From Symptom to Diagnosis: A Case of Organophosphate Poisoning in an Unconscious Paediatric Patient

Introduction: Organophosphates are used as pesticides in agriculture and poisoning is widespread all over the world. Organophosphates inhibit the enzyme cholinesterase which breaks down acetylcholine in the nervous system. As a result of this inhibition, acetylcholine accumulates in the central nervous system, autonomic ganglia and nerves. This leads to cholinergic discharge. The clinical picture depends on cholinergic discharge and varies from nonspecific symptoms to coma. Mortality and morbidity are high. Case report: A 3.5-year-old male patient was brought to the emergency department unconscious. On initial evaluation, he had a Glasgow coma scale of 10 and concomitant myosis and bradycardia. Haemogram, blood electrolytes, blood glucose, brain tomography and electrocardiogram were normal. In his medical history, it was learnt that he had contact with organophosphate inhalation. Procedure and treatment were planned. Conclusion: The diagnosis of organophosphate poisoning is based on medical history and clinical findings and there is no specific laboratory test. Therefore, it is vital to make a differential diagnosis in patients presenting with coma and confusion. In our patient, the diagnosis of organophosphate poisoning was understood after a detailed medical history and we would like to emphasise the importance of medical history in the differential diagnosis.