Isofenphos poisoning: prolonged intoxication after intramuscular injection

Treatment methods following suicidal self-administration of IV organophosphate: What can additional lipid administration change?

Organic phosphor compounds are highly toxic and life-threatening compounds that are widely used in agriculture, households and gardens worldwide. While oral intakes are observed frequently, toxic effects can also be seen through contract or inhalation. However, toxic cases through the parenteral route have rarely been reported. We had three main aims: first, to present a male patient who self-administered 2ml of monocrotophos intravenously to commit suicide. Our second goal was to present the current multiple treatment methods, such as fast general support, antidote treatment, lipid emulsion treatment, and plasmapheresis along with the literature. Third, we aimed to emphasize that with these treatments, patients' intensive care needs, intermediate symptoms, and hospitalization periods can be decreased and thus mortality and morbidity increase can be prevented.

Intra-aural Route of Insecticide Poisoning

Organophosphate (OP) compounds are commonly ingested with the intention of deliberate self-harm. Parenteral route of OP compound exposure is an uncommon yet significant source of toxicity. Deliberate injections via intravenous, intramuscular, and subcutaneous routes and accidental dermal absorption due to occupational exposure have been described earlier. We report an unusual case of intentional insecticide poisoning by pouring the OP compound into both ears. This was successfully treated with aural irrigation using normal saline and prompt administration of the antidote.

A case of organophosphate poisoning presenting with seizure and unavailable history of parenteral suicide attempt

Organophosphate (OP) poisoning is common in India. Only few case reports of parenteral OP poisoning have been described. We report a case of self-injected methyl parathion poisoning, presenting after four days with seizure, altered sensorium, and respiratory distress which posed a diagnostic and therapeutic dilemma. Despite nonavailability of history of OP poisoning, he was treated based on suspicion and showed a good clinical response to treatment trial with atropine and pralidoxime, and had a successful recovery. Atypical presentations may be encountered following parenteral administration of OP poison, and even a slight suspicion of this warrants proper investigations and treatment for a favorable outcome. Persistently low plasma cholinesterase level is a useful marker for making the diagnosis.

Homicidal poisoning by injection of methidathion: The first ever report

We present the first ever case of homicidal poisoning due to injection of methidathion, an organophosphate insecticide. Case: A 4-month-old baby presented to the emergency department with chief complaints of unconsciousness and irregular respiration. A bitter odour and an injection site with a greenish blue colouration and two bullaous lesions were noticed by the emergency department physicians. Postmortem examinations revealed a wide shiny blue colouration of the antecubital region with oedematous muscular fascia and focal liquefaction necrosis. Blood and tissue levels were positive for methidathion. Our case report emphasizes the necessity of a detailed crime scene investigation and postmortem examination for the possibility of homicide in such cases. Although injection sites may be the expected results of medical treatment, dermal lesions also may be associated with injections of toxic substances.

Suicide attempt with injection of insecticide in both wrists

Organophosphates that are commonly used in agriculture, houses, gardens, and in veterinary medicine worldwide, may be used for suicidal purposes. But suicide attempt with self-injection of organophosphates is rare. This article presents a case of a suicide attempt of a young man with self-injection of an organophosphate insecticide (dichlorvos) to both his wrists.

Upper extremity injection of household insecticide: a report of five cases

Self-injection of household insecticide into the upper extremity in 5 patients is reported. All patients had mental problems, such as depression, substance abuse, or both. Four of the 5 cases were suicide attempts. Household insecticides can be divided into 3 categories based on the main chemical component. The hydrocarbon vehicle used in these insecticides, however, is poorly cleared by the local tissues and is responsible for fever, leukocytosis, and liquifaction necrosis. The focus for the hand surgeon is recognition and early and frequently repeated debridement. Psychiatric treatment and hand therapy are required.