What discharge advice should be given to patients treated for organophosphorus poisoning?

Discharge Advice for Organophosphorus Poisoning

Patients treated for organophosphorus poisoning should be kept under observation for at least 48 to 72 hours after exposure, even if they appear to be improving, due to the risk of fatal relapses from continued absorption of the poison. 1

Key Elements of Discharge Advice

Follow-up Monitoring

• Schedule follow-up within 1 week to monitor cholinesterase activity levels
• Continue monitoring until cholinesterase activity returns to normal levels 2
• Return immediately to the hospital if any symptoms recur, particularly:
  • Respiratory difficulties
  • Increased secretions
  • Muscle weakness or twitching
  • Mental status changes

Medication Instructions

• Complete the full course of prescribed medications
• Avoid medications that may interact with organophosphate poisoning recovery:
  • Morphine
  • Theophylline and aminophylline
  • Reserpine
  • Phenothiazine-type tranquilizers
  • Succinylcholine 2, 1

Potential Delayed Complications to Watch For

• Intermediate syndrome (occurs 24-96 hours after acute cholinergic crisis)
  • Characterized by respiratory insufficiency
  • Proximal muscle weakness
  • Cranial nerve palsies
• Delayed polyneuropathy (occurs 2-3 weeks after exposure)
• Neuropsychiatric effects (may persist for weeks to months) 2

Prevention of Re-exposure

• For accidental exposures:
  • Proper storage of pesticides in original containers, away from food and children
  • Use of protective equipment when handling organophosphates
  • Thorough washing after potential exposure
• For intentional ingestion:
  • Mental health referral before discharge
  • Suicide risk assessment
  • Family support and counseling 2

Special Considerations

Continued Decontamination

• Instruct patients to continue washing skin and hair thoroughly with soap and water for several days after discharge if dermal exposure occurred
• Wash all potentially contaminated clothing separately, twice, with detergent 2

Occupational Considerations

• Patients with occupational exposure should:
  • Be cleared medically before returning to work
  • Review proper handling techniques for organophosphates
  • Consider job modification if appropriate

Nutrition and Hydration

• Maintain adequate hydration to support elimination of toxins
• Follow a balanced diet to support recovery

Pitfalls to Avoid

1. Premature discharge: The most critical pitfall is discharging patients too early. Fatal relapses have been reported after initial improvement due to continued absorption from the lower bowel 1

2. Inadequate monitoring: Cholinesterase activity should be monitored until it returns to normal levels 2

3. Failure to recognize intermediate syndrome: This potentially fatal complication typically occurs 24-96 hours after the acute cholinergic crisis has been treated, making post-discharge vigilance critical 2

4. Overlooking mental health needs: For intentional poisonings, comprehensive psychiatric evaluation and follow-up are essential before discharge

5. Medication interactions: Certain medications can interact dangerously with residual organophosphate effects and should be avoided 2, 1

By providing comprehensive discharge instructions covering these areas, healthcare providers can significantly reduce the risk of complications and mortality following organophosphorus poisoning.