Document Detail

Neurotoxic effects of organophosphorus insecticides. An intermediate syndrome.
MedLine Citation:
PMID:  3029588     Owner:  NLM     Status:  MEDLINE    
Acute neurotoxic effects during the cholinergic phase of organophosphorus insecticide poisoning and delayed neurotoxic effects appearing two to three weeks later are well recognized. We observed 10 patients who had paralysis of proximal limb muscles, neck flexors, motor cranial nerves, and respiratory muscles 24 to 96 hours after poisoning, after a well-defined cholinergic phase. The compounds involved were fenthion, monocrotophos, dimethoate, and methamidophos. Four patients urgently required ventilatory support. The paralytic symptoms lasted up to 18 days. A delayed polyneuropathy later developed in one patient. Three patients died. Electromyographic studies showed fade on tetanic stimulation, absence of fade on low-frequency stimulation, and absence of post-tetanic facilitation, suggestive of a postsynaptic defect. This neuromuscular junctional defect may have been the predominant cause of the paralytic symptoms, with neural and central components contributing to various degrees. Our patients appeared to have a distinct clinical entity (a so-called intermediate syndrome) that developed after the acute cholinergic crisis and before the expected onset of the delayed neuropathy.
N Senanayake; L Karalliedde
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The New England journal of medicine     Volume:  316     ISSN:  0028-4793     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  1987 Mar 
Date Detail:
Created Date:  1987-04-07     Completed Date:  1987-04-07     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  761-3     Citation Subset:  AIM; IM    
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MeSH Terms
Dimethoate / poisoning
Fenthion / poisoning
Insecticides / poisoning*
Middle Aged
Monocrotophos / poisoning
Neuromuscular Junction / drug effects
Organothiophosphorus Compounds / poisoning
Peripheral Nervous System Diseases / chemically induced*
Respiratory Paralysis / chemically induced
Synaptic Transmission / drug effects
Time Factors
Reg. No./Substance:
0/Insecticides; 0/Organothiophosphorus Compounds; 10265-92-6/methamidophos; 55-38-9/Fenthion; 60-51-5/Dimethoate; 6923-22-4/Monocrotophos

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