Separate guidelines needed for the treatment of organophosphorus insecticide self-poisoning

Separate guidelines are needed for the treatment of different types of organophosphorus insecticide self-poisoning, concludes an article in this week’s issue of The Lancet.

Organophosphorus insecticide poisoning is a major global health problem, with hundreds of thousands of deaths each year. Most of these are in developing countries but this type of poisoning is also an important type of self-poisoning in the developed countries. Currently guidelines do not give specific treatment advice for particular organophosphorus insecticides.

Michael Eddleston (University of Oxford, UK) and colleagues analysed the outcome for 802 Sri Lankan patients that were treated in hospital for organophosphorus insecticide self-poisoning. The patients had used one of three organophosphorus insecticides - chlorpyrifos, dimethoate, and fenthion - to poison themselves. The researchers found that there was substantial variation in clinical course, response to treatment, and outcome between patients poisoned with different insecticides. They also found that the toxicity of the insecticides in animals was not a good predictor of toxicity in humans.

Dr Eddleston states: “Organophosphorus insecticide self-poisoning causes hundreds of thousands of deaths each year. Current treatment is only partly effective, with case fatality often greater than 10% in even the best intensive care units. Part of the problem is that there is little evidence on which to base management. But another problem is that all organophosphorus insecticides have been grouped together, with no attempt being made to develop specific management protocols or identify particular insecticides that are difficult to treat…Each organophosphorus insecticide should be considered as an individual poison and, consequently, patients might benefit from management protocols developed for particular organophosphorus insecticides.”

This week’s issue of The Lancet also features a seminar on self-harm, which states that between 5-9% of Australian, US, and English teenagers may have self-harmed in the previous year.