Intensive care management of sniper (organophosphate) poisoning secondary to deliberate self-harm: A case report

Abstract

Sniper, an insecticide made of synthetic organophosphate, is a choice substance used for suicide in Nigeria among the youth due to its ready availability. The aim of this study was to describe the management of a case of organophosphate poisoning. A 24-year-old male medical student presented on account of loss of consciousness for 2 h, with vomiting, the passage of loose stool, and a preceding history of suicidal ideation. He was found in his room with an empty bottle of sniper. The patient was in obvious respiratory distress with excessive salivation. His baseline vital sign was as follows: pulse rate-124 bpm, blood pressure-150/80 mmHg, respiratory rate of 34 cpm, SpO2 86%, and temperature of 36.8°C. He was intubated, admitted into the intensive care unit, and placed on a mechanical ventilator. He was commenced on intravenous (IV) atropine 2 mg stat and IV glycopyrrolate 0.4 mg 8 hourly. On the 4th day, he was placed on IV atropine infusion 1 mg/h, while IV phenytoin 300 mg stat and then 150 mg nocte were commenced on account of provoked seizure. The patient had the IV atropine infusion for 10 days. He was placed on midazolam infusion for sedation and had potassium and magnesium correction. The patient was subsequently extubated, transferred to the ward, and discharged home after 10 days in the ward. Organophosphate poisoning management could be challenging and fatal. Early presentation, prompt and appropriate airway management, use of atropine infusion, prompt use of antibiotics, and other supportive care can improve survival.