Acute organophosphorus poisoning complicated by acute coronary syndrome

• Published in: Journal of the Association of Physicians of India Vol. 62; no. 7; pp. 614 - 616
• Main Authors: Pankaj, Madhu, Krishna, Kavita
• Format: Journal Article
• Language: English
• Published: India 01.07.2014
• Subjects: Acute Coronary Syndrome - chemically induced; Acute Coronary Syndrome - diagnosis; Adult; Alcoholic Intoxication; Chlorpyrifos - pharmacokinetics; Chlorpyrifos - toxicity; Echocardiography - drug effects; Electrocardiography - drug effects; Humans; India; Male; Metabolic Clearance Rate - physiology; Organophosphate Poisoning - diagnosis; India
• ISSN: 0004-5772

We report a case of 30 year old alcoholic male admitted with vomiting, drowsiness, limb weakness and fasciculations after alleged history of consumption of 30 ml of chlorpyriphos insecticide. He had low serum cholinesterase levels. With standard treatment for organophosphorus poisoning (OPP), he improved gradually until day 5, when he developed neck and limb weakness and respiratory distress. This intermediate syndrome was treated with oximes, atropine and artificial ventilation. During treatment, his ECG showed fresh changes of ST elevation. High CPK & CPK-MB levels, septal hypokinesia on 2D echo suggested acute coronary syndrome. Coronary angiography was postponed due to his bedridden and obtunded status. The patient finally recovered fully by day 15 and was discharged. Acute coronary syndrome is a rare occurrence in OP poisoning. The present case thus emphasises the need for careful electrocardiographic and enzymatic monitoring of all patients of organophosphorus poisoning to prevent potential cardiac complication which can prove fatal.