ORGANOPHOSPHATE POISONING (OP) Organophosphate\npoisoning is poisoning due to organophosphates (OPs). There\nare nearly 3 million poisonings per year resulting in two hundred thousand\ndeaths. Around 15% of people who are poisoned die as a result. Organophosphate\npoisoning has been reported at least since 1962. <\/p>\n\n\n\n

While most often the exposure occurs from an agricultural\npesticide, there are household items, such as ant and roach spray, that also\ncontain organophosphate compounds. Organophosphate pesticides are one of the\ntop causes of poisoning worldwide, with an annual incidence of poisonings among\nagricultural workers varying from 3-10% per country. <\/p>\n\n\n\n

Organophosphate insecticides are common household products\nin Nigeria, where they are used mainly to control mosquitoes and other household\npests such as cockroaches and bed bugs. More than 80% of the reported toxic\nexposures to insecticides are attributable to organophosphates. <\/p>\n\n\n\n

The prevalence of accidental childhood poisoning across\ndifferent countries ranges from 0.74% – 7.2% of paediatric admissions with\norganophosphate poisoning accounting for 7.5%-34.6% of cases of accidental\nchildhood poisoning in Nigeria. <\/p>\n\n\n\n

The World Health Organization (WHO) noted that pesticide\npoisoning is now the most common method of suicide worldwide. About two million\npeople attempt suicide and one million accidental poisoning cases occur each\nyear worldwide. <\/p>\n\n\n\n

In Nigeria, suicide is traditionally a taboo. However, the\nrecent report of cases of intentional poisoning is probably as a result of\nmedia influence or breakdown of our traditional social fabric. A ten-year\nretrospective study of childhood poisoning in Warri, South-south Nigeria, noted\nthat intentional poisoning occurred in the adolescent age group and mainly\ninvolved female teenagers. Organophosphates were observed to be the sole agent\nfor intentional poisoning in the retrospective review of cases seen in\nNorth-central Nigeria and these were adolescent females. <\/p>\n\n\n\n

WHAT IS ORGANOPHOSPHATES <\/strong>(OP)? Organophosphate (OP) compounds are a diverse group of chemicals used in both domestic and industrial settings. They are often constituents of pesticides and insecticides. Some of these products are produced in an unregulated manner and sold by unregistered vendors on the streets and in market places in sub-Saharan Africa. When purchased, and improperly stored, children may easily have access to, and inadvertently consume them. Indeed, globally, organophosphate poisoning is the most significant cause of severe toxicity and mortality resulting from acute poisoning.  <\/p>\n\n\n\n

Examples of organophosphates include the following:\nInsecticides \u2013 Malathion, parathion, diazinon, fenthion, dichlorvos,\nchlorpyrifos, ethion. Nerve gases \u2013 Soman, sarin, tabun, VX. Ophthalmic agents\n\u2013 Echothiophate, isoflurophate. Antihelmintics \u2013 Trichlorfon. Herbicides \u2013\nTribufos (DEF), merphos. Industrial chemical (plasticizer) \u2013 Tricresyl\nphosphate. <\/p>\n\n\n\n

The most popular source of organophosphate\ninsecticide\/pesticide in Nigeria is the locally made variety called\n\u2018Otapiapia\u2019. The main active ingredient in \u2018otapiapia\u2019 is dichlorvos or 2,\n2-dichlorovinyl dimethyl phosphate (DDVP), and are readily available for\npurchase on the streets. \u2018Sniper\u2019, which is another common variety of DDVP has\na more refined packaging and is available in stores nationwide at a higher cost.\n<\/p>\n\n\n\n

OP poisoning occurs most commonly as\na suicide attempt in farming areas of the developing\nworld and less commonly by accident.  Exposure can be from drinking,\nbreathing in the vapors, or skin exposure.   <\/p>\n\n\n\n

Cheap locally-made preparations of organophosphates are\nwidely available and unregulated in low income settings such as in Nigeria.\nThese preparations are stored at home in old soft drink or juice containers\nwhich attract unsuspecting children resulting in unintentional poisoning. <\/p>\n\n\n\n

Sniper, is marketed in Nigeria by Swiss-Nigerian Chemical\nCompany, as a synthetic organophosphorus but which many Nigerians have\nconverted to an indoor insecticide. There have been cases of sniper poisonong\nin Nigeria; a 400-level student of the Department of English and Literary\nStudies, University of Nigeria, Nsukka (UNN), allegedly drank two\nbottles of Sniper insecticide leading to his death on Tuesday, May 14, 2019.\nFriends said he had a long battle with depression before his death.  <\/p>\n\n\n\n

Other cases are A Niger Delta University student, who\ncommitted suicide by drinking Sniper after he discovered he had \u2018carryover\u2019 in\nhis courses. This came shortly after two female students of University of Lagos\nwere reported to have killed themselves using the insecticide following the accusations\nthat they stole clothes in their hostel. Another 32-year-old banker and mother\nof two in Delta State, committed suicide over her husband\u2019s alleged infidelity.\nShe also took Sniper.<\/p>\n\n\n\n

MORTALITY\/MORBIDITY<\/strong>: Worldwide mortality studies report mortality rates from 3-25%. The compounds most frequently involved include malathion, dichlorvos, trichlorfon, and fenitrothion\/malathion.   Mortality rates depend on the type of compound used, amount ingested, general health of the patient, delay in discovery and transport, insufficient respiratory management, delay in intubation, and failure in weaning off ventilatory support.   Complications include severe bronchorrhea, seizures, weakness, and neuropathy. Respiratory failure is the most common cause of death. <\/p>\n\n\n\n

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Written by St. Nicholas Hospital Pharmacy Department<\/em><\/p>\n\n\n\n

REFERENCES<\/em><\/p>\n\n\n\n