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Question

A 14-year-old girl is brought with the alleged consumption of a liquid poison. Her clinical examination reveals the pulse rate to be 52/min, BP 100/70 mmHg, and respiratory rate 8/min. She has a shallow breathing. Her skin is cold and clammy. She has excessive salivation. On auscultation of the lungs, she has crepitations. The CNS examination reveals all 4 limbs to be flaccid, and she has fasciculations. What is the most probable poison?

The correct answer is
Organophosphorus compound

To determine the most probable poison consumed by the 14-year-old girl based on her symptoms, let's analyze the details provided:

  • Bradycardia: The pulse rate is 52/min, which is slower than the normal range for her age.
  • Hypotension: Blood pressure is 100/70 mmHg, which is relatively low.
  • Respiratory Depression: Respiratory rate is 8/min with shallow breathing.
  • Cold, Clammy Skin and excessive salivation: These are symptoms of increased parasympathetic activity.
  • Crepitations on auscultation: This occurs often with increased secretions in the lungs.
  • Flaccid paralysis and fasciculations: These are signs of neuromuscular transmission issues.

These symptoms align well with poisoning due to Organophosphorus compounds, which are known to inhibit acetylcholinesterase. This results in an accumulation of acetylcholine, causing symptoms such as:

  • Increased parasympathetic activity: bradycardia, hypotension, excessive salivation, wheezing/crackles due to bronchorrhea.
  • Neuromuscular effects: fasciculations, paralysis, and respiratory depression.

The other options do not match the symptomatology:

  • Barbiturates: Typically cause CNS depression, decreased respiratory rate, and hypotension but not the widespread parasympathetic symptoms seen here.
  • Copper sulphate: Causes gastrointestinal irritation, hemolysis, and renal toxicity but lacks the neurological and parasympathetic signs.
  • Opioids: Cause CNS depression and miosis but do not cause parasympathetic overactivity or fasciculations.

Therefore, the clinical presentation is most consistent with Organophosphorus poisoning.

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Important Questions from Acute Poisoning

  1. Whole Bowel Irrigation (WBI) as a method of gastrointestinal decontamination is useful for poisoning with :
  2. Poisoning with which of the following drugs causes hypothermia ?
  3. Consider the following agents and the cardiac effects in case of overdose or poisoning: 

    1. Prolonged PR interval - Lithium 

    2. Prolonged QTc interval - Amiodarone 

    3. Wide QRS complex - Kerosene ingestion 

    4. Tachycardia - Organophosphates 

    How many of the pairs given above are correctly matched ?

  4. Urinary alkalinization as a method for enhancing excretion for poisoning is aimed at achieving
  5. Exchange transfusion as a method to enhance excretion of poison is indicated in
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