Citation

Yanagawa Y, Takeuchi I, Noda K. J. Emerg. Trauma Shock 2023; 16(3): 137-138.

Copyright

(Copyright © 2023, INDO-US Emergency and Trauma Collaborative, Publisher Medknow Publications)

DOI

10.4103/jets.jets_13_23

PMID

38025500

PMCID

PMC10661569

Abstract

We herein introduce our hypothesis based on a case of organophosphate poisoning (OP) inducing parkinsonism that was effectively treated by antiparkinson drugs, including atropine. A 59-year-old female was found unconscious in her home by her family. Her history included schizophrenia and an overdose 2 years earlier. On arrival, she was in a deep coma and shock state with pinpoint pupils, a kerosene-like smell and hyperhidrosis. Whole-body including head computed tomography did not show any specific findings. The main results of a biochemical analysis of her blood showed an extremely low level of butyrylcholinesterase (6 IU/L, [normal range, 178-433]), renal failure (creatinine, 1.88 mg/L), leukocytosis (20,600/μL), hypokalemia (2.7 mEq/L), and hyper hyperamylasemia (1622 U/L). She was clinically diagnosed with OP. She underwent tracheal intubation with mechanical ventilation, massive infusion, and continuous infusion of atropine. Her postadmission course was eventful, as she was complicated with prolonged consciousness disturbance, cholinergic symptoms, convulsion, pneumonia, urinary tract infection, drug rash, and parkinsonism. When continuous infusion of atropine was ceased, her parkinsonism repeatedly deteriorated, so she was treated with a modern antiparkinson drug (9 mg of rotigotine), resulting in further improvement [Figure 1]. She was finally transported to another hospital for rehabilitation. We herein report a case of acute OP-induced parkinsonism that was effectively treated with antiparkinson drugs, including atropine.[1] To our best knowledge, no previous cases received atropine to treat OP-induced parkinsonism. As atropine is frequently used for managing cholinergic symptoms induced by OP,[2] our hypothesis is that OP-induced parkinsonism might have been treated unintentionally, and the actual incidence might be more frequent than reported...

Language: en