Carbophos poisoning

In the summer, repair and construction work is quite often carried out. The substances used for this are quite dangerous, have toxic properties. These substances are especially dangerous for children, because their metabolism is much faster, respectively, the symptoms of pathology develop much faster.

In medical practice, more and more have to deal with such diagnoses as poisoning of FOV. First of all, let's figure out what this abbreviation is. Decoding is quite simple - FOV are organophosphorus substances. Also, a synonym is often found - FOS (organophosphorus compound). This is a group of substances that are most often used as an insecticide, pesticide. It is worth noting that this includes a large number of substances, including kalbofos.

Pesticide poisoning most often occurs in the summer, when various work is done on a personal plot, and crops and vegetation are processed. Acute poisoning develops quickly, sharply. The main symptoms are the development of signs of intoxication.

In case of poisoning, there is no time to wait, so you need to call an ambulance. When calling an ambulance, you should inform the dispatcher in advance about the case of poisoning. This can facilitate the work of the doctor: he will immediately take with him the antidote, everything necessary to provide assistance. This will reduce the risk of complications.

There are certain principles for the treatment and diagnosis of poisoning. First you need to carry out treatment (provide emergency care). Only after a person is already safe, and his condition is stable, you need to proceed to the diagnosis. At the initial stage, before providing emergency care, the diagnosis should be minimized, and it comes down to the fact that first you need to at least approximately identify the area of damage, identify those organs and systems that have undergone the greatest pathology. This will allow you to most effectively support vital functions, and also allow you to determine the picture of the pathology, based on which further treatment will be selected. You may need an antidote that simply neutralizes the poison and removes it from the body.

After stabilization of the body, choose the most effective methods of instrumental diagnostics, in accordance with the suspected pathologies.

Epidemiology

Acute pesticide poisoning is currently an important cause of morbidity and mortality worldwide (Jeyaratnam 1990). According to estimates by the World Health Organization (WHO) published in 1990, about 3 million cases of poisoning annually. [1]

Organophosphate pesticide poisoning is an important clinical problem in rural areas of the developing world, where about 200,000 people die every year. [2] About 99% of these deaths occur in developing countries.

According to statistics, the household method of karbofos poisoning accounts for approximately 15%. This is a private work using this substance, its storage at home. Approximately 65% of poisonings occur in industrial poisoning that occurs in connection with the professional activities of workers. Approximately 15% are children and animals, incapacitated persons who are poisoned at random. The remaining 5% are poisoned for the purpose of committing murder or suicide.

Of all the poisonings, approximately 69% are acute poisonings, the remaining 31% are chronic poisonings. In the absence of treatment and failure to provide emergency care, 98% of poisonings result in death. If timely emergency care is provided, about 15-30% of cases of poisoning are fatal. [3]

Causes of the karbofos poisoning

The causes of poisoning are many. Poisoning can occur by accident, or intentionally. Most poisoning nevertheless occurs by accident: with prolonged contact with toxic substances, during work on a production or personal plot, during repair or construction, and during the processing of gardens and kitchen gardens.

In addition, poisoning occurs with people who, due to their professional duties, are forced to come into contact with karbofos, and other similar substances. This often happens in production, in laboratories. This happens both in connection with a malfunction of the working equipment, and in connection with the carelessness, negligence, or irresponsibility of employees. A common reason is non-compliance with the rules of operation, or operating conditions of the equipment, the absence of an exhaust hood or its malfunctioning condition, an unventilated room.

Often poisoning occurs in children, because they have a natural, natural curiosity and a desire for knowledge. Finding something new, they will certainly try it. Banal carelessness and distraction can cause poisoning. For example, if you store the product without a label, or with food, you can mix up the substances, which will lead to poisoning.

If we talk about deliberate cases of poisoning. Then they rarely happen. Nevertheless, there are such cases, mainly with the aim of committing suicide or murder.

Risk factors

The risk factors are the need to be in contact with karbofos: whether it is periodic contacts arising in connection with the need to carry out certain works, or constant, prolonged contact, which leads to the development of chronic poisoning. At risk are people of various professions who are associated with the need to use various toxic substances, including kalbofos. Also at risk are small children, animals, the elderly, people with mental disorders. Personality disorders, impaired consciousness, memory, psychosis, neurosis, neuropsychiatric disorders.

Pathogenesis

Exposure to organophosphorus pesticides may occur by inhalation, ingestion, or skin contact. Crops encountered by farm workers may also include organophosphorus substances such as apples, celery, bell peppers, peaches, strawberries, nectarines, grapes, spinach, lettuce, cucumbers, blueberries and potatoes.

Organophosphorus pesticides inhibit esterase enzymes, especially acetylcholinesterase (EC 3.1.1.7) in synapses and on erythrocyte membranes, and butyrylcholinesterase (EC 3.1.1.8) in plasma. Although acute inhibition of butyrylcholinesterase does not seem to cause clinical manifestations, inhibition of acetylcholinesterase leads to the accumulation of acetylcholine and excessive stimulation of acetylcholine receptors in the synapses of the autonomic nervous system, central nervous system and neuromuscular connections. Subsequent autonomic, central nervous system, and neuromuscular characteristics of organophosphate poisoning are well known. 

Clinical features  due to excessive stimulation of muscarinic acetylcholine receptors in the parasympathetic system:

• bronchospasm;
• bronchorrhea;
• miosis;
• lacrimation
• urination;
• diarrhea;
• hypotension;
• bradycardia;
• vomiting
• salivation.

Clinical features  due to excessive stimulation of nicotinic acetylcholine receptors in the sympathetic system:

• tachycardia;
• mydriasis;
• hypertension;
• sweating.

Clinical features  due to excessive stimulation of nicotinic and muscarinic acetylcholine receptors in the central nervous system:

• confusion;
• agitation;
• coma;
• respiratory failure.

Clinical features  due to excessive stimulation of nicotinic acetylcholine receptors in the neuromuscular junction:

• muscle weakness;
• paralysis;
• fasciculations.

The basis of poisoning karbofosom is the development of an intoxication process. Poisoning substances enter the body in one of the known ways - through the respiratory tract, through the gastrointestinal tract, or through the mucous membranes and skin integuments. It is worth noting that pathogenesis depends on which pathway the substance penetrates, how much substance has penetrated the body, and also how long the substance has entered the body.

When penetrating through the respiratory tract, mucous membranes burn, further toxins penetrate into the respiratory cells and tissues, the development of edema and irritation on the mucous membranes of the upper and lower respiratory tract. The accumulation of the main substance occurs in the alveoli. There they are absorbed, absorbed through cell membranes. The substance is absorbed, and then enters the bloodstream, where the main poisonous effect is carried out.

When penetrating through the digestive tract, a chemical burn of the esophagus and stomach develops. The main absorption occurs through the walls of the large intestine, then through the walls of the small intestine. After absorption, the substance enters the bloodstream, and then has a toxic effect there.

The substance is transported in the blood, then it penetrates the liver, where a number of transformations take place, it undergoes neutralization. It is the process of processing the substance by the liver that determines the further course of poisoning. A number of transformations are taking place in the immune system, kidneys, and liver.

Symptoms of the karbofos poisoning

The main symptoms of karbofos poisoning are nausea, vomiting, dizziness, loss of consciousness, diarrhea. In the future, if you do not provide emergency care, the condition worsens. There is a sharp pain in the stomach, profuse vomiting, bleeding. A person can lose consciousness, his body temperature rises or falls sharply, his pulse slows, his blood pressure drops. Cardiac arrhythmia, suffocation, cough, confusion, hallucinations and delirium appear. Later, signs of damage to the liver, kidneys, dyspeptic syndromes join. As the condition worsens, hepatic or renal failure, heart failure develops. Pulmonary or cerebral edema may develop. Gradually, multiple organ failure develops, which is fatal. [4]

The first signs are a general deterioration in well-being, in which a person has a slight tremor in the body, sweaty-cold limbs become. The temperature of the body gradually rises, weakness develops, appetite decreases, a person is not able to concentrate, his ability to work decreases sharply. Cold sweat appears, palpitations, breathing become more frequent. Individual reactions develop - blood pressure can either increase or decrease. With a tendency to allergic reactions, an allergic reaction develops, anaphylactic shock, an asthma attack. The victim needs emergency care. [5]

Carbophos poisoning through the skin

Carbophos poisoning can also occur through the skin. In this case, the toxic substance is absorbed through the surface of the skin with further transport throughout the body through the blood. This route of penetration of the substance into the blood is called the transdermal barrier. The main manifestation is damage to the surface layers of the skin, the development of a chemical burn. It is necessary to stop the exposure of the poisonous substance to the body as soon as possible with the further provision of emergency care. To do this, immediately wash the affected area with water, then wipe the affected area with a fatty substance (oil, cream on a greasy basis, glycerin). [6], [7]

Then the victim is taken to the hospital as soon as possible, where further diagnosis and treatment is carried out. Diagnosis is based on the definition of a typical pattern of poisoning, which is characteristic of this particular type of poisoning. The main analysis for any type of poisoning is traditionally considered a toxicological study and a biochemical blood test. Then carry out the remaining analyzes. Typically, standard tests are prescribed - clinical tests of blood, urine, feces. This allows us to assess the general orientation of the pathological process, to identify the spectrum of damage that has arisen in connection with the effect of the poison on the body. [8]

Carbophos poisoning is indicated by:

• high levels of eosinophils;
• the appearance of mast cells in the blood;
• increase in ESR;
• high bilirubin level;
• the presence of white blood cells or a large amount of protein in the urine;

The exact clinical picture of the pathology with a detailed description of the symptoms, early signs of the pathology is also important. Based on the diagnosis, you can make the basic assumption regarding the cause of poisoning, on the basis of which further treatment will be prescribed. Therefore, when the first signs of poisoning, malaise appear, you need to see a doctor as soon as possible.

Organophosphate intoxication

When working with organophosphorus pesticides, severe intoxication of the body can occur, in which the toxin enters the body. It can get into the blood in various ways. This can occur through the skin (transdermal barrier), or through the respiratory tract, or through the digestive tract. A typical pattern of poisoning develops, which is practically no different from other types of poisoning. [9]

The first signs of poisoning are a sharp deterioration in the general condition of the body, a deterioration in well-being, dizziness, lack of air, and suffocation. Gradually, nausea, vomiting, diarrhea. Convulsive syndrome, abdominal pain, which are accompanied by delirium, clouding of consciousness, sometimes hallucinations, can develop. As symptoms develop, the condition worsens, weakness appears, cold sweat, tremors develop in the body.

Emergency care is required, and it is also urgent to call an ambulance, which will provide professional assistance, and if necessary, will be taken to the hospital for further hospitalization and treatment.

It must be borne in mind that with poisonous karbofos there are specific diagnostic features. First, the patient is given emergency care, and the diagnosis is carried out later, after the threat to life has passed. It is quite simple to explain: poison can act secretly, asymptomatically. Long-term consequences are also possible, which will manifest much later. But changes take place at an early stage, and they can be identified and eliminated in a timely manner.

It is important to conduct a toxicological study, since toxins are contained in human biological fluids. Biochemical analysis shows what changes have occurred in the body under the influence of toxins. If it is impossible to conduct a toxicological or biochemical analysis, a routine clinical blood test is performed. The clinic will indicate an inflammatory, infectious, or allergic process. According to the blood formula, the cause of the pathology can be assumed. [10]

To refine the data, various methods of laboratory research can be used, including: allergy tests, analysis for the content of general and specific immunoglobulin E, analysis for histamine levels, analysis for toxins, a detailed immunogram, rheumatic tests, analysis for the level of C-reactive protein, analysis of an determination of the level of the CEC, etc.

Chronic pesticide poisoning

In chronic pesticide poisoning, a toxic substance acts on the body for a sufficiently long period of time. Usually observed in those people who, due to their professional activities, are forced to work with pesticides. Face them for a long period of time, systematically and regularly. Poisoning can proceed slowly, gradually the symptoms become more pronounced, the severity of intoxication increases. [11]

When the first signs of poisoning appear, it is necessary to provide first aid to the victim, call an ambulance. An ambulance doctor will provide emergency care, make a diagnosis, hospitalize. To make a diagnosis, it is important to describe in detail to the doctor who arrived all the symptoms, to say which substances you had to deal with. You need to understand that the doctor needs as much information as possible about what substances the victim was in contact with, how the reaction to poisoning developed (this will make it possible to quickly navigate in the current situation, make a diagnosis, provide necessary assistance). Treatment consists, first of all, in the correct and quick first aid to the victim. Only after the first aid is provided, and it is established that the patient’s life is not in danger, can we continue to further treatment.

Metaphos poisoning

Metaphos poisoning is indicated by the development of a clinical picture typical of intoxication. A muscle reaction develops mainly: convulsions appear, breathing is disturbed, involuntary stools, vomiting, rapid heartbeat and urination appear. A coma is possible in the absence of treatment.

What you need to do when the symptoms of poisoning appear is to neutralize the poison, stop its effect on the body. If you know exactly what substance the victim was poisoned with, you need to give him an antidote as soon as possible. The antidote of metaphos is atropine (administered intramuscularly or intravenously in an amount of 0.5-1 ml). The mechanism of action is that atropine has a relaxing effect on blood vessels, smooth muscles. Further treatment is carried out in the hospital. Hospitalization is recommended, even if the patient is feeling well.
After first aid is provided, and the condition is stabilized, detoxification therapy is carried out (sorbents are administered), and concomitant symptomatic therapy with the use of medications is carried out. During therapy, the introduction of vitamin complexes, minerals, glucose, Ringer's solution, and other supporting substances into the body is recommended. Restorative therapy is an equally important stage of complex treatment. At this time, it is important to observe dietary nutrition (table No. 1). Symptomatic treatment and prevention. Often poisoning is accompanied by a deficiency of vitamin A, vitamin therapy is accordingly prescribed. Sometimes hormone therapy, antibiotic therapy is required. At this stage, there is a need for physiotherapeutic methods. Inhalations, thermal procedures, some electrical procedures, KUF, drug administration by electrophoresis may be required.

Complications and consequences

The consequences of poisoning are unfavorable, complications almost always appear. First of all, poisoning negatively affects the state of the circulatory system. The nervous and cardiovascular systems also suffer. Immunity is significantly reduced. The kidneys and liver suffer, because these are the main organs that take part in the metabolism of toxins, take part in the elimination and neutralization of toxic substances.

Death due to cardiac causes during poisoning with karbofos poisoning occurs either due to arrhythmias,  [12] or due to severe and refractory hypotension, cardiac arrest.  [13] Although shock is mainly vasodilating  [14],   [15] peripheral endocardial ischemia with cardiogenic shock and death also has been reported poisoning by malathion. [16] Autopsy of patients who died of the following poisoning with FOS showed pericarditis, atrial thrombus, and right ventricular hypertrophy and dilatation. Heart attack, interstitial edema, interstitial inflammation, blood clots and myocarditis were histological findings. [17] 

Metabolic complications such as hyperglycemia, glycosuria, [18] and diabetic ketoacidosis are described . [19]

Respiratory failure occurs in 24-66% of patients. [20] The severity of poisoning was a major determinant of respiratory failure. [21] Other factors contributing to respiratory failure include pneumonia, cardiovascular collapse, acute pulmonary edema,  [22] and acute respiratory distress syndrome. 

Coma is observed in 17-29% of patients and can last from several hours to several days. [23] Poisoning can also manifest as a brain stem stroke. [24]

Diagnostics of the karbofos poisoning

The diagnosis of karbofos poisoning, like any other chemical substance, is based, first of all, on determining the typical pattern of poisoning, which is characteristic of this particular type of poisoning. To do this, you need a medical history of the patient, and an accurate clinical picture of the pathology with a detailed description of the symptoms, early signs of the pathology. It is on this basis that we can make the basic assumption regarding the cause of poisoning, on the basis of which further treatment will be prescribed. The sooner a diagnosis is made, the greater the chances of a successful outcome. Therefore, when the first signs of poisoning, malaise appear, you need to see a doctor as soon as possible.

In case of poisoning, there is no time to wait, so you need to call an ambulance. It is in your interests to describe as much as possible to the arriving doctor all the symptoms, to say which substances you had to deal with. This will give him the opportunity to quickly navigate in the current situation, make a diagnosis, provide the necessary assistance. Even better, by calling an ambulance, inform the dispatcher in advance about everything that happened, perhaps the doctor will immediately suggest poisoning, and will take with him an antidote, everything necessary to provide assistance. There is a chance to help the patient more efficiently with minimal complications and risks.

Diagnostic features - first the patient is given emergency care, and the diagnosis is carried out later. The poison can act covertly, or have long-term effects that will manifest much later. But this does not mean that changes in the body have not already occurred in the early stages, and they cannot be detected during diagnostic measures. 

Analyzes

The diagnosis of organophosphate poisoning should ideally be confirmed by analysis of plasma butyrylcholinesterase activity (or whole blood acetylcholinesterase). However, the results of such tests are rarely available on time to influence clinical decision making. Their importance to guide clinical trials; An understanding of their limitations is important in interpreting studies of individual pesticides and specific interventions.

Studies show that erythrocyte acetylcholinesterase is a good marker of synaptic function and atropine needs in patients poisoned with organophosphorus compounds, and therefore, probably a good marker of severity. [25]

The main analysis for any type of poisoning is traditionally considered a toxicological study and a biochemical blood test. These are express methods that allow you to quickly and efficiently assess the situation. Toxicology shows which toxins are contained in human biological fluids, and biochemical analysis shows what changes have occurred in the body under the influence of these toxins, what measures should be taken first of all for first aid.

Then the rest of the analyzes are carried out, without which it is impossible to assess the state of the body. Typically, standard tests are prescribed - clinical tests of blood, urine, feces. This allows us to assess the general orientation of the pathological process, to identify the spectrum of damage that has arisen in connection with the effect of the poison on the body. An ordinary blood test may turn out to be very informative (it will indicate an inflammatory, infectious, or allergic process). According to the blood formula, one can assume the cause of the pathology - bacterial or viral pathology. You can also roughly assume in which system of organs the main pathological process occurs, what is its severity; whether the processes that occur in the body are reversible, or damage to tissues and organs has already become irreversible.

A direct indication of acute poisoning is a high level of eosinophils, the appearance of mast cells in the blood, and an increase in ESR. Similarly, high bilirubin levels indicate liver disease. The higher the level of bilirubin, the harder the pathological process. Also, the presence of white blood cells or a large amount of protein in the urine indicates the development of an inflammatory process in the kidneys. Based on these general data, the course of further diagnosis can be determined. This will eliminate a large number of unnecessary, uninformative analyzes and, at the same time, will reduce the time spent on diagnostics and significantly increase the effectiveness of the diagnostic measures themselves.

To refine the data, various methods of laboratory research can be used:

• allergy tests;
• analysis for the content of general and specific immunoglobulin E;
• histamine level analysis;
• analysis of toxins;
• detailed immunogram;
• rheumatic tests;
• analysis of the level of C-reactive protein
• analysis; determination of the level of CEC - circulating immune complexes and many other studies.

Instrumental diagnostics

You need to understand that first you need to at least approximately identify the area of damage, identify those organs and systems that have undergone the greatest pathology. After that, the most effective instrumental diagnostic methods are selected that are adequate to the current situation.

In many ways, the choice of method depends on the route of penetration of the poison into the body. So, kalbofos, entering the body through the digestive tract, can cause the corresponding pathology of the digestive tract, and associated organs and systems. If such injury is suspected, or the development of any gastrointestinal disease, gastroscopy, radiography, ultrasound, and colonoscopy may be required.

If acetone vapor enters the respiratory tract, injuries and diseases of the respiratory system develop. In this case, the following research methods can be used:

• spirogram
• roentgenogram
• functional tests
• fluorographic study.

Almost universal research methods that are used regardless of how the poison penetrated the body, are various methods of studying the cardiovascular, nervous, musculoskeletal systems, since they are most exposed to the poison. Apply:

• electrocardiogram
• angiography
• Ultrasound of the heart,
• magnetic resonance imaging and computed tomography.

Differential diagnosis

The main differential diagnosis is carbamate poisoning, which is clinically indistinguishable. 

The basis of differential diagnosis is the need to clearly distinguish between the symptoms of several similar pathologies and conditions that have similar manifestations, and make the most accurate diagnosis. In particular, in case of poisoning, it is important to accurately determine the substance, or at least the group of substances that caused the poisoning. Further treatment directly depends on this, its effectiveness, and sometimes even the patient’s life.

So, when a doctor tries to make a differential diagnosis, he usually already has several presumptive diagnoses that fit the symptoms. At this stage, it is important to carefully examine the history and analyze the available data. The patient is required to describe as much as possible to the doctor his condition, his subjective sensations, which is an important diagnostic indicator. At the early stages of diagnosis, a standard examination is carried out: the doctor first interviews the patient, collects general information about him, a history of life. Then the doctor conducts a compulsory medical history, on the basis of which he can judge the features of the course of poisoning. It is on the basis of anamnesis that the doctor can predict the further development and outcome of poisoning. The results of existing laboratory, instrumental research methods are taken into account. You also need to know if any treatment has been carried out, what is its effectiveness, what other measures have been taken. Based on this, further treatment can already be developed and a final diagnosis is made.

Treatment of the karbofos poisoning

The treatment of karbofos poisoning   consists primarily in the correct and quick provision of first aid to the victim. First of all, life depends on this, and secondly, the health of the patient.

Prevention

Prevention - compliance with the rules of work with karbofos. Especially if there are children in the house, because their body is more sensitive to the effects of any toxins. You can not leave acetone unattended, because children can drink it because of curiosity. Do not leave with food.

Forecast

Factors affecting the outcome of organophosphate pesticide poisoning:

• Toxicity: Toxicity is usually evaluated according to the oral LD50 in rats. This scale can approximately differentiate between safe and very toxic pesticides. However, after poisoning with organophosphorus compounds with approximately the same toxicity to animals, large differences in human toxicity were found and this classification does not take into account the effects of treatment. [26], [27]
• Impurities: Toxicity classification WHO evaluates fresh pesticide from approved manufacturers. Storing pesticides in hot conditions can lead to chemical reactions with toxic products. Such a process was blamed for the death of pesticide sprayers using malathion in Pakistan in the late 1970s [28], [29], and was also noted with both diazinone and dimethoate. [30], [31]
• Composition: The toxicity of the pesticide will vary depending on the composition, which varies depending on the organophosphorus compound and the place of production. For example, malathion is available as an 80% solution in street kiosks with pesticides in Burma, but as a 3% powder in Sri Lanka.
• Alkyl subgroups: most pesticides have either two methyl groups attached via oxygen atoms to phosphate (organophosphorus phosphorus) or two ethyl groups (organophosphate diethylate). Aging of acetylcholinesterase occurs much faster with dimethyl poisoning than with diethyl poisoning, therefore, to be effective, oximes must be given quickly to patients with dimethyl poisoning. Some pesticides have atypical structures, and another alkyl group (for example, propyl in profenophos) is attached to the phosphate group through a sulfur atom. These organophosphorus pesticides age with acetylcholinesterase even faster and oximes are probably not effective.
• The need for activation. Many compounds are inactive thioates (with a double sulfur bond attached to the phosphorus atom) and must be desulfurized to form an active oxone via cytochrome P450 enzymes in the intestinal wall and liver. P450 3A4 appears to be the most active enzyme when organoform is present in high concentrations, as occurs after poisoning.  [32]
• The rate of activation and inhibition of AChE. The rate of activation of thioate organophosphates varies between pesticides. [33]There are also large differences in the rate of inhibition of acetylcholinesterase between organophosphorus pesticidal oxones.
• The duration of the effect is fat solubility and half-life. Some fat-soluble organophosphate thioate pesticides (such as fenthion) are distributed in large quantities to fat stores after absorption. Apparently, this reduces the peak concentration of the organophosphorus compound in the blood, and early cholinergic symptoms are usually minor. Subsequent slow redistribution and activation cause repeated cholinergic manifestations, lasting several days or weeks. Peripheral respiratory failure is characteristic of these organophosphorus compounds, probably due to continued inhibition of acetylcholinesterase. Aging begins only after inhibition of acetylcholinesterase, therefore, theoretically, oximes can be useful for many days in such patients. In contrast, other organophosphorus compounds (for example, dichlorvos) do not need activation, are insoluble in fats and can have a much faster onset of action and a shorter duration of activity. Fat solubility is estimated by Kow (logarithm octanol / water coefficient): less than 1 · 0 = insoluble in fats; more than 4 · 0 = very fat soluble. [34]

The above factors have important consequences for the rate of poisoning with organophosphorus compounds after oral administration. Ingestion of an organophosphorus oxone, which rapidly inhibits acetylcholinesterase, will lead to early clinical signs and respiratory arrest before admission to the hospital, increasing the risk of hypoxic brain damage and aspiration. The conversion of the thioate organophosphorus parathion to paraoxone occurs so quickly that patients can pass out after 20 minutes. Clinical signs after poisoning with other thioate organophosphorus compounds, such as dimethoate and fenthion, appear later, giving the patient more time to transport to the hospital.

If you provide first aid to the patient in a timely manner, neutralize the toxin, give the victim an antidote, and then carry out the necessary treatment, the prognosis will be favorable. Carbophos poisoning ends in death only if first aid is not provided in a timely manner.