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. 2010 Mar 19;6(4):379–385. doi: 10.1007/s13181-010-0012-y

Hypothermia and Fever After Organophosphorus Poisoning in Humans—A Prospective Case Series

Alison Moffatt 1,2, Fahim Mohammed 1,3,5, Michael Eddleston 1,3,4, Shifa Azher 1,5, Peter Eyer 1,6, Nick A Buckley 1,7,✉
PMCID: PMC2996541  PMID: 20300985

Abstract

There have been many animal studies on the effects of organophosphorus pesticide (OP) poisoning on thermoregulation with inconsistent results. There have been no prospective human studies. Our aim was to document the changes in body temperature with OP poisoning. A prospective study was conducted in a rural hospital in Polonnaruwa, Sri Lanka. We collected data on sequential patients with OP poisoning and analyzed 12 patients selected from 53 presentations who had overt signs and symptoms of OP poisoning and who had not received atropine prior to arrival. All patients subsequently received specific management with atropine and/or pralidoxime and general supportive care. Tympanic temperature, ambient temperature, heart rate, and clinical examination and interventions were recorded prospectively throughout their hospitalization. Initial hypothermia as low as 32°C was observed in untreated patients. Tympanic temperature increased over time from an early hypothermia (<35°C in 6/12 patients) to later fever (7/12 patients >38°C at some later point). While some of the late high temperatures occurred in the setting of marked tachycardia, it was also apparent that in some cases fever was not accompanied by tachycardia, making excessive atropine or severe infection an unlikely explanation for all the fevers. In humans, OP poisoning causes an initial hypothermia, and this is followed by a period of normal to high body temperature. Atropine and respiratory complications may contribute to fever but do not account for all cases.

Keywords: Organophosphorus, Pesticide, Poisoning, Thermoregulation, Cholinergic

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Acknowledgements/Funding

We thank the doctors of the SACTRC-OxCol Poisoning Study Team and their patients at Polonnaruwa General Hospital for their assistance in conducting this study. ME is a Wellcome Trust Career Development Fellow, funded by grant GR063560. The South Asian Clinical Toxicology Research Collaboration is funded by a Wellcome Trust/National Health and Medical Research Council International Collaborative Research Grant GR071669. The authors declare that they have no competing interests.

Open Access

This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

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