Table of Contents  
CASE REPORT
Year : 2013  |  Volume : 15  |  Issue : 2  |  Page : 156-158

Rodenticide poisoning in an unusual setting and its management challenges in a resource-limited setting: Report of three cases


Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria

Date of Web Publication24-Dec-2013

Correspondence Address:
Aliyu Ibrahim
Department of Paediatrics, Aminu Kano Teaching Hospital, Kano
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2276-7096.123614

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  Abstract 

Organophosphate poisoning occurs worldwide. Both sexes are equally affected and accidental poisoning is commonest between the ages of 2 and 8 years. The use of organophosphate as homemade insecticide has exposed children to the risk of organophosphate toxicity; furthermore, poor regulation of these hazardous chemicals makes them easily accessible to individuals. The case of three siblings who ate fried fish poisoned with organophosphate meant to serve as bait for rodents in the farm is reported.

Keywords: Children, organophosphate, poison


How to cite this article:
Ibrahim A. Rodenticide poisoning in an unusual setting and its management challenges in a resource-limited setting: Report of three cases. J Med Trop 2013;15:156-8

How to cite this URL:
Ibrahim A. Rodenticide poisoning in an unusual setting and its management challenges in a resource-limited setting: Report of three cases. J Med Trop [serial online] 2013 [cited 2023 Jun 4];15:156-8. Available from: https://www.jmedtropics.org/text.asp?2013/15/2/156/123614


  Introduction Top


Organophosphates have been in existence since the 1800s, but their use began in Germany in the 1920s. [1] Their application ranges from biological warfare, clinical medicine, to agriculture, [2] which make them easily accessible at homes especially in resource-limited countries where there is poor regulation in their sales, handling and usage; thereby increasing the risk of exposure and poisoning.

They are often used as insecticides and pesticides; [3] hence, places of contact often extend beyond the home up to the farm. Common organophosphates include: Ethyl parathion, methyl parathion, and malathion. [4] They are prepared in different combinations and concentrations which if not properly controlled increases the risk of poisoning; therefore, there is the need to ensure strict regulation in their labels, storage and usage. A common example of homemade organophosphates is the locally made ''otapia-pia,'' which is found in some Nigerian homes and used as insecticide and rodenticide. [5],[6] The exact combination of organophosphates and their concentration in otapia-pia preparations are usually not known by the consumer.

Organophosphate poisoning occurs worldwide, [7] ways of exposure include inhalation, eye or skin contact and ingestion. Poisoning in children may be accidental or intentional, accounting for 56.8% of childhood poisoning. [8] Accidental poisoning is commonest and occurs between the ages of 2 and 8 years with equal sex distribution. [1] They mostly occur at homes especially when these products are poorly secured and kept within reach of children and wrongly stored in soft drink bottles; hence, children mistake them for water or soft drinks. [4] Therefore, the case of three siblings who unknowingly ate organophosphate poisoned fried fish they picked in a farm en route to buy farm produce is reported.


  Case Series Top


Case 1

A 12-year-old female who was apparently well suddenly presented at the emergency pediatric unit with vomiting, diarrhea and difficulty in breathing which started about 2 h before presentation. She had several episodes of vomiting which were nonbilious; the loose stools were watery, nonmucoid, not blood stained, and with no history of fever. She had gone on an errand in the morning hours to buy farm produce with her other two siblings who also developed the same symptoms. There was no any complaint of disagreements or overt psychosocial problems. On clerking the third case that had fewer complaints, the information was obtained that they ate fried fish they picked in another farm on their way to buy farm produce and shortly afterward they all developed vomiting and diarrhea. On examination, she was afebrile with cold extremities and was severely dehydrated. She was dyspneic and tachypneic with widespread bilateral coarse crepitations. She was also tachycardic with small volume pulses and hypotensive with prolonged capillary refill time of 4 s. She was unconscious and the pupils were pin-point at presentation. On the basis of these complaints and the clinical finding and a pin-point pupil, the diagnosis of organophosphate poisoning was made. She was undressed, bathed, resuscitated with normal saline, and her vital signs normalized; she had hyperglycaemia with random blood glucose of 12 mmol/L; the blood sugar normalized at the 12 th h of admission, though insulin was not given. She had 2 mg of atropine sulphate every 20 min and was fully atropinized by the 2 nd hour of commencement. The bronchorrhea, diarrhea, and vomiting resolved at the 1st, 5 th and 10 th h respectively of commencement of atropine sulphate. Her level of consciousness progressively improved and she regained full consciousness at about the 6 th h of commencement of atropine sulphate. The farmer was contacted who confirmed that the fish was poisoned with otapia-pia which was used as bait for rodents that troubled his crops. She was discharged on the 2 nd day.

Case 2

A 10-year-old girl also ate the same fish but had lesser severity of symptoms. She complained of vomiting, diarrhea, and abdominal pain. She was conscious at presentation and was not dehydrated. She had oral rehydration solution for replacement of ongoing loss, her blood glucose was normal. She also improved and was discharged on the 2 nd day.

Case 3

The third patient was 6 years old; she also partook in eating the fish, but was asymptomatic at presentation. She was only kept for short observation and subsequently discharged home on the same day.

The possibility of suicidal intent was ruled out. The law enforcement agents were also involved, and the possibility of any criminal intent was ruled out. Both parents and the children were counseled on importance of good conduct.


  Discussion Top


The severity of signs and symptoms of organophosphate and carbamate poisoning may be influenced by the age of the patient, the type of organophosphate involved and the severity of exposure or dose of the poison taken. [1],[9] The exposure in our patients occurred following consumption of poisoned fish meant as bait for rodents. Ordinarily, children of these ages who are not mentally retarded should not pick and eat such fish (poverty not being an excuse) more so they had their meal that morning before setting out. Furthermore, the smaller child who ordinarily should have had severe disease had none; it was later realized that she had a little share of the fish, while the eldest had the largest share, this explained her being more symptomatic.

Organophosphates inhibit the activities of acetyl cholinesterase in the central and peripheral nervous systems, [7] increasing concentration of acetylcholine in synapses and neuromuscular junctions; its acute effect on muscarinic receptors has been described using the acronym ''SLUDGE'' which stands for: Salivation, lacrimation, urination, defecation, gastrointestinal distress and emesis which manifested in the first and second case. The commonest mode of exposure is via ingestion, [10] which is similar with the index cases. The predominant symptoms may vary with age of the patient; Sofer et al., [11] and Lifshitz et al., [12] reported predominance of the central nervous system depressant effect in children; while Lima and Reis [13] reported more of excessive muscarinic effect, which was similar to the observations in these cases.

Atropine sulphate was the main stay of therapy in the first case. The oximes like pralidoxime, obidoxime which are potent antidotes are not readily available in most resource-limited centers like ours. Although other drugs like clonidine, magnesium sulphate and sodium bicarbonate have been shown to improve the outcome in patients with serve poisoning, we are yet to use them in our setting. While emphasis should be on preventing the occurrence of organophosphate poisoning, there is the need to ensure that these antidotes are readily available in our health facilities because atropine does not regenerate the depleted cholinesterase and it has limited efficacy in recovery of skeletal muscle paralysis in serve poisoning. [14]

Prevention is achievable if strict regulations on the production, labeling and distribution of these products are enforced; parents should also be educated on the importance of proper handling of these hazardous chemicals, and the practice of using homemade preparations such as ''otapia-pia'' as pesticides should be discouraged. The campaign on the use of insecticide treated nets should be intensified, as it will reduce the demand for these homemade organophosphate preparations.


  Conclusion Top


Doctors working in such communities should be aware of the possibility of organophosphate poisoning occurring in atypical settings and should be familiar with their clinical features. Regulation of production and usage of these chemicals would minimize poisoning and subsequent consequences. Furthermore, there is the need for community enlightenment on the dangers of these harmful chemicals and parents should properly supervise their wards in order to avert such dangers.

 
  References Top

1.William F, Mark ER. Pediatric organophosphates toxicity. Available from: www.emedicine. medscape.com [Last accessed on 2012 Oct 12].  Back to cited text no. 1
    
2.Lawrence DT, Kirk MA. Chemical terrorism attacks: Update on antidotes. Emerg Med Clin North Am 2007;25:567-95.  Back to cited text no. 2
[PUBMED]    
3.Waddell BL, Zahm SH, Baris D, Weisenburger DD, Holmes F, Burmeister LF, et al. Agricultural use of organophosphate pesticides and the risk of non-Hodgkin's lymphoma among male farmers (United States). Cancer Causes Control 2001;12:509-17.  Back to cited text no. 3
    
4.Pat Q. Emergency preparedness. US Environmental Protection Agency. Available from: http://www.epa.gov [Last accessed on 2012 Oct 12].  Back to cited text no. 4
    
5.Okeniyi JA, Lawal OA. Accidental poisoning with otapia-pia: A local organophosphate-containing rodenticide: A Case Report. Nig Med Pract 2007;52:100-1.  Back to cited text no. 5
    
6.Umar M, Stephen SH, Abdullahi M, Garba M. Dichlorvos concentrations in locally formulated pesticide (ota-piapia) utilized in northeastern Nigeria. Sci Res Essay 2010;5:49-54.  Back to cited text no. 6
    
7.Dyro FM. Organophosphates. Available from: http://emedicine.medscape.com/article/1175139-overview#a0199 [Last accessed on 2013 Aug 6].  Back to cited text no. 7
    
8.Shivani R, Neelam G, Rakesh S, Hemant S. Acute poisoning in children: Seven year experience at a tertiary care hospital of north India. Curr Pediatr Res 2011;15:65-8.  Back to cited text no. 8
    
9.Zwiener RJ, Ginsburg CM. Organophosphate and carbamate poisoning in infants and children. Pediatrics 1988;81:121-6.  Back to cited text no. 9
[PUBMED]    
10.Dippenaar R, Diedericks RJ. Paediatric organophosphate poisoning: A rural hospital experience. S Afr Med J 2005;95:678-81.  Back to cited text no. 10
[PUBMED]    
11.Sofer S, Tal A, Shahak E. Carbamate and organophosphate poisoning in early childhood. Pediatr Emerg Care 1989;5:222-5.  Back to cited text no. 11
[PUBMED]    
12.Lifshitz M, Shahak E, Sofer S. Carbamate and organophosphate poisoning in young children. Pediatr Emerg Care 1999;15:102-3.  Back to cited text no. 12
[PUBMED]    
13.Lima JS, Reis CA. Poisoning due to illegal use of carbamates as a rodenticide in Rio de Janeiro. J Toxicol Clin Toxicol 1995;33:687-90.  Back to cited text no. 13
[PUBMED]    
14.Adebayo DO, Tanwirul H. Insecticide/organophosphate compound poisoning in children. Ann Saudi Med 1998;18:171-2.  Back to cited text no. 14
    



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