Carbamate and organophosphate poisoning in young children

Objective: Retrospective evaluation of the clinical course of carbamate and organophosphate poisoning in young children. Design: The records of 36 children intoxicated with carbamate and 16 childr en intoxicated with organophosphate (age range: 2 to 8 years, median: 2.8 y ears) were examined retrospectively. The carbamate agents were identified a s methomyl or aldicarb, anal the organophosphate as parathion, fenthion, ma lathion, and diazinon, The causes of poisoning were accidental ingestion in 46 children and inhalation in six children, Clinical setting: Pediatric Intensive Care Unit of a teaching hospital. Interventions: Gastric lavage was performed, and activated charcoal was adm inistered to all children who had ingested poisonous pesticides. Atropine s ulphate was administered intravenously in repeated doses to all children wi th bradycardia, diarrhea, salivation, and miosis, Obidoxime chloride was ad ministered to patients with organophosphate poisoning and to those in whom the ingested material was unidentified on admission. Results: Predominant symptoms were related to central nervous system depres sion and severe hypotonia, Other clinical signs such as mitosis, diarrhea, salivation, bradycardia, and fasciculation were less frequent, while tearin g and diaphoresis were not observed. Pulmonary edema developed in six patie nts with organophosphte poisoning. Three children required mechanical venti lation for several hours. One child (osganaphosphate poisoning) died shortl y after arrival at the emergency department. All other children recovered c ompletely. Conclusion: Based on a relatively large group of young pediatric patients w ith carbamate and organophosphate poisoning, it is concluded that the clini cal presentation differed from those described in adults. Absence of classi c muscarinic effects does not exclude the possibility of cholinesterase inh ibitor agents poisoning in young children with central nervous system depre ssion.