Med . 2006;34:502–510
  32. Guven M , Sungur M , Eser B , Sari I , Altuntas F . The effects of fresh frozen plasma on cholinesterase levels and outcomes in patients with organophosphate poisoning . J Toxicol Clin Toxicol . 2004;42:617–623

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