Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jun;27(6):397-402.
doi: 10.5005/jp-journals-10071-24475.

Quantification of Organophosphorus Insecticide Removed by Gastric Lavage in Acutely Poisoned Patients: An Observational Study

Asisha Janeela Mathansingh  1 , Arun Jose  2 , Jude Joseph Fleming  2 , Kundavaram Paul Prabhakar Abhilash  3 , Vignesh Kumar Chandiraseharan  1 , Audrin Lenin  1 , Samuel George Hansdak  1 , Ramya Iyyadurai  1 , Thenmozhi Mani  4 , John Victor Peter  5 , Michael Eddleston  6 , Anand Zachariah  1
Affiliations

Quantification of Organophosphorus Insecticide Removed by Gastric Lavage in Acutely Poisoned Patients: An Observational Study

Asisha Janeela Mathansingh et al. Indian J Crit Care Med. 2023 Jun.

Abstract

Introduction: The effectiveness of gastric lavage in organophosphorus (OP) poisoning has not been established. We assessed the ability of gastric lavage to remove OP insecticides as a preliminary stage in assessing effectiveness.

Patients and methods: Organophosphorus poisoning patients presenting within 6 hours were included, irrespective of prior gastric lavage. A nasogastric tube was placed and gastric contents aspirated, followed by at least three cycles of gastric lavage with 200 mL of water. Samples from the initial aspirate and the first three lavage cycles were sent for identification and quantification of the OP compounds. Patients were monitored for complications of gastric lavage.

Results: Around 42 patients underwent gastric lavage. Eight (19.0%) patients were excluded from the study because of a lack of analytical standards for ingested compounds. Insecticides were detectable in the lavage samples of 24 of 34 (70.6%) patients. Lipophilic OP compounds were detected in 23 of 24 patients, while no hydrophilic OP compounds could be detected in six patients with reported ingestion of hydrophilic compounds. For chlorpyrifos poisoning (n = 10), only 0.65 mg (SD 1.2) of the estimated ingested amount (n = 5) of 8,600 mg (SD 3,200) was recovered by gastric lavage. The mean proportion of the compound removed by initial gastric aspirate was 79.4% and subsequent three cycles removed 11.5, 6.6, and 2.7%.

Conclusion: Lipophilic OP insecticides could be quantified in the stomach contents of OP poisoning patients with the first aspiration or lavage being most effective. The amount removed was very low; hence, routine use of gastric lavage for OP poisoning patients arriving within 6 hours is unlikely to be beneficial.

How to cite this article: Mathansingh AJ, Jose A, Fleming JJ, Abhilash KPP, Chandiraseharan VK, Lenin A, et al. Quantification of Organophosphorus Insecticide Removed by Gastric Lavage in Acutely Poisoned Patients: An Observational Study. Indian J Crit Care Med 2023;27(6):397-402.

Keywords: Efficacy; Gastric lavage; Insecticide poisoning; Organophosphorus.

PubMed Disclaimer

Conflict of interest statement

Source of support: Nil Conflict of interest: None

Figures

Fig. 1
Fig. 1
STROBE figure
Fig. 2
Fig. 2
Amount of chlorpyrifos removed vs time to presentation to our hospital in those who had and did not have a prior gastric lavage
See this image and copyright information in PMC

References

    1. Bertolote JM, Fleischmann A, Butchart A, Besbelli N. Suicide, suicide attempts and pesticides: A major hidden public health problem. Bull World Health Organ. 2006;84(4):260. doi: 10.2471/blt.06.030668. - DOI - PMC - PubMed
    1. Gunnell D, Eddleston M. Suicide by intentional ingestion of pesticides: A continuing tragedy in developing countries. Int J Epidemiol. 2003;32(6):902–909. doi: 10.1093/ije/dyg307. - DOI - PMC - PubMed
    1. Gunnell D, Eddleston M, Phillips MR, Konradsen F. The global distribution of fatal pesticide self-poisoning: Systematic review. BMC Public Health. 2007;7(1):357. Available from: https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-7-357. - DOI - PMC - PubMed
    1. Rao CS, Venkateswarlu V, Surender T, Eddleston M, Buckley NA. Pesticide poisoning in south India – Opportunities for prevention and improved medical management. Trop Med Int Health. 2005;10(6):581–588. doi: 10.1111/j.1365-3156.2005.01412.x. - DOI - PMC - PubMed
    1. Eddleston M, Dawson A, Karalliedde L, Dissanayake W, Hittarage A, Azher S, et al. Early management after self-poisoning with an organophosphorus or carbamate pesticide – A treatment protocol for junior doctors. Crit Care. 2004;8(6):R391–397. doi: 10.1186/cc2953. - DOI - PMC - PubMed

LinkOut - more resources