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1、ORGANOPHORUSPESTICIDESPOISONINGLVLINGDEPARTMENTOFOCCUPATIONALDISEASEHUASHANHOSPITALFUDANMEDICALCOLLEGE1SpecificPropertiesBasicchemicalstructuresR1-OR2-OPYX2PhysicalandchemicalpropertyAoilorcrystallinesubstance,thatisyellowtobrownpossessinganunpleasantsmell.Insolubleinwater;solubleinorganicliq
2、uid.Easilydissolvedinalkalizingcondition.3DegreeoftoxicityManyofthemarehighlyorextremelytoxic.4ExposuresituationsOccupationalEnviromental5AbsorbandMetabolismAbsorb-Maybeabsorbedthroughrespiratoryordigestivetract-Alsothroughskin.Metabolism-Mainlyintheliver-byoxidation,detoxicationprocesses6Mec
3、hanismoftoxicactionTheAChE(acetylcholinesteraseofcholinesterase)isinhibited.OrganophoruscombinestheAChE,resultingorganophosphate-cholinesterase.causingacumilationofacetylcholine.7ClinicalmanifestationsAcutepoisoning-Muscarinicsign:presentedwithconstraction,excessivelacrimalsecretion-Nicotinic
4、sign:Excessiveaccumulationof-CentralnervoussystemsignsAChEinneuromusculartransmission8Degreeofpoisoning-Mildpoisoning:Msign-Moderatepoisoning:Nsign,muscularfibrillation-Heavypoisoning:coma、pulmonaryedemabreathparalysis、brainedema9OrganophosphateInducedDelayedPolyneuropathy(OPIDP)2~3weeks(4~45
5、days)afterdisappearanceofacutesymptoms.ItisnotrelatedtotheinhibitionofChE,butisrelatedtoinhibitionofneuropathytargetedNTE.10-Progressivestage:-Stablestage:3-12months.-Remissionstage:6-18months.11Intermediatesyndrome24~96hoursafteracutepoisoning,muscleparalysis.ItisrelatedtolonginhibitionofChE
6、(delayeliminationofpesticides,notduetoenoughdrug,solubleinorganicliquid).Skindamage12LaboratoryTestingCHEinwholeblood-Specificmarkfororganophoruspesticidepoisoning.-mildpoisoning:ChE50~70%oftheactivityinnormalindividuals;-moderate:30~50%-heavy:<30%13metabolismproductsinurineEMG14DiagnosisExpo
7、surehistoryClinicalmanifestations:M,NsignsandCNSDeterminationofChEactivity:〈50%Responsetospecifictreatments15DifferentialdiagnosesMuscarinicTetrodotoxinHeatillnessAcutegastrointestinalinflammationBraininfectionOtherpesticides16TreatmentMakedi