臨床症例報告ジャーナル

Homicidal Attempt by Injection of an Organophosphate Insecticide in a Seven Month-Old Baby

Abstract

Laila M El- Zalabany and Ahmed R Ragab

The present case reports the first ever case of homicidal poisoning due to injection of an organophosphate insecticide with successful resuscitation and reporting. Case: A 7-month-old baby presented to the emergency department with a history of insect bite since 5 hours by his relatives with a main complaint of irritability, disturbed conscious level, irregular respiration and wheezy chest. The injection site has appeared as oval area of redness and swelling at right elbow region that were noticed by the pediatric emergency department physician, with a medical history of resistance to medications for suspected insect bite (antihistaminic and corticosteroids in pediatric dosage) from referral hospital. By toxicological consultation, we revealed disturbed conscious level (GCS 10), pinpoint pupils and increase all body secretions, salivation, bronchorrhea and incontinence in urine and stools. The clinical toxicology consultant suspected a case of acute anticholine esterase toxicity and recommended a plasma pseudocholinesterase level that appeared to be very low, consistent with acute intoxication with organophosphate insecticide. The management of organophosphate poisoning was started, as airway management, administration of oxygen and fluids, as well as atropine in increasing doses and pralidoxime. Our case report emphasizes the necessity of a detailed history taken and careful smart medical examination for the possibility of homicide in such cases. Although injection sites may be the expected results of insect bite, medical treatment, dermal lesions also may be associated with injections of toxic substances.