A case of organic phosphorus insecticide poisoning that developed prolonged respiratory failure

Abstract

This report describes a case of organic phosphorus insecticide (malathion) poisoning that developed prolonged respiratory failure. A 56-year-old man was found to be unconscious (JCS 300) in his home and was trans-ferred to our hospital. He presented with miosis (1.0 mm), hypothermia and weak spontaneous breathing. Mechanical ventilation and administration of atropine and pyridine 2-aldoxime methiodide in association with gastric lavage was effective to improve the level of consciousness and general conditions. However, weaning from mechanical ventilation was extremely difficult because of the repeated episodes of sudden apnea accompanied with unconscious-ness, hypotension and miosis, the episodes being observed without any exacerbation of serum cholinesterase level. He eventually weaned from mechanical ventilation and discharged from ICU without any sequelae.
It is suggested that there exists a relapse of respiratory insufficiency following inorganic phosphorus insecticide poisoning even after the serum cholinesterase level recovers to normal level.