Intermediate syndrome in acute organophosphorus poisoning: a case report

Abstract

Organophosphate poisoning is one of the most frequent intoxications in human beings, due to the wide availability of these substances in the developing countries; besides the cholinergic crisis, this poisoning can cause neuromuscular compromise after acute exposition. Among them, there is paralysis type two or intermediate syndrome, a rare disorder that can increase morbidity and mortality if it appears, due to the compromise of the rib cage muscles, leading to a respiratory paralysis.This article presents a 16 years old female, who was refered to the “Clinica Universitaria Bolivariana” (CUB) after an organophosphorus poisoning and was admitted to the emergency room with an acute cholinergic syndrome. After antidotal treatment with atropine, she developed the intermediate syndrome as an acute complication that was managed with mechanical ventilation during the ventilatory compromise. During the recovery phase, it is evident that the neuromuscular compromise involves the four limbs, but it begun to recover gradually without any pharmacological intervention, a phenomenon that is characteristic of such liabilities.