Organophosphate compounds include: phosphoric acid esters ( tributyl phosphate, triphenyl phosphate, tricresyl phosphate, trixylene phosphate, gardona, dibromo, dichlorvos, phosphacol, cyodrin, nuvacron, chlorphenvinphos, ruelen); esters of thiophosphoric acid ( thiophos, metaphos, methylnitrophos, trichlormetaphos, methylmercaptophos, chlortion, baytex, karal, bazudin, ronnell, bromophos, cyanox, abat, dursban, valeksong afugan, hostation, hostaquik, actellic); esters of dithiophosphoric acid ( karbofos, phosphamide, phthalophos, saiphos, acetion, butyphos, antiio, thiocron, fenkapton, fosalon, cydeal); esters of alkylphosphonic, alkylphosphinic and fluorophosphoric acids ( chlorophos, nibufin, army, diisopropyl fluorophosphate); esters, amides and amidoesters of pyrophosphoric acid ( tetraethyl pyrophosphate, hexaethyl tetraphosphate, pyrophos, dithio).
FOS are most widely used in agriculture as insecticides, acaricides, fungicides, herbicides and defoliants, as well as plasticizers and medicines.
Pathogenesis and symptoms of FOS poisoning: By the mechanism of action, most of them belong to anticholinesterase substances. By blocking cholinesterase and other enzymes of the esterase class, FOS promotes the accumulation of excess amounts of the neurotransmitter acetylcholine and leads to poisoning associated with the excitation of cholinergic systems. Possibly a direct effect of FOS on cholinergic systems. Some OPs also have an effect on the body, which depends not on changes in the cholinergic systems, but, apparently, on the structural features of their molecules.
FOS are poisons of the central and autonomic nervous system. They disrupt the functions of respiration, blood circulation, glands of external and internal secretion, blood, internal organs.
organophosphates anxiety, nausea, salivation, vomiting, abdominal pain, diarrhea, blurred vision, lacrimation are noted. In the future, there is difficulty breathing, bradycardia, gait disturbance, tremors of the upper limbs, head and other parts of the body, fibrillar twitching of individual muscle groups, speech disorders, disorientation in space, confusion. In severe cases, there are clonic-tonic convulsions, abrupt changes in breathing (bronchospasm, depression of the respiratory center, impaired transmission of impulses to the respiratory muscles, sometimes improper breathing of the Cheyne-Stokes type). Blood pressure rises at first, and when the condition worsens and coma develops, it decreases greatly. Involuntary discharge of urine and feces is observed. Pulmonary edema may occur. Death occurs from respiratory paralysis, as a rule, on the 1st, sometimes on the 2nd day after poisoning, less often later. With recovery, headache, dizziness, insomnia, general weakness, and decreased appetite are noted within a few days. Sometimes these phenomena are delayed for weeks. After poisoning with some FOS (chlorophos), cases of late development of inflammatory changes in the central and peripheral nervous system, leading to the occurrence of paresis and paralysis, have been described.
Symptoms of FOS poisoning divided into
Muscarinic (susceptible to atropine),
- nicotine-like and
- central.
Muscarinic ones include nausea, vomiting, drooling, lacrimation, spasms of the intestinal muscles, increased bronchial secretion, chest tightness, bronchospasm, bradycardia, miosis, increased sweating. Nicotine-like signs: twitching of the tongue, and then the muscles of the face and neck, the appearance of nystagmus, fnbrillary twitching of the muscles of the whole body.
Damage to the central nervous system leads to mental disturbances, changes in speech, ataxia, tremors of the limbs and other parts of the body, disorientation in space, clonic and tonic seizures. Symptoms of poisoning depend on the pathways of the entry of FOS into the body. With inhalation, vision is disturbed earlier (miosis), bronchospasm and other changes in the respiratory system are observed. In case of contact with FOS on the skin, fibrillar twitching of the muscles at the site of application is noted, when it enters the stomach, vomiting, intestinal spasm, diarrhea, tenesmus appear, and then other symptoms are already observed.
First aid and treatment for FOS poisoning:
Since FOS is rapidly absorbed into the bloodstream, first aid should be provided as early as possible... If it gets through the mouth, the victim is given several glasses of water to drink (preferably with a suspension of carbolene or sodium bicarbonate - a teaspoon in a glass of water) and cause vomiting by irritating the root of the tongue or the back of the throat. This manipulation is repeated 2-3 times. After that, give half a glass of 2% sodium bicarbonate solution to drink with the addition of 1-2 tablespoons of activated carbon (first aid). Medical help consists in a thorough gastric lavage through a tube. If FOS gets on the skin, it is treated with 5-10% solution of ammonia and 2-5% solution of chloramine B. Thoroughly wash the affected area with soap and water, and the eyes with water or 1% sodium bicarbonate solution.
The success of treatment also largely depends on how early antidote therapy is started, the use of anticholinergic drugs, cholinesterase reactivators.
Of the anticholinergic drugs, the most widely used is atropine sulfate, which must be administered in very large doses.
In the initial stage of poisoning(nausea, vomiting, bronchospasm, agitation) 2-3 ml of 0.1% atropine sulfate is injected intramuscularly. Repeat injections if necessary. In the case of muscle fibrillation and seizures, 4-6 ml of 0.1% atropine sulfate solution is injected intravenously and then every 8-10 minutes 2-3 ml intramuscularly until the seizures stop. In the stage of coma and paralysis, higher doses of the drug are given. If the treatment is carried out in the stage of seizures, up to 20-25 mg of atropine sulfate is administered within 1 hour, and during the period of maintenance atropinization (2-3 days) another 50-60 mg per day. If treatment is started in the stage of coma and paralysis, with intensive atropinization, 30-50 mg of the drug is administered within 1 hour, and then (maintenance atropinization) another 80-100 mg per day.
Atropinization is carried out until muscle fibrillation, seizures stop and normal breathing is restored.
Along with atropine sulfate, other anticholinergic drugs are recommended. One of the drugs is injected intravenously: 2-3 ml of 0.1% amisil solution, 1 ml of 1% tropacin solution, 2 ml of aprofen, 1 ml of 1% pentafen solution, 1 ml of 1% solution of cyclodol (artan). Repeat injections if necessary. Some of the listed compounds better than atropine sulfate relieve the symptoms of excitation of the central and peripheral n-cholinergic systems. Atropine sulfate should be combined with intravenous magnesium sulfate or ganglion blocking agents (benzohexonium, pachicarpine hydroiodide).
The effect of anticholinergic drugs is significantly enhanced with the simultaneous use of cholinesterase reactivators. Of these, dipiroxime is the most widely used. Depending on the severity of the poisoning, it is prescribed once or repeatedly. At the initial signs of FOS poisoning, 1 ml of a 15% solution of dipyrrxime is injected intramuscularly in combination with atropine sulfate (1-2 ml of a 0.1% solution). If the symptoms of poisoning do not disappear, the injection is repeated after 30-60 minutes. When a patient develops fibrillar muscle twitching, tremors, seizures and bronchorhea, 3-4 ml of 0.1% solution of atropine sulfate is injected intravenously and at the same time 1 ml of 15% dipiroxime solution is intramuscularly administered. Injections of atropine sulfate (1-2 ml intramuscularly) are done every 10-15 minutes until the symptoms of poisoning disappear. Dipiroxime is reintroduced every 1-2 hours. In severe cases (severe clonic and tonic convulsions, coma, respiratory paralysis), 4-6 ml of 0.1% atropine sulfate solution is injected intravenously and 1 ml of 15% dipiroxime solution is intramuscularly or intralingually. Intramuscular injections of atropine sulfate (2 ml) are carried out every 8-10 minutes, dipiroxime - after 1 - 2 hours. The average dose of the latter is 1-1.5 g per course. Isonitrosine and the reactivator toxogonin (efoksim) used abroad also have therapeutic activity in case of FOS poisoning. The proposed new cholinesterase reactivator dietixime (B, E. Krivenchuk et al., 1969) penetrates into the central nervous system and has a pronounced antidote effect in case of intoxication with various FOS (Yu.S. Kagan et al., 1971, 1975; N.V. Kokshareva et al., 1975). Enter it intramuscularly in 5 ml of 10% solution. The injection is repeated every 2-3 hours for 1 day.
Removal of poison from the body achieved by forced diuresis with the use of osmotic diuretics (hypertonic glucose or mannitol solution). For the fight against acidosis and hyperkalemia, see p. 41. Plasma alkalinization is shown in case of thiophos poisoning (EA Luzhnikov, 1968).
Resuscitation measures carried out with the phenomena of asphyxia and coma. In these cases, intubation or tracheostomy with prolonged suction of fluid, apparatus artificial respiration are necessary.
Antibiotics are used in large quantities to treat or prevent pneumonia. For the same purpose, frequent changes in body position, chest massage, repeated flushing of the respiratory tract, vitamins are recommended. Aminazine and morphine hydrochloride are contraindicated (potentiate the effects of FOS).
Characteristics of some FOS and their effect on the human body
Cyodrin- a highly toxic insectoacaricide used in animal husbandry and for plant protection. Poisoning is possible if the drug enters the stomach, on the skin, or inhales the vapors. It develops rapidly and is characterized by cholinergic symptoms.
Afugan(pyrazophos) is an organophosphorus fungicide. It is used for processing grapes, berries, vegetables and grain crops. Possesses moderate toxicity, has an embryotoxic effect.
Hostation(triazophos). Has insecticidal, acaricidal and nematicidal action. Highly toxic to humans and animals. In case of poisoning, the cholinergic component is expressed.
Hostaquick- highly toxic insecticide. With intoxication, cholinergic signs of poisoning are expressed.
Cyanox- insectoacaricide of a wide spectrum of action, low toxicity. In case of poisoning, the cholinergic component is expressed.
Abat(diphos). Low-toxic insecticide.
Valexon(valoton, foxim). Broad spectrum insecticide. Low toxicity.
Dursban... Broad spectrum insecticide. Highly toxic to humans and animals. In case of poisoning, cholinergic signs of intoxication are expressed.
Actellik(pirimifosmethyl) is a broad-spectrum insecticide. Low toxicity for warm-blooded animals.
Metaphos(vofatox, methylparathion) is widely used as an insecticide in agriculture in the form of emulsion concentrates (for the preparation of emulsions) and dusts (vofatox). Strong poisonous substance.
Methylmercaptophos(methylsistox, metasytox, methyldameton) is widely used for the destruction of pests of cotton and fruit crops. Highly toxic. Poisoning is possible if the drug gets inside, on the skin and if the vapors are inhaled.
Byteks(lebaitsid) is used to kill household insects, flies, mosquitoes, as well as in agriculture. Highly toxic.
Karbofos(malathion) is an insecticide of average toxicity used in agriculture and in everyday life. Cases of poisoning are described when the drug gets inside and on the skin.
Phosphamide(rogor, dimethoate; Bi-58) is an effective systemic insectoacaricide. It is used to combat pests of cotton and fruit crops. Highly toxic.
Intration(preparation M-81, ecatin) is an effective systemic insectoacaricide used to destroy pests of cotton and fruit crops. Highly toxic.
Phthalofos(imidane) is used as an insectoacaricide for the treatment of fruit, vegetables, forage crops, in animal husbandry and in everyday life. Highly toxic. Possesses embryotoxic properties.
Saiphos(menazone) is used for the destruction of aphids in agriculture (aficide).
Antio(formotion) is used as a mixed and contact insecticide. Highly toxic.
Butifos(folex, DEF, merphos) is used for pre-harvest drying of cotton leaves.
Fozalon(benzophosphate) is widely used in agriculture as an insecticide, highly toxic.
Tsideal(cydial) - an effective contact insecticide, highly toxic.
Treatment of acute poisoning, 1982
Organophosphorus compounds: dichlorvos, karbofos, mercaptophos, metaphos, chlorophos, DFP, phosphacol, armin, etc. They are used as insecticides, acaricides, toxic substances (sarin, soman, tabun).
Toxic effect: psychotropic, neurotoxic, due to the inhibition of cholinesterases in the synapses of the central and peripheral nervous system with a sharp increase in cholinergic processes (development of muscarinic, nicotine and curariform effects).
The toxic effect of FOS is associated with its structural affinity for the natural substrate "cholinesterase-acetylcholine". Penetrating into the body, FOS strongly binds to the esterase center of cholinesterase, forming an enzyme extremely resistant to hydrolysis, unable to react with acetylcholine molecules. Blocking cholinesterase in two phases: 1ph - reversible suppression of the enzyme function and 2ph - irreversible inhibition after some time (depending on temperature, structure and concentration of the organic phosphorus compound).
Respiratory disorders play the main role in the pathogenesis of FOS poisoning. The leading mechanisms leading to the inhibition of the function of the respiratory system are:
The first symptoms of FOS intoxication develop immediately or several hours after exposure.
There are three stages in the development of poisoning:
In case of inhalation: if a gas mask is not worn, rinse your eyes and face abundantly with water, put on a gas mask or a cotton-gauze bandage moistened with a 2% solution of baking soda. Urgent evacuation from the outbreak.
Free from embarrassing clothing.
The emergency drug is atropine (or another anticholinergic). Urgent administration of atropine intramuscularly or intravenously before relieving signs of intoxication.
Rinse open skin areas with inhalation and percutaneous intake with plenty of water.
For oral administration - gastric lavage through a tube with 10-12 liters of cold water, followed by the introduction of laxatives and activated carbon (20-40 g of water suspension).
In case of ineffectiveness or cessation of breathing, artificial ventilation is indicated. According to indications - cardiovascular drugs.
Intravenous infusion therapy with the obligatory inclusion of potassium chloride. The administration of sodium bicarbonate and calcium preparations is contraindicated. If necessary, continue atropinization until signs of a moderate overdose of atropine appear (tachycardia, mydriasis, dry skin).
Cholinesterase reactivators (carboxyme).
Organophosphorus compounds (FOS) widely used in agriculture and everyday life as a means of fighting insects, rodents, weeds. Poisoning can be seasonal and widespread.
Toxic doses. According to the classification of L.I. The bear is distinguished by the following groups of toxic substances:
highly venomous(DL 50 less than 50 mg / kg): thiophos (parathion, parafos), metaphos (methylparathion, metacid), mercaptophos (sytox, demeton, vnuran), octamethyl (shradan);
highly toxic(DL 50 - 200mg / kg): methyl mercaptophos (methyl sistox, methyldemeton), phosphamide (dimethoate, ditrol, rogor), dichlorphos (vapona, vinyl phosphate, DDVF), ethion, phthalophos;
moderate toxicity(DL 50 - 200 - 1000 mg / kg): chlorophos (dipterex, diplox, trichlorfos), karbofos (malaton, malathion), methylnitrophos (sumithion, folithion, methylchlorothion), saiphos, tribufos, cyanophos;
low toxic(DL 50 above 1000 mg / kg): bromophos, demufos, temefos.
Mechanism of toxicity. FOS inhibit cholinesterase enzymes, mainly acetylcholinesterase, which degrades acetylcholine. As a result, there is an accumulation of acetylcholine, which leads to excitement, and subsequently to depletion and persistent paralysis of cholinergic structures. Acetylcholine acts as a mediator in the following structures:
synapses of postganglionic parasympathetic nerve fibers (muscarinic-sensitive, or M-cholinergic receptors), innervating internal organs, smooth muscles and heart, as well as postganglionic sympathetic nerve fibers, innervating their sweat glands;
in all ganglia, as well as in the neuromuscular synapses of the transversely striated muscles (nicotine-sensitive, or H-cholinergic receptors);
in the M- and N-cholinergic receptors of the central nervous system. The connection of FOS with cholinesterase is fragile during those seconds, in the next few hours it stabilizes and becomes strong after about 5 hours.
Symptoms of FOS poisoning. In the clinical course of oral poisoning, there are three stages:
excitement;
hyperkinesis and seizures;
paralysis.
Muscarinic action is manifested by stimulation of the digestive glands (salivation, nausea, vomiting, diarrhea), bronchial glands (bronchorhea), lacrimal glands (lacrimation), sweat glands (excessive sweating). Bradycardia is also characteristic. As a result of the effect of FOS on smooth muscles, bronchospasm develops, the motility of the alimentary canal and other internal organs increases. Persistent miosis is noted. Large fluid losses lead to hypovolemia and shock. The nicotine-like effect is manifested by general weakness, moderate arterial hypertension, tachycardia, tremor, twitching of individual muscles or their groups with the subsequent development of paresis and paralysis. Damage to the central nervous system is accompanied by headache and agitation, hallucinations, depression of consciousness of varying degrees up to deep coma, tonic-clonic seizures, and respiratory depression are possible.
The clinical picture depends on the route of entry of the poison into the body, it may differ in the speed and sequence of development of individual symptoms. So, with inhalation poisoning, rhinitis and bronchorhea, miosis develop faster; with percutaneous - sweating, myofibrillation at the point of contact between FOS and the skin (if it is the scalp, then symptoms of central nervous system damage develop rapidly). When the poison enters the stomach in the early stages of intoxication, symptoms of damage to the alimentary canal predominate - nausea, vomiting, diarrhea, later myofibrillations of the tongue may persist for a long time.
Diagnostics. The diagnosis is established on the basis of anamnesis data, a characteristic clinical picture, a specific odor of FOS, especially from gastric lavage when the poison is ingested.
Twitching of the muscles of the tongue and lower legs is most pronounced and persists for a long time.
The absence of a reaction of constricted pupils to intravenous administration of 1 - 2 mg of atropine sulfate, the presence of a corresponding clinical picture most often indicates FOS intoxication
Determine the presence of FOS in biological fluids and the activity of cholinesterase. Clinical symptoms appear when cholinesterase activity is inhibited by 25 - 30%; when it is inhibited by more than 50%, all the characteristic symptoms of intoxication are usually observed. If this figure is 80 - 90%, then this indicates severe intoxication. Determination of cholinesterase activity in dynamics makes it possible to assess the effectiveness of the treatment.
Treatment. First of all, it is necessary to normalize the functions of external respiration (sanitation of the oral part of the pharynx, intubation of the trachea, sanitation of the tracheobronchial tree, mechanical ventilation). Gastric lavage is carried out until the odor of FOS from the wash water is eliminated, enterosorbent and saline laxative are introduced. Anti-shock infusion therapy is prescribed. Cholinesterase reactivators are specific antidotes for FOS. Currently, alloxim and dietixime are used.
Alloxim in the 1st stage of poisoning is administered intramuscularly at 0.075 g every 3 hours (daily dose 0.15 - 0.3 g); in the 2nd - 0.15 g each after 3 hours for the first 12 hours, then 0.075 g each after 3 hours (daily dose up to 0.9 g); in the third stage - 0.15 g each after 2 hours for the first 12 hours, then 0.075 g each after 2 hours (daily dose up to 1.5 g).
Dietixim in the 1st stage of poisoning is administered intramuscularly at 0.5 g every 4 hours (daily dose up to 1.5 g); in the 2nd - 0.5 g each after 2 - 3 hours (daily dose up to 6 g); in the 3rd stage - 0.5 g each after 1 - 2 hours (daily dose up to 8 g).
In the absence of alloxime and dietixime, dipiroxime is used.
In the 1st stage, dipiroxime is prescribed at 0.15 - 0.3 g 2 - 3 times a day intramuscularly; in the 2nd - 0.15 - 0.3 g every 2 hours (daily dose 3.6 g) intramuscularly. In the 3rd stage, dipiroxime is prescribed at 0.3 g every 1.5 hours intramuscularly.
Cholinesterase reactivators are usually used on the 1st day from the moment of poisoning, since in the future FOS binds to acetylcholinesterase firmly and irreversibly.
To stop the muscarinic action of FOS, atropine sulfate is administered subcutaneously, intramuscularly or intravenously. The initial dose of the drug is 1 - 2 mg. It is administered until the disappearance of the phenomena of hypersalivation, bronchorhea, hyperhidrosis, bradycardia and until signs of atropinization appear: pupil dilation, dry skin.
The total dose of atropine sulfate in the 1st stage is up to 5 mg, in the 2nd - up to 20 mg, in the 3rd stage - up to 50 mg. In this regard, in the early stages of the use of extracorporeal detoxification methods, phenomena of excessive atropinization may develop, up to severe atropine delirium. Therefore, in the absence of muscarinic-like effects of FOS after extracorporeal detoxification sessions, there is no need to administer atropine sulfate.
Extracorporeal detoxification methods - hemosorption, hemodialysis, hemofiltration - are effective in the early stages of poisoning.
Symptomatic therapy is aimed at eliminating hypovolemia and combating shock. Assign solutions of crystalloids, dextrans, if necessary, in combination with corticosteroids and sympathomimetics. To eliminate convulsive syndrome, benzodiazepines and barbiturates are used. In order to prevent and treat pyoinflammatory complications, broad-spectrum antibiotics are prescribed. For the prevention of lesions of the nervous system, large doses of ATP, vitamin therapy are prescribed. The most pronounced therapeutic effect is shown by nicotinamide - per os, 10 - 20 mg 4 times a day or intramuscularly, 1 - 2 ml of a 1% solution 2 times a day.
Organophosphorus chemical compounds are part of the teeth, bones and all kinds of cells in the human body. It is phosphorus that makes the teeth and skeletal system strong and resistant to various types of stress. Without organophosphorus compounds (abbreviated as FOS or FOV), the nervous system simply could not function properly. However, a large number of them can adversely affect human health and will require first aid in case of poisoning with these poisonous elements.
Organic phosphorus compounds in their molecular composition contain many elements: phosphines (self-igniting, characterized by chemical instability, are considered the strongest poisons; metaphos; karbofos; butyphos; methyl-nitrophos. FOS include: phosphamide; chlorophos;? Octamethyl; thiophos.
A small concentration of FOS is capable of suppressing enzyme systems in the body of dogs and cats; therefore, these compounds are often used as drugs for the treatment of malignant tumors and glaucoma in animals. Scientists have found that organophosphates have mutagenic effects on cells.
Symptoms in case of OPP poisoning primarily depend on the way the chemical enters the body, the category of the pesticide and the degree of toxicity. Due to the fact that these elements inhibit enzymes, disorders of the nervous system and problems with the work of internal organs can be observed.
Also organophosphorus elements were used as a poison in wartime. Often FOS is used in traditional medicine - the compounds are included in ophthalmic drops, medicines that help to normalize the gastrointestinal tract. With the help of a chemical, head lice can be cured.
FOS by their consistency are both solid and liquid, they have a pronounced garlic-kerosene odor. The compounds react well with fats and dissolve in them, but react very poorly with water. For humans, toxic waste is toxic and dangerous. Chemical elements can enter the human body through the upper respiratory tract, skin and digestive system. Organic phosphorus compounds can be poisoned through contaminated water, food, clothing, and household items.
When ingested, organic phosphorus compounds are instantly absorbed from the mouth, stomach, intestines and end up in the blood plasma. Poisoning with elements is dangerous for humans due to serious complications: about fifty percent of the compounds are transformed in the body and become more toxic. In 7-10% of people who have been poisoned with FOS at least once, relapses often appear. Recurrent contact with phosphamide, thiophos, or butifos is not required for a relapse to occur. Re-emergence of poisoning is called chronic phosphorus intoxication.
Doctors distinguish three stages of poisoning, which have their own signs and symptoms: the first is an acute period (lasts from 1 to 3 days), the second is complications appear (lasts from 4 days to 2 weeks), the third is long-term consequences (lasts from 1 month) up to 3 years). During the first stage of poisoning, various systems of the body are excited, the peripheral and central nervous systems are affected.
Acute symptoms of organophosphate poisoning include:
If a large amount of toxic substances has entered the body, the victim may lose consciousness and even fall into a coma. Also, in the acute period of poisoning, nerve cells are affected, shortness of breath, a decrease or increase in body temperature, fluctuations in blood pressure, convulsions and agitation appear.
When complications arise, the symptoms practically go away, but other signs appear: pneumonia; cyanosis of the skin; toxic hepatitis; swelling in the brain; complete absence of reflexes; kidney damage; hypotension. The last stage is the most dangerous, since the muscular and nervous systems, liver, kidneys and other internal organs are almost irretrievably affected.
The diagnosis is made based on the symptoms of the nervous system: loss of vision; disruption of the digestive tract; seizures; tremor; increased salivation. In order to diagnose the degree of poisoning and the level of toxic effects rendered, it is necessary to examine in detail the place where the injured person was at that moment.
When you feel the garlic-kerosene smell from things and household items, you can talk about the presence of phosphorus compounds in the room. The doctor will be able to establish an accurate diagnosis after receiving the results of a biochemical analysis of blood plasma, which the patient must immediately pass.
In an acute period of poisoning, symptoms can occur immediately or after a certain period of time. If a person has a fulminant form of poisoning, they will have seizures half an hour after contact with OPF, otherwise, the tremor will come after 3-5 days.
In case of FOS poisoning, a person should be taken out of the room into fresh air so that toxic substances do not affect the body and are not inhaled along with oxygen. It is recommended to take off the victim's clothes and wrap them in a warm blanket. If there are clean clothes, it is advisable to change into them.
People around you can help the victim by doing a gastric lavage procedure. In case of poisoning, you need to constantly monitor the amount of saliva in a person. To alleviate the patient's condition, a saline laxative, liquid paraffin, activated carbon or sodium sulfate should be given.
People around you can provide first aid for organophosphate poisoning by washing the affected areas of the epidermis. Damaged skin should be washed with clean water, laundry soap and a 2% soda solution. It is recommended to treat the skin with "Chlorhexidine" or "Chloramin".
The essence of first aid for organophosphate poisoning is the intravenous administration of a solution of "Atropine". Injections should be carried out 2-3 times a day until bronchorrhea, increased salivation and excessive sweating stop. The appearance of dryness in the oral cavity is considered a positive result of therapy. A single dose ranges from 0.5 to 2 milliliters of solution.
It is recommended to inject other drugs with anticholinergic action together with "Atropine": "Aprofen", "Amisil" or "Tropacin". "Atropine" must be administered until the symptoms disappear completely, otherwise a relapse is possible.
In combination with "Atropine" in the first 24 hours you need to inject every 2 hours intravenously or intramuscularly 1 milliliter of a fifteen percent solution of "Dipiroxime".
You should also pay attention to symptomatic treatment. If the victim has increased blood pressure, it is recommended to inject 1.5 milliliters of one percent "Diabazole". If a person has severe hypertension and tremors, "Sodium oxybutyrate" should be injected three times a day, 100 milligrams per 1 kilogram of body weight.
In a state of paralysis of the respiratory muscles, artificial ventilation of the lungs is indicated. In this case, "Hydrocortisone" is injected intramuscularly 5 milligrams per 1 kilogram of body weight once a day. In case of blockade and low activity of enzymes in the body, it is recommended to carry out a blood replacement operation. This serious procedure is carried out 3-4 days after poisoning.
In order not to be poisoned by organophosphorus compounds, safety rules should not be neglected. When working with organic phosphorus substances, special protective clothing must be worn so that toxic elements do not get on the skin.
As a preventive measure, small children should be kept away from containers with OPA. The container must be disposed of in a timely manner. If, nevertheless, a poisonous chemical compound gets on a shirt or pants, then they must be removed immediately. If organic phosphorus substances get on the nail plates and hair, the following measures must be taken: hands must be washed with soap and water and the nails must be cut off, and the affected hair must be cut off. These manipulations are carried out so that chemical elements do not enter the body through the hair, nails and epidermis.
First aid in case of FOS poisoning, of course, will help the injured person, but it is imperative to call an ambulance team to hospitalize the patient. Timely provision of first aid by people around and the early arrival of medical workers can save a person's life and minimize the likelihood of complications and serious consequences.
Organophosphorus compounds (FOS) are organic substances that affect the transmission of nerve impulses. Their complex chemical formula contains phosphorus. FOS surrounds us everywhere, and we ourselves consist of them. Nucleic acid, which carries genetic information, nucleotides and phospholipids are natural organophosphorus substances.
Synthetic phosphorus-containing compounds are used in industry for the extraction of rare and non-ferrous metals, improving the quality of lubricating oils and hydraulic fluids, and plastics. In agriculture they are used as pesticides. In everyday life, they are used in the form of aerosol insecticides.
What is FOS?
Synthesized organophosphorus drugs are prescribed to reduce intraocular pressure in the treatment of certain malignant tumors. Adenosine triphosphoric acid (ATP), cocarboxylase, vitamins - are prescribed for diseases of the cardiovascular system.
Previously, organophosphorus compounds were used in the manufacture of chemical weapons of mass destruction. Nerve gases (Zarin, Cyclosarin, Soman, Tabun) in 1993 were banned for storage and production all over the world.
Given the prevalence and variable physicochemical state (gas, liquid, solid), OPO can enter the human body in several ways.
Classification of organophosphorus compounds
The body's nerve cells are interconnected by processes that transmit a nerve impulse. Ultimately, along a chain of neurons, information from the perceiving sensory endings is transmitted to the nuclear structures of the brain. The received signal is processed, a response occurs, which is transmitted in a similar way to the motor nerves. The process of transmitting an impulse lasts a fraction of a second. We do not hesitate to withdraw our hand if we touch something hot. One moment - and many nerve cells reacted to the potential danger.
A nerve impulse is not an electric shock. This is a series of chemical reactions that take place at the junctions of the processes of nerve cells - in synapses. The synapse consists of the terminal section of the transmitting process (axon), the initial section of the receiving process (dendrite) and the synaptic cleft between them. Excitation, carried from cell to cell by the chemical mediator acetylcholine, is manifested by the contraction of the corresponding muscle.
When a nerve impulse is transmitted in the synaptic cleft, an excess amount of acetylcholine is formed, controlled by cholinesterase. This protein enzyme breaks down the unclaimed neurotransmitter of nervous excitement, reduces its concentration, preventing muscle hypertonia.
Danger of FOS poisoning
Organophosphorus compounds block (phospharylate) acetylcholinesterase, contributing to the uncontrolled formation of acetylcholine. When the H-cholinergic receptors of the nerve synapses are blocked, tremor (tremor) of the muscles develops, convulsive syndrome followed by paralysis.
The most dangerous paralysis of the nervous apparatus of the respiratory muscles, which in acute poisoning leads to respiratory arrest. The defeat of the M-cholinergic receptors of the nerve synapses is manifested by a decrease in the secretion of glands, constriction of the pupils, hypertonicity of the smooth muscles of the gastrointestinal tract and respiratory organs, and a slowdown in heart contractions.
Organophosphorus compounds bind some blood proteins, reduce the level of hemoglobin, which leads to hypochromic anemia. They initiate the formation of stable methemoglobin, which is unable to attach oxygen molecules. At the same time, there is a change in the number and quality of leukocytes: toxic granularity, leukocytosis or leukopenia appears. The erythrocyte sedimentation rate decreases.
As a result of contact with organophosphorus compounds, allergic reactions may develop: dermatitis, conjunctivitis, bronchitis with an asthmatic component or bronchial asthma.
In case of poisoning with organophosphorus compounds, after the first symptoms from irritation of the inner lining of the trachea, bronchi, and the alimentary canal, a complete clinical picture unfolds, due to the ingress of compounds into the blood.
Signs of intoxication with organophosphorus compounds
The clinic of poisoning can develop immediately after the poison enters the body or appears after a few hours, the symptoms increase or remain the same intensity. Organophosphorus compounds are neurotropic poisons. Headache, insomnia or drowsiness, dizziness appear. Subsequently, damage to the neuromuscular apparatus develops.
The severity of symptoms depends on the degree of organophosphate toxicity. The clinical picture is influenced by the time of exposure, the dose of OPA, the route of administration and the state of the organism. Acute phosphorus poisoning occurs with mild, moderate and severe symptoms.
The mild degree is characterized by general symptoms that gradually disappear if contact is terminated. With continued exposure, a spasm of the smooth muscles of the upper respiratory tract and gastrointestinal tract develops, coughing, inspiratory dyspnea, abdominal pain, and diarrhea appear. Blood pressure rises, the contraction of the heart muscle becomes more frequent, the pupils narrow, hypersalivation appears.
In moderately severe OPP poisoning, a decrease in muscle tone or atony is added, tendon areflexia develops, and body temperature rises. Changes in the bronchi progress, hypoxia develops, manifested by cyanosis of the skin and visible mucous membranes. Stiffness of movements and muscle tremor appear, due to the excitability of the nervous apparatus of the skeletal muscles.
The severe course of acute poisoning with organophosphate compounds is caused by paralysis of the nervous apparatus of muscle tissue: skeletal muscles do not take part in the act of breathing, which is supported only by the diaphragm. Periodic muscle cramps in the limbs are replaced by tremors. Paralysis of the nervous apparatus of smooth muscles leads to a decrease in the tone of the vascular wall, collapse develops.
The effect on the myocardium is manifested by an increase in the frequency of unproductive heart contractions. Hypersecretion of the glands of the inner bronchial membrane appears, which ends with mucus asphyxiation. Pulmonary edema caused by heart failure joins. Consciousness becomes clouded, a sharp decrease or complete loss of vision develops. Symptoms of a mental disorder appear.
After suffering mild or moderate poisoning, there are residual symptoms for a long time: astheno-vegetative syndrome, polyneuritis, mental disorders.
With prolonged contact, nerve agents lead to the development of chronic disease. Basically, this is an occupational pathology.
General jaundice of the skin and visible mucous membranes appears. Allergic dermatitis is necrotic in nature. Muscle damage leads to the appearance of paralysis, and respiratory arrest develops. The pupils remain constricted even after the death of the patient.
Diagnostics of the FOS intoxication
Differential diagnosis of poisoning with toxic phosphates is based on history, clinical symptoms, laboratory and toxicometric studies. The activity of cholinesterase of erythrocytes and blood serum is determined, qualitative and quantitative chemical reactions are carried out for individual groups of organophosphates. To obtain additional non-specific indicators, a general blood test and a coagulogram are done.
Poisoning is characterized by a decrease to the complete absence of cholinesterase, hypochromic anemia, toxic granularity of leukocytes, leukopenia or leukocytosis appears. A decrease in the erythrocyte sedimentation rate develops, methemoglobin appears, blood coagulability is impaired from hyper- to hypocoagulation, and tolerance to heparin decreases.
Emergency help in case of suspicion of organophosphate poisoning:
When providing first aid, you should take care of your own protection: you must wear rubber gloves, a mask, goggles.
Emergency care for organophosphate intoxication
Treatment for poisoning with organophosphate poisons, carried out in poison control centers, includes antidote and symptomatic therapy. The antidote (Trimedoxin bromide, Isonitrosin, Dietixin) - a cholinesterase reactivator - is administered intravenously repeatedly until the symptoms disappear.
Symptomatic therapy is aimed at maintaining cardiac and pulmonary activity, eliminating visual impairment, eliminating convulsive syndrome of smooth and striated muscles, restoring the rheological properties of blood, detoxification, and accelerated elimination of toxins from the body.
If clinical signs of respiratory arrest appear, tracheal intubation is performed. To reduce the concentration of methemoglobin, blood transfusion is used. Cleansing the inner lining of the respiratory tract is achieved by flushing the bronchial tree. Removal of the toxic substance from the membranes of the gastrointestinal tract is carried out using gastric lavage and cleansing enemas.
Isonitrosin is one of the antidotes for FOS poisoning
The main principle for the prevention of OPP poisoning is compliance with the rules for working with the drug. To reduce the likelihood of contact of harmful substances on the skin and mucous membranes, use protective clothing, a mask or respirator, rubber gloves, and goggles. It is necessary to adhere to the instructions for the use of organophosphorus substances, without changing the concentration and time of working with the poison.
Consider alternative processing methods to reduce the risk of toxicity. If you still have to use OPF, remember about personal protective equipment, symptoms and stages of poisoning, the principles of providing emergency care when the first signs of intoxication appear.
Organophosphates have been used as chemical weapons of mass destruction. Watch an educational film about this.
