Severe acute organophosphate poisoning managed with 2-month prolonged atropine therapy: a case report

INTRODUCTION AND IMPORTANCE: Organophosphate (OP) poisoning is a common and potentially fatal condition that requires prompt and aggressive treatment with atropine, oximes, and supportive care. We report a rare case of OP poisoning that needed high doses of atropine and intensive care for 60 days. CASE PRESENTATION: A 39-year-old male ingested 200 ml of chlorpyrifos, an OP compound, and presented with vomiting and epigastric pain. He received an initial dose of atropine of 60 ml (36 mg, 1 ml=0.6 mg), followed by an infusion of 16 ml/h (9.6 mg/h). He developed hypoxia, cardiac arrest, delirium, fever, and persistent bronchorrhea. He was intubated, resuscitated, and transferred to ICU, where he continued showing signs of OP excess and therefore, he received up to 170 ml/h (102 mg/h) of atropine infusion, along with triple inotropes and sedation. He underwent tracheostomy and gradual weaning of atropine. He recovered completely and was discharged in stable condition. CLINICAL DISCUSSION: This case demonstrates the need for prolonged monitoring of patients with OP poisoning wherein the patient can develop signs of OP excess even after initial atropinization, the effectiveness of multiple doses of atropine in OP poisoning, and the importance of monitoring for complications associated with a prolonged hospital stay. It also shows the potential need for prolonged atropine therapy and intensive care in OP poisoning. CONCLUSION: OP poisoning can be life-threatening and requires early and aggressive treatment with atropine, oximes, and supportive care. Clinicians should be aware of the potential need for prolonged atropine therapy in OP poisoning cases to improve the chances of survival.