Preventable acute organophosphate poisoning deaths

Poisoning with cholinesterase inhibiting insecticides such as organophosphates (OP) is a major health problem in Sri Lanka, with over 10,000 hospital admissions and over 1,000 hospital deaths annually. Atropine and pralidoxime are the most useful antidotes in the treatment of OP poisoning. Three cases of fatal OP poisoning are described where although the initial diagnosis and therapy were correct, patients did not survive due to inadequate atropine therapy. The need for continuous monitoring and administering adequate doses of atropine in OP poisoning for several days is stressed.