Hypotension in severe dimethoate self-poisoning

Figures & data

Fig. 1.  Peripheral vasodilatation in patients 1 and 2 while hypotensive on admission. Both photographs were taken when the patients were supine with BPs of 85/35 mmHg (top, case 1) and 55/30 mmHg (bottom, case 2), respectively.

Fig. 2.  Clinical course of patient 1. The top half of the figure shows heart rate, mean arterial pressure (•) together with systolic and diastolic arterial pressures (↕), and oxygen saturations. The bottom half of the figure shows the infusion rates of both dopamine and dobutamine.

Table 1.  Dimethoate concentration, butyrylcholinesterase activity, and cardiac enzymes in the three study patients

Case	1		2	3
Time after admission	40 min	22 h	45 min	30 min
Dimethoate concentration (μM)	1,177	438	1,670	1,619
BuChE (mU/mL)	455	134	431	442
CK (U/L; RR 40–180)	43	12,640	109	ND
Tn T (ng/mL; RR <0.09)	0.00	0.03	0.00	ND

BuChE, butyrylcholinesterase (plasma pseudocholinesterase); CK, creatine kinase; ND, not done; RR, reference range; Tn T, troponin T.

Plasma was separated from an EDTA blood sample and frozen at –20°C. BuChE activity was assayed as described (30,31). The median (IQR) BuChE activity in this population is 4,500 (3,200–5,200) mU/mL (Eyer, unpublished). Plasma dimethoate concentrations were quantified by reversed phase HPLC and UV detection (lower limit of quantitation 1 nmol/mL plasma). CK and Tn T were assayed in a clinical laboratory.

P Eyer. The role of oximes in the management of organophosphorus pesticide poisoning. Toxicol Rev 2003; 22:165–190.

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F Worek, U Mast, D Kiderlen, C Diepold, and P Eyer. Improved determination of acetylcholinesterase activity in human whole blood. Clin Chim Acta 1999; 288:73–90.

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