Respiratory failure in organo-phosphate poisoning in childhood
Tal, A.; Bar-Ziv, J.; Sofer, S.
Harefuah 110(7): 335-337
1986
ISSN/ISBN: 0017-7768 PMID: 3732945 Document Number: 274376
During a six-year period (1979-85) 13 children were admitted because of organophosphate poisoning (OPP). Six of them, aged three months to seven years, developed acute pulmonary edema and respiratory failure. In these six, the presenting symptoms included severe respiratory distress and central nervous system manifestations, including coma and hypotonia. They were all hypoxic on admission and showed radiographic evidence of pulmonary edema without cardiomegaly. The typical muscarinic effects of OPP: salivation, sweating and overproduction of respiratory mucus, were present in only two patients, and only one had bradycardia. One infant died shortly after admission. In the remaining five children, mechanical ventilation with high oxygen concentrations (60-100%) and positive end-expiratory pressure (4-10 cm H2O) resulted in prompt and complete recovery in all except one girl who developed adult respiratory distress syndrome which lasted eight weeks and resulted in chronic lung disease. We suggest that pulmonary edema with acute respiratory failure is a frequent complication of OPP in childhood. Prompt diagnosis, specific drug therapy (atropine sulphate and obidoxime chloride) and intensive respiratory treatment are essential to reduce mortality and improve the chances of complete recovery.