An unusual case of organophosphate intoxication of a worker in a plastic bottle recycling plant: An important reminder

young man was sent to our emergency unit because he had suffered from vomit ing and cold swearing for 2 days. At the time he was admitted, he had no ac ute abdominal pains or gastrointestinal symptoms, and a physical examinatio n revealed nothing but a faster heart rate and moist, hushing skin. The pat ient had worked for 6 years at a plastic bottle-recycling factory, but none of his co-workers had the same symptoms. Nevertheless, because the plant a lso recycled pesticide bottles, we suspected organophosphate pesticide into xication. The patient's plasma acetylcholinesterase level was checked, reve aling 1498.6 muU/L (normal range: 2,000-5,000) on the first day and 1,379 m uU/L on the second day. Upon questioning, the patient recalled that one of his shoe soles had been damaged and that his foot had been wet from walking all day in rain collected on the factory floor on the day char his symptom s first occurred. We conducted a study in the change of preshift. and posts hift acetylcholinesterase levels among six of his co-workers on a rainy day . We used the Wilcoxon signed rank test to compare the preshift and postshi ft plasma acetyl-cholinesterase levels; no significant difference was revea led (p = 0.600), leaving contamination via the damaged shoe sole suspect. W e reviewed the literature on organophosphate intoxication; pesticide bottle -recycling factories were reported to be at a low risk of organophosphate t oxicity in the working environment. However, because the potential risk of intoxication is still present, protective equipment such as clothing, glove s, and water-proof shoes should be worn, and employees should be educated o n the potential risks.