Abstract
A 22-year-old woman was admitted to our hospital because of coma, tonic convulsion, and urinary incontinence. Peripheral pulse was irregular, and the rate was 50-60/min. Respiratory rate was 13/min, soon she became apneic. She was intubated and connected to the respirator. She had taken 10g of agricultural carbamate insecticide (LD=340mg/kg) for suicide. Electrocardiogram showed Wenckebach type 2nd degree atrio-ventricular block, ST depression, and QT prolongation. When heart rate became under 40/min, we admin-istered 1A (0.5mg) of Atropine, and heart rate increased to 140/min (sinus tachycardia). Injection of 3-5A (1.5-2.5mg) of Atropine every 1 hour was cotinued, and she became alert 3 hours later. Forty ml of sodium bicarbonate was also administered. Laboratory data showed ChE 0.01ΔPH, blood sugar 238mg/dl, LDH 616, S-K 2.7mEq/l, WBC 22000/mm3, and PH 7.031. ChE recoverd within normal range on the 9th hospital day.
Agricultural carbamate insecticides inhibit acetylcholine esterase. Carbamate poisoning causes headache, salivation, dyspnea, convulsion, tachycardia, hypertension, pulmonary edema, coma, etc. But report of bradyarrythmia is rare. In this case, we think that atrio-ventricular block was induced by increased Ach and severe acidosis.
