Management of intoxication by cholinesterase inhibitors: an experience in a rural hospital in Ecuador

Abstract

Objectives: We review the management of patients intoxicated by pesticides in a Second Level Hospital in a rural area.

Methods: An epidemiological review of 70 cases of poisoning by phosphorus organs (OF), attended in the period 2009 - 2012, at the Pedro Vicente Maldonado Hospital. The data were obtained from the medical records contained in the Hospital's Computer System. In addition, a bibliographic review of the existing evidence of poisoning by phosphorus organs in the world is carried out.

Results: Of the 70 cases of intoxication caused by OF in the rural hospital, 6 were complicated, requiring transfer to third level, two of these patients died in the third level. 63 were handled locally. In all of them, atropine was exclusively used as an antidote, without the need for oximes (2-PAM).

Conclusions: Phosphorus organ poisonings occur more frequently in rural areas and most cases must be handled in the second level. This study suggests that, with few drugs and trained human resources, this pathology, often fatal, should be part of rural medical training. As health policies, developing countries should consider limiting access to certain types of agricultural products.