OPI (Organo Phosphorus Insecticide) Poisoning Patient Presenting with Lower Limbs Weakness after 2-Weeks

Muhammad Ghufran; Muhammad Omer Sultan; Muhammad Inam Khan; Kumari Hina; Balram Dass; Abdul Baqi

doi:10.70749/ijbr.v3i2.2538

Authors

Muhammad Ghufran Department of Internal Medicine, Jinnah Postgraduate Medical Center (JPMC), Karachi, Sindh, Pakistan.
Muhammad Omer Sultan Department of Internal Medicine, Jinnah Postgraduate Medical Center (JPMC), Karachi, Sindh, Pakistan.
Muhammad Inam Khan Department of Internal Medicine, Jinnah Postgraduate Medical Center (JPMC), Karachi, Sindh, Pakistan.
Kumari Hina Department of Internal Medicine, Jinnah Postgraduate Medical Center (JPMC), Karachi, Sindh, Pakistan.
Balram Dass Department of Internal Medicine, Jinnah Postgraduate Medical Center (JPMC), Karachi, Sindh, Pakistan.
Abdul Baqi Department of Internal Medicine, Jinnah Postgraduate Medical Center (JPMC), Karachi, Sindh, Pakistan.

DOI:

https://doi.org/10.70749/ijbr.v3i2.2538

Keywords:

Organophosphorus Insecticides, Poisoning, Lower Limb Weakness, Atropine, Pralidoxime, Cholinesterase Levels, Neurological Effects.

Abstract

Background: Organophosphorus insecticides (OPIs) are commonly used in farming, but they are very detrimental to a person in case of exposure. Although the symptoms of acute poisoning are well-reported, delayed neurologic effects, including lower-limb weakness, are less characterized. Objective: To investigate the clinical presentation, diagnosis, and long-term neurological effects, specifically lower limb weakness, in patients with organophosphorus insecticide poisoning. Methods: The study type was a retrospective one that happened in Jinnah Postgraduate Medical Center (JPMC), Karachi, between June and November 2024. They included patients who had OPI poisoning and reported lower limb weakness within two weeks of exposure. The levels of serum cholinesterase, clinical results, and treatment outcomes were evaluated. Results: Out of 65 affected patients, 42 (64.6%) presented with weakness in the lower limbs. Atropine and pralidoxime therapy at early stages resulted in partial recovery among 66.7 percent of patients. Nevertheless, 12 percent of patients succumbed to severe respiratory failure. Conclusion: OPI poisoning can cause significant long-term neurological effects, and early treatment is crucial for improving recovery outcomes.

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References

1. Faluomi, M., Cialini, M., Naviganti, M., Mastromauro, A., Marinangeli, F., & Angeletti, C. (2022). Organophosphates pesticide poisoning: A peculiar case report. Journal of Emergency and Critical Care Medicine, 6, 30-30.

https://doi.org/10.21037/jeccm-22-64

2. Diwan, A., & Jagtap, S. (2021). Reversible parkinsonism: A rare presentation of dual poisoning. Bharati Vidyapeeth Medical Journal, 1(1), 42-46.

https://doi.org/10.56136/bvmj/2021_00011

3. Yasawardene, P. C., De, S. A., & Atapattu, P. M. (2022). Quality of sleep of medical students undergoing online medical education at the time of the COVID-19 pandemic in a selected medical faculty in Sri Lanka. Sri Lanka Journal of Physiology, 3-9.

https://mail.pssl.org.lk/downloads/sljp_2022.pdf

4. Hoq, M. E., Islam, A. S., Sharmin, R., Akbar, M. S., Islam, M. M., Roy, S., & Fayaz, M. A. (2022). Clinical profile of adult Organophosphorus compound poisoning in a tertiary care hospital. Central Medical College Journal, 5(2), 76-83.

https://doi.org/10.3329/cemecj.v5i2.61486

5. Samsamshariat, S., Maghami-Mehr, A., Salehi, Z., Forghani, M., & Zoofaghari, S. (2025). Examination of Magnesium, Calcium, Phosphorus, and Albumin Levels in Critically Ill Patients (intubated or admitted to the intensive care unit) Poisoned with Organophosphorus Poisons. International Journal of Medical Toxicology and Forensic Medicine, 15(4).

6. Dassanayake, T. L., Weerasinghe, V. S., Gawarammana, I., & Buckley, N. (2021). O-EV002. Auditory event-related potential changes over 6 months following acute organophosphate insecticide poisoning: A follow-up study. Clinical Neurophysiology, 132(8), e75.

https://doi.org/10.1016/j.clinph.2021.02.152

7. Eisa, H., Nomier, M., Arafa, M., & Khayal, E. E. (2021). Amylase and lipase enzymes as factors affecting acute Organophosphorous poisoning morbidity and mortality. Zagazig Journal of Forensic Medicine and Toxicology, 19(2), 76-99.

https://doi.org/10.21608/zjfm.2021.61072.1070

8. Abdalla, M. E., Morsy, S. K., Abdel rehman, K. M., & ElGhazoloy, Y. G. (2025). Leucocytic count and serum Acetylcholinesterase level as predictors of acute organophosphate poisoning (A prospective study). Zagazig Journal of Forensic Medicine and Toxicology, 23(1), 101-109.

https://doi.org/10.21608/zjfm.2022.134709.1115

9. Diawara, M. O., Li, S., Zhang, M., Bigambo, F. M., Yang, X., Wang, X., Dong, T., Wu, D., Yan, C., & Xia, Y. (2024). Evaluation of multiple organophosphate insecticide exposure in relation to altered thyroid hormones in NHANES 2007‐2008 adult population. Ecotoxicology and Environmental Safety, 273, 116139.

https://doi.org/10.1016/j.ecoenv.2024.116139

10. Maksimović, Ž. M., Škrbić, R., & Stojiljković, M. P. (2022). Dose-dependency of toxic signs and outcomes of Paraoxon poisoning in rats. Acta Medica (Hradec Kralove, Czech Republic), 65(1), 8-17.

https://doi.org/10.14712/18059694.2022.10

11. Chen, C., Shi, X., Yin, S., Fan, N., Zhang, T., Zhang, X., Yin, C., & Mi, W. (2024). Application of the online teaching model based on BOPPPS virtual simulation platform in preventive medicine undergraduate experiment. BMC Medical Education, 24(1).

https://doi.org/10.1186/s12909-024-06175-7

12. Juananda, D., Asmedi, A., Ghazali Malueka, R., & Sari Kusuma Harahap, I. (2021). Peripheral nerve disorders O-PN001. Comparison of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio before and after plasma exchange treatment in Guillain-Barre syndrome patients. Clinical Neurophysiology, 132(8), e75-e76.

https://doi.org/10.1016/j.clinph.2021.02.154

13. Zhao, H., & Kang, X. (2024). Associations of depression score with Dialkyl phosphate metabolites in urine: A cross-sectional study. Brain Sciences, 14(12), 1290.

https://doi.org/10.3390/brainsci14121290

14. Kehayova, G., Stoeva-Grigorova, S., Dragomanova, S., Hvarchanova, N., Dimitrova, S., Stoychev, E., ... & Zlateva, S. (2025). Intravenous lipid emulsions as an antidote: A new hope for opioid overdose treatment?. Scripta Scientifica Pharmaceutica, 10(2).

https://journals.mu-varna.bg/index.php/ssp/article/view/10287

15. Duan, M., Zhang, Z., He, R., Zhang, Y., Zhang, X., Dilshat, M., & He, J. (2025). Urinary metabolomics reveals myo-inositol and (e)-monocrotophos associate with prognosis in ACS comorbid with T2DM and preserved renal function. Scientific Reports, 15(1).

https://doi.org/10.1038/s41598-025-96010-w

16. Morsi, N., Wassem, M., Badr, M., & Abdel Latif, A. K. (2022). Biochemical, molecular and histopathological studies on malathion toxicity on some vital organs of male rats. Egyptian Academic Journal of Biological Sciences, B. Zoology, 14(1), 193-207.

https://doi.org/10.21608/eajbsz.2022.231218

17. Yasawardene, P. C., De, S. A., & Atapattu, P. M. (2022). Quality of sleep of medical students undergoing online medical education at the time of the COVID-19 pandemic in a selected medical faculty in Sri Lanka. Sri Lanka Journal of Physiology, 3–9.

18. Sacak, M. E. (2020). An analysis of 1344 consecutive acute intoxication cases admitted to an academic emergency medicine department in Turkey. Northern Clinics of Istanbul, 8(4), 377.

https://doi.org/10.14744/nci.2020.98957

19. Abdel Gawad, H., Soliman, S., Taha, H., Aly, M., A. Abd El Kader, M., & Hegazy, B. (2021). Pathogenic effects of Ethion residues and the expected protective role of the Ethanolic extract of Rosemary (Rosmarinus Officinalis L.) leaves in male rats. Egyptian Journal of Chemistry, 64(4), 1817–1829.

https://doi.org/10.21608/ejchem.2021.59950.3282