Cargando…
Small Bowel Enteritis and Myocardial Depression Complicating Organophosphorus Poison in a Patient With Sleeve Gastrectomy and Intestinal Bypass Surgeries: An Atypical Presentation
Organophosphate (OP) is a pesticide that has been used in agriculture and domestic pest control since the mid-1900s. Acute OP toxicity is caused by inhibiting the acetylcholinesterase (AChE) enzyme, resulting in a cholinergic surge. It is treated with atropine and pralidoxime. Our case is a patient...
Autores principales: | , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Cureus
2023
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10058513/ https://www.ncbi.nlm.nih.gov/pubmed/37007328 http://dx.doi.org/10.7759/cureus.35522 |
_version_ | 1785016649957507072 |
---|---|
author | Shaban, Mohammed Sosa, Franklin Anwar, Muhammad Yasir Atogwe, Irhoboudu Dickson Khaja, Misbahuddin |
author_facet | Shaban, Mohammed Sosa, Franklin Anwar, Muhammad Yasir Atogwe, Irhoboudu Dickson Khaja, Misbahuddin |
author_sort | Shaban, Mohammed |
collection | PubMed |
description | Organophosphate (OP) is a pesticide that has been used in agriculture and domestic pest control since the mid-1900s. Acute OP toxicity is caused by inhibiting the acetylcholinesterase (AChE) enzyme, resulting in a cholinergic surge. It is treated with atropine and pralidoxime. Our case is a patient with a past history of sleeve gastrectomy and intestinal bypass surgery presented after oral OP intake. He initially had small bowel enteritis, followed by lactic acidosis, acute renal injury, and distributive shock. The serum troponin had peaked 50-folds. The echocardiography showed myocardial depression and global hypokinesia with no significant wall motion abnormalities. In contrast to classic bradycardia with OP poisoning, our patient developed persistent sinus tachycardia on the second day. He had a concomitant alcohol withdrawal syndrome, which was managed with intravenous (IV) hydration and benzodiazepines. He had a dramatic improvement on the third day with near resolution of creatinine and lactic acid. The outpatient cardiac follow-up showed partial resolution of the left ventricular ejection fraction (EF) to 48%. In this literature, we discuss the complications and long-term effects of bariatric surgeries, particularly on gastric emptying and medication absorption. We also discuss OP mechanism of action, clinical presentation, therapeutic lines, and atypical presentations in the prior literatures. |
format | Online Article Text |
id | pubmed-10058513 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Cureus |
record_format | MEDLINE/PubMed |
spelling | pubmed-100585132023-03-30 Small Bowel Enteritis and Myocardial Depression Complicating Organophosphorus Poison in a Patient With Sleeve Gastrectomy and Intestinal Bypass Surgeries: An Atypical Presentation Shaban, Mohammed Sosa, Franklin Anwar, Muhammad Yasir Atogwe, Irhoboudu Dickson Khaja, Misbahuddin Cureus Cardiac/Thoracic/Vascular Surgery Organophosphate (OP) is a pesticide that has been used in agriculture and domestic pest control since the mid-1900s. Acute OP toxicity is caused by inhibiting the acetylcholinesterase (AChE) enzyme, resulting in a cholinergic surge. It is treated with atropine and pralidoxime. Our case is a patient with a past history of sleeve gastrectomy and intestinal bypass surgery presented after oral OP intake. He initially had small bowel enteritis, followed by lactic acidosis, acute renal injury, and distributive shock. The serum troponin had peaked 50-folds. The echocardiography showed myocardial depression and global hypokinesia with no significant wall motion abnormalities. In contrast to classic bradycardia with OP poisoning, our patient developed persistent sinus tachycardia on the second day. He had a concomitant alcohol withdrawal syndrome, which was managed with intravenous (IV) hydration and benzodiazepines. He had a dramatic improvement on the third day with near resolution of creatinine and lactic acid. The outpatient cardiac follow-up showed partial resolution of the left ventricular ejection fraction (EF) to 48%. In this literature, we discuss the complications and long-term effects of bariatric surgeries, particularly on gastric emptying and medication absorption. We also discuss OP mechanism of action, clinical presentation, therapeutic lines, and atypical presentations in the prior literatures. Cureus 2023-02-27 /pmc/articles/PMC10058513/ /pubmed/37007328 http://dx.doi.org/10.7759/cureus.35522 Text en Copyright © 2023, Shaban et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Cardiac/Thoracic/Vascular Surgery Shaban, Mohammed Sosa, Franklin Anwar, Muhammad Yasir Atogwe, Irhoboudu Dickson Khaja, Misbahuddin Small Bowel Enteritis and Myocardial Depression Complicating Organophosphorus Poison in a Patient With Sleeve Gastrectomy and Intestinal Bypass Surgeries: An Atypical Presentation |
title | Small Bowel Enteritis and Myocardial Depression Complicating Organophosphorus Poison in a Patient With Sleeve Gastrectomy and Intestinal Bypass Surgeries: An Atypical Presentation |
title_full | Small Bowel Enteritis and Myocardial Depression Complicating Organophosphorus Poison in a Patient With Sleeve Gastrectomy and Intestinal Bypass Surgeries: An Atypical Presentation |
title_fullStr | Small Bowel Enteritis and Myocardial Depression Complicating Organophosphorus Poison in a Patient With Sleeve Gastrectomy and Intestinal Bypass Surgeries: An Atypical Presentation |
title_full_unstemmed | Small Bowel Enteritis and Myocardial Depression Complicating Organophosphorus Poison in a Patient With Sleeve Gastrectomy and Intestinal Bypass Surgeries: An Atypical Presentation |
title_short | Small Bowel Enteritis and Myocardial Depression Complicating Organophosphorus Poison in a Patient With Sleeve Gastrectomy and Intestinal Bypass Surgeries: An Atypical Presentation |
title_sort | small bowel enteritis and myocardial depression complicating organophosphorus poison in a patient with sleeve gastrectomy and intestinal bypass surgeries: an atypical presentation |
topic | Cardiac/Thoracic/Vascular Surgery |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10058513/ https://www.ncbi.nlm.nih.gov/pubmed/37007328 http://dx.doi.org/10.7759/cureus.35522 |
work_keys_str_mv | AT shabanmohammed smallbowelenteritisandmyocardialdepressioncomplicatingorganophosphoruspoisoninapatientwithsleevegastrectomyandintestinalbypasssurgeriesanatypicalpresentation AT sosafranklin smallbowelenteritisandmyocardialdepressioncomplicatingorganophosphoruspoisoninapatientwithsleevegastrectomyandintestinalbypasssurgeriesanatypicalpresentation AT anwarmuhammadyasir smallbowelenteritisandmyocardialdepressioncomplicatingorganophosphoruspoisoninapatientwithsleevegastrectomyandintestinalbypasssurgeriesanatypicalpresentation AT atogweirhoboududickson smallbowelenteritisandmyocardialdepressioncomplicatingorganophosphoruspoisoninapatientwithsleevegastrectomyandintestinalbypasssurgeriesanatypicalpresentation AT khajamisbahuddin smallbowelenteritisandmyocardialdepressioncomplicatingorganophosphoruspoisoninapatientwithsleevegastrectomyandintestinalbypasssurgeriesanatypicalpresentation |