Joseph Jenny, Thangavelu Saravanan, Shanjitha J, Jacob Deepak
Department of General Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India.
J Family Med Prim Care. 2023 Jul;12(7):1454-1456. doi: 10.4103/jfmpc.jfmpc_1590_22. Epub 2023 Jul 14.
Organophosphorus compounds (OPC) are major components of pesticides and nerve gas agents. Self-harm by ingestion of OPC pesticides is one of the common problems encountered in the emergency room (ER), especially in developing countries such as India. It is recognised by the World Health Organization (WHO) as the third most prevalent means of suicide. In addition to the cholinergic effects caused by these agents, they can induce metabolic dysregulations. We present a case of a 22-year-old male patient, without previous history of diabetes, who was brought to the ER in an unresponsive state with an HbA1c of 5%. His initial laboratory investigations revealed hyperglycemia, high anion gap metabolic acidosis, ketonuria, and glycosuria. His relatives revealed intentional ingestion of OPC. He was treated for both OPC poisoning and hyperglycemic ketoacidosis. Adequate acute care was instigated though prognosis could not be gauged due to the early discharge of the patient against medical advice. This case highlights that OPC poisoning can be a possible etiological factor for hyperglycemic ketoacidosis. It can mimic diabetic ketoacidosis leading to delayed diagnosis. Thus, early identification and immediate management are crucial because of the effect of hyperglycemic ketoacidosis on the outcome of a patient with OPC poisoning.
有机磷化合物（OPC）是农药和神经性毒剂的主要成分。摄入OPC农药导致的自我伤害是急诊室（ER）常见的问题之一，在印度等发展中国家尤为如此。世界卫生组织（WHO）将其认定为第三大常见自杀方式。除了这些药剂引起的胆碱能效应外，它们还可诱发代谢失调。我们报告一例22岁男性患者，既往无糖尿病史，被送至急诊室时处于无反应状态，糖化血红蛋白（HbA1c）为5%。其初始实验室检查显示高血糖、高阴离子间隙代谢性酸中毒、酮尿症和糖尿。其亲属透露患者系故意摄入OPC。患者接受了OPC中毒和高血糖酮症酸中毒的治疗。尽管因患者不听从医嘱提前出院而无法评估预后，但已采取了充分的急救措施。该病例突出表明，OPC中毒可能是高血糖酮症酸中毒的一个病因。它可模仿糖尿病酮症酸中毒导致诊断延迟。因此，鉴于高血糖酮症酸中毒对OPC中毒患者预后的影响，早期识别和立即处理至关重要。
