INTRODUCTION:
A 38-year-old male was brought to Emergency department with a history of
ingestion of organophosphate insecticide (Chlorpyrifos) of around 100 ml
in a suicidal manner. His complaints were mainly tongue (Video S1) and
diffuse lower limb fasciculation with generalized muscle weakness plus
minimal vomiting and sweating. On examination, 4/5 muscle power in both
upper and lower limbs bilaterally with intact neck muscle strength.
Following admission, a Ryle’s tube gastric lavage was performed, and a
total of 66 mg of atropine was administered intravenously. After 8
hours, the fasciculation stopped, and the power of his limbs returned to
normal (5/5). Children often have OP poisoning with isolated nicotinic
receptor-mediated symptoms, whereas adults rarely do
[1]. This
case/video highlights the importance of isolated/predominant nicotinic
symptoms of OP poisoning in adults and the treating/emergency physician
should be aware of such findings to initiate early treatment.
Video S1: Tongue showing diffuse fasciculation in our patient who
presented to ED after OP ingestion.