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Role of intravenous lipid emulsion therapy and packed red blood cell transfusion as adjuvant treatment in the management of a child with severe organophosphate poisoning (chlorpyrifos)
  1. Marquis Von Angelo Syquio G Joson1,
  2. Fides Roxanne M Castor1 and
  3. Charmaine Victoria Micu-Oblefias2
  1. 1Department of Pediatrics, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
  2. 2National Poison Management and Control Center, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
  1. Correspondence to Dr Marquis Von Angelo Syquio G Joson; marquisjoson{at}gmail.com

Abstract

A previously well 3-year-old child presented with rapidly deteriorating clinical status minutes after ingestion of an orange-coloured liquid housed in a soda bottle (HomeTrek—chlorpyrifos). She had miotic pupils, copious oral secretions, crackles on lung auscultation, hyperactive bowel sounds, impending signs of respiratory failure and declining sensorium. A diagnosis of severe organophosphate (OP) toxicity was made. Despite resuscitation and atropine administration, she deteriorated and exhibited atropine toxicity. She was given 20% intravenous lipid emulsion therapy and red blood cell (RBC) transfusion as adjunctive therapy with favourable outcome. She was discharged after 11 days and her RBC cholinesterase levels were 45% and 17% below normal, taken on day 10 and day 35 postingestion, respectively. She showed no signs of intermediate syndrome and delayed polyneuropathy. This case highlights the need for timely recognition of severe OP poisoning, and the role of lipid emulsion therapy and packed RBC transfusion as adjunctive treatment.

  • Paediatrics (drugs and medicines)
  • Poisoning
  • Toxicology

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Footnotes

  • Twitter @marquisjoson

  • Contributors MJ, FC and CO gathered and summarised the data of the presented case. MJ, FC and CO evaluated the treatment regimen and outcome. MJ, FC and CO are major contributors in writing the discussion of the manuscript. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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