The “Intermediate Syndrome” as Critical Sequelae of Organophosphate Poisoning: The First Report of Two Cases in Thailand
Winai Wananukul, MD*, Sumalee Kiateboonsri, MD**, Amnuay Thithapandha, PhD***
Affiliation : * Division of Clinical Pharmacology & Toxicology, Department of Medicine and Ramathibodi Poison Center ** Division of Pulmonary and Critical care, Department of Medicine *** Division of Academic affairs, Faculty of Medicine, Ramathibodi Hospital, Mahidol University
The authors report 2 cases of organophosphate poisoning which developed intermediate syndrome. The first case was a man who took an organophosphate insecticide, monocrotophos, and developed severe organophosphate poisoning. Respiratory support was needed. He was treated with atropine and 2-PAM. Weakness of neck muscles, proximal limb and respiratory muscle developed in the 3rd day after ingestion. By supportive treatment and careful monitoring, however, he recovered after 11 days of the poisoning. The second case was a lady who took dicrotophos. She developed severe organophosphate poisoning for which respira- tory support was also needed. High dose of atropine, but without 2-PAM, was administered. She developed bulbar palsy, proximal muscle and respiratory weakness 3 day after the ingestion. Ventilation support was needed for 13 days before weaning was successful. This report did not support an efficacy of pralidoxime (2- PAM) in alleviation of the intermediate syndrome, but aims to alert physicians to recognize the intermediate syndrome for which adequate respiratory care is the crucial key for its management.
Keywords : Organophosphate, Pralidoxime, Balbar palsy, Proximal muscle weakness, Respiratory failure
