JIST

Abstract

Organophosphate (OP) and carbamate (CM) insecticides are commonly involved in poisoning cases in India. These compounds act by inhibiting acetylcholinesterase, causing accumulation of acetylcholine resulting in cholinergic effects, and are therefore called anticholinesterase insecticides. In addition, there are often direct CNS effects including tremulousness, altered sensorium, slurred speech, ataxia, and seizures, followed by coma in the final stage.

Aside from these, OP poisoning can also cause an “intermediate syndrome” (IMS) manifesting mainly as proximal muscle weakness and paralysis; a “delayed syndrome” (organophosphate induced delayed neuropathy or OPIND) which is a combination of polyneuropathy and weakness of distal limb muscles; as well as neuropsychiatric disturbances (chronic organophosphate induced neuropsychiatric disorder or COPIND).Other complications have been occasionally reported, such as hepatic dysfunction, pancreatitis, vocal cord palsy, etc. 

The case being reported here is one of combined organophosphate-carbamate poisoning with a rare complication, parkinsonism. This complication is very rare, and only a few cases have been published relating to it.