ANTICHOLINESTERASE AGENT POISONING IN A PEDIATRIC PATIENT: CASE REPORT

Abstract

Exogenous organophosphate pesticide poisoning constitutes a toxicological emergency with high morbidity and mortality, requiring immediate diagnosis and intervention, particularly in the pediatric population. We report a case of accidental organophosphate poisoning in a 12-year-old pediatric patient admitted to the emergency room with severe acute cholinergic syndrome, characterized by generalized seizures, decreased level of consciousness, and cardiorespiratory arrest. The diagnosis was corroborated by laboratory tests that demonstrated marked suppression of acetylcholinesterase (AChE) activity, with initial values ​​below 0.2 U/mL (reference value: 5.9 to 12.22 U/mL). Despite the institution of intensive care, including mechanical ventilation and high-dose atropine, the patient presented an unfavorable clinical course, developing hypoxic-ischemic encephalopathy and subsequently being diagnosed with brain death. The fatal outcome, even with protocol-based clinical management, highlights the severity and potential therapeutic refractoriness of severe poisonings, reinforcing the critical importance of epidemiological surveillance and the implementation of primary prevention policies to mitigate exposure to these toxic agents.