Skip to main content
Journal of Medical Toxicology logoLink to Journal of Medical Toxicology
. 2010 Jun 8;6(3):311–314. doi: 10.1007/s13181-010-0095-5

Late Onset, Prolonged Asystole Following Organophosphate Poisoning: A Case Report

Jose Chacko 1,, Ashok Elangovan 1
PMCID: PMC3550479  PMID: 20532843

Abstract

Introduction

Organophosphate (OP) compounds are commonly used as suicidal agents and produce characteristic toxic effects. Cardiac arrhythmias are often observed in the acute phase of toxicity; late onset polymorphic ventricular tachycardia preceded by prolonged QT interval on the EKG is also known to occur. However, there are no reports of late onset, prolonged asystole without preceding arrhythmias and after acute toxicity had abated.

Case Report

We report a case of prolonged asystole 12 days after ingestion of an OP compound, after apparent recovery from the acute toxic effects. Asystole persisted for 25 min, followed by successful resuscitation without any sequelae.

Discussion

Although cardiac arrhythmias and circulatory arrest are known to occur following OP ingestion, these are often in the acute phase of toxicity. Our patient had no preceding cardiac manifestations but developed prolonged refractory asystole after 12 days of ingestion of the compound when the acute effects had subsided. We emphasize the importance of being aware of the potential for OP compounds to cause late onset asystole and the need for continued EKG monitoring even after the acute symptoms appear to have settled.

Keywords: Organophosphate, Late onset, Asystole

Full Text

The Full Text of this article is available as a PDF (194.3 KB).

Footnotes

Source of funding None

Previous presentation of data Not presented

References

  • 1.Sidell FR. Clinical effects of organophosphorus cholinesterase inhibitors. J Appl Toxicol. 1994;14(2):111–113. doi: 10.1002/jat.2550140212. [DOI] [PubMed] [Google Scholar]
  • 2.Ludomirsky A, Klein H, Sarelli P, Becker B, Hoffman S, Thitelman U, et al. QT prolongation and polymorphous (“torsade de pointes”) ventricular arrhythmias associated with organophosphate insecticide poisoning. Am J Cardiol. 1982;49:1654–1658. doi: 10.1016/0002-9149(82)90242-9. [DOI] [PubMed] [Google Scholar]
  • 3.Luzhnikov EA, Savina AS, Shepelev VM. On the pathogenesis of cardiac rhythm and conductivity disorders in cases of acute insecticide poisoning. Kardiologiia. 1975;15:126–129. [PubMed] [Google Scholar]
  • 4.Wang MH, Tseng CD, Bair SY. QT interval prolongation and pleomorphic ventricular tachyarrhythmia (‘Torsade de pointes’) in organophosphate poisoning: report of a case. Hum Exp Toxicol. 1998;17:587–590. doi: 10.1177/096032719801701010. [DOI] [PubMed] [Google Scholar]
  • 5.Rubinshtein R, Bar-Meir E, Grubstein A, Bitterman H. Early onset of ventricular tachyarrhythmias in organophosphate intoxication. IMAJ. 2002;4:63–64. [PubMed] [Google Scholar]
  • 6.Karki P, Ansari JA, Bhandary S, Koirala S. Cardiac and electrocardiographical manifestations of acute organophosphate poisoning. Singapore Med J. 2004;45:385–389. [PubMed] [Google Scholar]
  • 7.Kiss Z, Fazekas T. Arrhythmia in organophosphate poisoning. Acta Cardiol. 1979;34:323–330. [PubMed] [Google Scholar]
  • 8.Saadeh AM, Farsakh NA, Al-Ali MK. Cardiac manifestations of acute carbamate and organophosphate poisoning. Heart. 1997;77:461–464. doi: 10.1136/hrt.77.5.461. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Dalvi CP, Abraham PP, Iyer SS. Correlation of electrocardiographic changes with prognosis in organophosphorus poisoning. J Postgrad Med. 1986;32:115–119. [PubMed] [Google Scholar]
  • 10.Yurumez Y, Yavuz Y, Saglam H, Durukan P, Ozkan S, Akdur O, et al. Electrocardiographic findings of acute organophosphate poisoning. J Emerg Med. 2009;36:39–42. doi: 10.1016/j.jemermed.2007.08.063. [DOI] [PubMed] [Google Scholar]
  • 11.Marosi G, Ivan J, Vass K, Gajdacs A, Ugocsai G. EKG repolarizations Zavar (QT megnyulas) ViZsgalata zserves foszfor- saveszter mergezesben. Orv Hetil. 1989;130:111–115. [PubMed] [Google Scholar]
  • 12.Manning GW, Hall GE, Banting FG. Vagus stimulation and the production of myocardial damage. Can Med Assoc J. 1937;37:314–318. [PMC free article] [PubMed] [Google Scholar]
  • 13.Hall GE, Ettinger GH, Banting FG. An experimental production of coronary thrombosis and myocardial failure. Can Med Assoc J. 1936;34:9–15. [PMC free article] [PubMed] [Google Scholar]
  • 14.Horio Y, Yasue H, Bokutanda M, Nakamura N, Ogawa H, Takaoka K, et al. Effects of intracoronary injection of acetylcholine on coronary arterial diameter. Am J Cardiol. 1986;57:984–989. doi: 10.1016/0002-9149(86)90743-5. [DOI] [PubMed] [Google Scholar]
  • 15.Roth A, Zellinger I, Arad M, Atsmon J. Organophosphates and the heart. Chest. 1993;103:576–582. doi: 10.1378/chest.103.2.576. [DOI] [PubMed] [Google Scholar]
  • 16.Anand S, Singh S, Saikia UN, Bhalla A, Sharma YP, Singh D. Cardiac abnormalities in OP poisoning. Clin Toxicol. 2009;47:230–235. doi: 10.1080/15563650902724813. [DOI] [PubMed] [Google Scholar]
  • 17.Martin GB, Nowak RM, Cisek JE, Carden DL, Tomlanovich MC. Hyperkalemia during human cardiopulmonary resuscitation: incidence and ramifications. J Emerg Med. 1989;7:109–113. doi: 10.1016/0736-4679(89)90253-9. [DOI] [PubMed] [Google Scholar]
  • 18.Schultz SC, Cullinane DC, Pasquale MD, Magnant C, Evans SRT. Predicting in-hospital mortality during cardiopulmonary resuscitation. Resuscitation. 1996;33:13–17. doi: 10.1016/s0300-9572(96)00986-0. [DOI] [PubMed] [Google Scholar]
  • 19.Evans JS, Oram MP. Neurological recovery after prolonged verapamil-induced cardiac arrest. Anaesth Intensive Care. 1999;27:653–655. doi: 10.1177/0310057X9902700617. [DOI] [PubMed] [Google Scholar]
  • 20.Holzer M, Sterz F, Schoerkhuber W. Successful resuscitation of a verapamil-intoxicated patient with percutaneous cardiopulmonary bypass. Crit Care Med. 1999;27:2818–2823. doi: 10.1097/00003246-199912000-00035. [DOI] [PubMed] [Google Scholar]
  • 21.Waxman AB, White KP, Trawick DR. Electromechanical dissociation following verapamil and propranolol ingestion: a physiologic profile. Cardiology. 1997;88:478–481. doi: 10.1159/000177380. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Medical Toxicology are provided here courtesy of Springer

RESOURCES