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      Respiratory complications of organophosphorus nerve agent and insecticide poisoning. Implications for respiratory and critical care.

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          Abstract

          Organophosphorus (OP) compound poisoning is a major global public health problem. Acute OP insecticide self-poisoning kills over 200,000 people every year, the majority from self-harm in rural Asia. Highly toxic OP nerve agents (e.g., sarin) are a significant current terrorist threat, as shown by attacks in Damascus during 2013. These anticholinesterase compounds are classically considered to cause an acute cholinergic syndrome with decreased consciousness, respiratory failure, and, in the case of insecticides, a delayed intermediate syndrome that requires prolonged ventilation. Acute respiratory failure, by central and peripheral mechanisms, is the primary cause of death in most cases. However, preclinical and clinical research over the last two decades has indicated a more complex picture of respiratory complications after OP insecticide poisoning, including onset of delayed neuromuscular junction dysfunction during the cholinergic syndrome, aspiration causing pneumonia and acute respiratory distress syndrome, and the involvement of solvents in OP toxicity. The treatment of OP poisoning has not changed over the last 50 years. However, a better understanding of the multiple respiratory complications of OP poisoning offers additional therapeutic opportunities.

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          Author and article information

          Journal
          Am. J. Respir. Crit. Care Med.
          American journal of respiratory and critical care medicine
          American Thoracic Society
          1535-4970
          1073-449X
          Dec 15 2014
          : 190
          : 12
          Affiliations
          [1 ] 1 Pharmacology, Toxicology, and Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
          Article
          10.1164/rccm.201406-1150CI
          4299648
          25419614
          4f50cf41-064e-4a51-a21d-186e47d9f426
          History

          nerve agent,insecticide,critical care,organophosphorus
          nerve agent, insecticide, critical care, organophosphorus

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