WELCOME
Presented by : Sonali. Pulse.
Under guidance of:
Dr. Sachidanand sir
ORGANO PHOSPHOROUS
CONTENTS
• INTRODUCTION
• DEFENITION
• TYPES
• ABSORBTION &METABOLISUM
• ACTION
• SIGN &SYMPTOMS
• CAUSE OF DEATH
• DIAGNOSIS
• TREATMENT
• POST MORTEM APPEARANCE
•
TYPES
• Organophosphorus are esters of phosphoric
acid &from 2 series of compound.
ALKYL Phosphates:-a)HETP
b)Dimefox
ARYL Phosphates:-a)paraoxon
b)parathion
ABSORPTION & METABOLISM
• absorbed by inhalation through skin, mucous
membrane& GIT.
METABOLISM:-
• Liver is main site of metabolism for more then
90%drug.
• aryl organophosphates require liver activation to
become toxic excretion of metabolism occurs in
urine.
• they are mixed with solvent,usually aromax which
is responsible for kerosine like smell in body
cavities,etc….
• Acetly choline,
• Acetyl choline estarage
• acetyl receptor
Acetylcholine Acetyl choline estarage
acetate+choline
ACTION
Acetyl choline formed Inside the neuron
Storage in the from of vesicals
Vesicals fuse with membrane of neuron
Release to its surroundes.bind to Ach receptor
Leads to the muscle activation
Ach estarage enzyme convert acetyl choline into acetate
&choline
WHEN OP POISON binds to AchE enzyme
Inactivate the phosphoralytion at myoneural
junction .
Keep on binding of acetylcholine to receptor
Leads to over muscle activity.
Leads to paralysis of nerve.
Action of enzyme
MECHANISUM OF ACTION
ROUTE OF EXPOSURE
PHASES OF OP POISONING
1.Acute OP Poisoning (within 24 hour of exposure)
-Muscarinic Features
-Nicotinic Features
-CNS Features
2.Intermediate syndrome[1-2 days]
3.Delayed neuropathy[24hours-2 weeks]
4.Neuro psychiatric disorder[After 2 weeks]
MUSCARINIC MANIFESTATION
BRONCHORRHOE
INTERMEDIATE SYNDROME
• In some cases after one to four days muscle
weakness & paralysis charatersid by motor
cranial nerve plasies.
• weakness of neck flexor & acute respiratory
paresis are seen due to prolonged cholinesterase
inhibition & muscle necrosis.
CNS MANIFESTATION :-symptoms like head
ache ,tremors,insomnia,coma&death.
FATAL DOSE:-
TEPP:-50 mg or 100 mg orally
OMPA:-80mg or 175 mg orally
Parathion:-80mg or 175 mg orally
• HETP:-60 mg or 350 mg orally
• Malthion &diazinon:-1g orally
• FATAL PERIOD :-in highly toxic cases within
24hrs.
• 2 to 3 days in mild toxic cases.
Cause of death
• Paralysis of respiratory muscle
• Respiratory arrest
• Cardio vascular arrest.
DIAGNOSIS
• 5ml of heparinised blood should be collected
for cholinesterase determination.
• the cholinestrase activity of blood &plasma
fall by 22 to 88%.
• Avg normal values are 77 to 142 in the RBCs
&41 to 142 in the plasma.
• Can be confirmed by giving 2mg
of injection of atropine to pt.
• Symptoms are relieved very
quickly.
• Were as in a normal person this
atropine makes atropinisation .
(increase heart rate,dryness of
mouth &nose).
TREATEMENT
• Patients are removed from source
of exposure, contaminated clothing
removed& exposure areas are
washed with soap &water.
• The air way should be kept
patent .tracheastomy may
required.
• If poison is ingested then go for
gastric lavage with 1:5000 KMNO4
solution.
• Atropine sulphate in the from of injection
which arrest \stop the muscurinic
effects.&CNS effects.
• DOSE OF ATROPINE:-2to4 mg as a test dose
followed by atropine is given in the from of
infussion untill heart rate become more than
140\min &the average dose require to
produce these effect is 40mg to 100mg per
day.
PAM INJECTION
• PAM Injection belongs to group of compounds
called oximes that bind to organophosphate
inactivated acetylcholinesterase.
POST MORTEM APPEARANCES
• Signs of asphyxia
• Cynosis of lips,fingers,nose.
• Stomach contents may smell of kerosene
• Lungs shows gross congestion ,excessive
oedema
• Heart is soft,&flabby
• Internal organ are congested.
CONCLUSION
• lots of development has occurred in field of
management of OPP ..
• Recent investigations have revealed more
understanding on basic principle of treatment
& newer medications are now available for
management.
• Prevention is a best modality of management .
