ACUTE MALATHION POISONING WITH INTERMEDIA RY SYNDROME

BACKGROUND: Acute poisoning by an organophosphorus insecticide is freq uently observed in Morocco. We report a case of malathion poisoning co mplicated by an intermediate syndrome. CASE REPORT: A 42-year-old woma n was hospitalized 3 hours after ingestion of 50 g of malathion. Intub ation and ventilatory assistance was required due to failing conscious ness and bronchial plugging. On day 4, a neurological syndrome suggest ive of the intermediary syndrome with diaphragmatic palsy made it nece ssary to continue ventilatory assistance to day 20. DISCUSSION: The in termediary syndrome occurs 24 to 96 hours after the acute cholinergic phase of organophosphorus poisoning, It consists of an exclusive neuro muscular involvement. The intermediate syndrome is confined to an abno rmality of neuromuscular function in specific muscle groups: proximal limb muscles, of neck flexors, motor cranial nerves and respiratory mu scles, with difficult weaning from respiratory assistance. The interme diary syndrome is quite uncommon. The risk of respiratory failure emph asizes the need for close monitoring in an intensive care setting for at least 96 hours, depending on the intensity of the cholinergic syndr ome. (C) 1998, Masson, Paris.