2023, Number 4
Carbamate poisoning as a cause of cholinergic syndrome and differences in the treatment of organophosphate poisoning
Mendoza BB
Full text
Language: Spanish
References: 8
Page: 692-695
PDF size: 197.06 Kb.
ABSTRACT
Background: Carbamates are a class of insecticides structurally and mechanically similar to organophosphate insecticides. The mechanism of organophosphate and carbamate poisoning involves the inhibition of acetylcholinesterase. This inhibition results in the accumulation of acetylcholine at cholinergic receptor sites, resulting in continuous stimulation of cholinergic fibers throughout the nervous system. Atropine is the essential antidote. The mortality rate in cholinergic crisis varies from 3% to 25% as reported.Clinical case: A 47-year-old male patient admitted to the emergency department due to loss of consciousness after fumigation of a melon crop, clinically under the context of cholinergic toxyndrome. The diagnosis of suspected cholinergic toxyndrome was justified by the presence of respiratory depression, miosis, bradycardia, abundant diffuse rales, urinary incontinence, increased peristalsis and diarrhea, as well as by the identification of the label of the responsible poison (furadan). Patient was managed with intravenous fluids and atropinization. The patient remained 4 days with ventilatory support, achieving successful withdrawal of mechanical ventilation and the atropine infusion was suspended after 72 continuous hours of administration.
Conclusions: Carbamate insecticide poisoning manifests as a cholinergic crisis clinically indistinguishable from organophosphate poisoning.
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