Jurnal Internasional Afrika vol. 13 issue 2 2023
African Journal of Emergency Medicine
Acute organophosphorus toxicity in a regional hospital in Johannesburg, South Africa: A retrospective chart review

Jurnal Internasional Afrika vol. 13 issue 2 2023
African Journal of Emergency Medicine
Acute organophosphorus toxicity in a regional hospital in Johannesburg, South Africa: A retrospective chart review

Organophosphorus toxicity Atropinisation dose Atropine toxicity Emergency department Cholinesterase levels

Introduction: Intentional and accidental organophosphorus exposures pose a significant healthcare-related bur- den on South African communities. This study will review the demographics, characteristics and clinical course of patients presenting with features of acute organophosphorus toxicity to a regional Emergency Centre in Jo- hannesburg, South Africa. Methods: This was a retrospective chart review of all patients treated for possible acute organophosphorus toxicity from January 2020 to August 2021. Results: A total of 205 patients were identified of which 134 patients were included in the study. The median age was 26 years with a male predominance (male = 56%, female = 44%). 109 patients (81.3%) survived, 18 pa- tients (13.4%) demised and the outcome of 7 patients (5.2%) was unknown. The median hospital length of stay was 8 days, (IQR = 5-13 days), and the longest hospital stay was 37 days in ICU. Atropinisation dose was signif- icantly higher for intubated patients (median = 140.0mg; IQR = 90mg-219.5mg) compared to patients who were not intubated (median = 60mg; IQR = 20.5mg-120mg, p < 0.05). The length of stay was significantly higher for intubated patients (median = 11 days; IQR = 7-15 days) compared to patients who were not intubated (median = 5 days; IQR = 3-8 days, p < 0.00). There was a moderate positive correlation between atropinisation dose and length of stay (Correlation coefficient = 0.37, p < 0.00). There was a moderate negative correlation between atropinisa- tion dose and cholinesterase level (Correlation coefficient = - 0.39, p < 0.00). Of those reported to have adverse effects 78.6%, were related to atropine toxicity. Conclusion: Our study shows a high mortality rate secondary to organophosphorus toxicity. Significant exposures and thus higher doses of atropine were associated with increased length of stay and need for intubation. We found a high incidence of atropine-related adverse effects. More studies are needed to further establish the balance between the therapeutic and adverse effects of high-dose atropine as a treatment modality for organophosphorus toxicity.

Vanessa Khonje
a ,
∗ , Jedd Hart
a ,
b , Jakus Venter
a ,
b , Saisha Deonarain
a , Saul Grossberg

www.elsevier.com/locate/afjem

4 April 2023

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