Accidental organophosphate insecticide intoxication in children: a reminder

Management of organophosphate poisoning consists of airway management, administration of oxygen and fluid, as well as atropine in increasing doses and pralidoxime. Decontamination of the patient's skin and the removal of the patient's clothes are mandatory in order to avoid recontamination of the patient as well as the surrounding healthcare personnel.Plasma pseudocholinesterase analysis is a cheap and an easy indicator for organophosphate insecticides intoxications and could be used for diagnosis and treatment monitoring.Organophosphate insecticides are widely used in rural areas. Intentional ingestion of organophosphates is associated with a high mortality rate [1]. Organophosphate intoxication (OI) induces irreversible inhibition of acetylcholinesterase. Organophosphates phosphorylate the serine hydroxyl group of acetylcholine, leading to accumulation of acetylcholine at the cholinergic synapses [2]. This accumulation leads to weakness and fasciculation of the muscle. In the central nervous system, neural transmission is disrupted. If this blockade is not reversed within 24 h, large amounts of acetylcholinesterase are permanently destroyed [3].Acetylcholinesterase is found in red blood cells as well as in nicotinic and muscarinic receptors. To determine the severity and/or the elimination time of OI, one should measure cholinesterase in blood, either by measuring plasma pseudocholinesterase (PCE) or by measuring the cholinesterase in erythrocytes (which is thought to reflect the cholinesterase in neurons and neuromuscular junctions). The first method is widely available and therefore commonly used [3,4].Herein, we report a case of siblings who, upon being sprayed with an organophosphate solution, developed severe OI associated with central nervous system (CNS) depression.A 7-year-old previously healthy boy was brought into the emergency department with vomiting and reduced consciousness by his mother. He had been in good health until he was found, 30 min prior to