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.