Presentation and outcomes of children admitted with organophosphate and carbamate poisoning at Rahima Moosa mother and child hospital

Abstract

BACKGROUND: Children are a vulnerable population for organophosphate and carbamate poisoning (OP/CBM). The World Health Organization reports mortality up to 10%. These agents then cause muscarinic, nicotinic and central nervous system collapse.

OBJECTIVES: To describe the demographics and clinical features of OP/CBM poisoning, document the treatment given and the response thereof. Observe the acetylcholinesterase levels in relation to clinical features and assess outcomes of the participants.

METHODS: A retrospective cross-sectional record review of patients (<14 years) presenting with OP/CBM poisoning at Rahima Moosa Mother and Child Hospital (RMMCH) from the 1st of February 2016 to the 31st of March 2018. Demographics, poisoning circumstances, clinical features, investigations, management and outcomes were analysed.

RESULTS: Over the two-year period, 28 participants were included in the study. Gender distribution was equal, and the median age was 31,5 months (Interquartile range [IQR]: 17.5-32.0). Majority was due to accidental poisoning (85%). On arrival to RMMCH, 42.9% were unconscious, displaying mostly Nicotinic (85.7%) vs Muscarinic (71.4%) symptoms. All the participants received Atropine as part of their initial treatment. Participants that had poor outcomes (i.e., demised, n=6/28, 4.7%) were more likely to require inotropes (p=0.02), suffer seizures (p=0.003) and have metabolic acidosis (p=0.02).

CONCLUSION: OP/CBM poisoning can have devastating outcomes. Improvement on trade, storage and legislation of these agents is of importance. Research on long-term effects of poisoning would be beneficial.