Dichlorvos poisoning in adults and children

Nowadays, dichlorvos poisoning is observed more and more often. This is explained by its wide distribution in everyday life, industry, and agriculture. In order to prevent serious consequences and save the life of the victim, it is necessary to know the causes of poisoning and the circumstances under which it can occur. In addition, it is important to know the basic principles of diagnosis, emergency care, and treatment of poisoning.

Epidemiology

Although the actual incidence of organophosphate poisoning is difficult to establish due to problems collecting surveillance data, it is estimated that 250,000 to 350,000 people die from organophosphate poisoning each year worldwide. Intentional poisoning accounts for about 51% of cases. Unintentional poisoning accounts for 21.7% of cases, and in 26.5% of cases the circumstances of poisoning are unknown. A significant number (50.2%) of intentional poisonings were suicides. Non-suicidal cases accounted for 47.4% of cases, and intentional unlawful poisoning accounted for 2.4% of cases. The mortality rate for the entire group was 3.4%.[ 1 ],[ 2 ]

Causes Dichlorvos poisoning in adults and children

The main cause of dichlorvos poisoning is the poison entering the human body and penetrating into the blood. The poison can enter the body in various ways - through the skin and mucous membranes, through the digestive tract and respiratory tract. The circumstances under which the poison enters the body can be different. Conventionally, several groups of these reasons can be distinguished - the poison entering the body through carelessness in domestic conditions (improper storage, keeping together with food products). Children often drink the poison if their parents leave it unattended (for children, trying everything new is a completely natural reaction, and this must be understood). This also includes non-compliance with the rules for the use of dichlorvos, when people do not use personal protective equipment when working with it, exceed concentrations, do not read the instructions, etc.

Chronic poisoning most often occurs due to the fact that the poison systematically, over a long period of time, enters the human body. These are most often cases of professional activity, when a person is forced to work with these poisons. Chronic poisoning is considered an occupational disease in some professions. In this case, it is also important to observe safety precautions, use only serviceable equipment, turn on hoods, ventilate the room, and observe all precautions. Use personal protective equipment.

There are also cases of deliberate poisoning with the aim of committing suicide or murder.

Risk factors

The risk group includes people who regularly encounter dichlorvos due to their professional duties. Childhood should be considered as additional risk factors. Children under 3 years of age are especially at risk, since they have an extremely high curiosity, they can drink the poison, it can get into their eyes, on the mucous membranes. Also at risk are elderly people with neurodegenerative disorders, sclerosis, people with impaired neuropsychiatric reactions, inadequate behavior, mental illnesses.

Pathogenesis

Poisoning is accompanied by disturbances in the basic metabolic processes at the cellular, tissue, and organismal levels.

Organophosphorus compounds irreversibly bind to acetylcholinesterase in plasma, erythrocytes, and cholinergic synapses [ 3 ] in the CNS and PNS. A decrease in cholinesterase activity in erythrocytes or plasma suggests exposure to dichlorvos. [ 4 ], [ 5 ]

Most symptoms and signs of dichlorvos poisoning are the result of excessive stimulation of muscarinic receptors. Signs such as tachycardia and high blood pressure, which are sometimes seen in acute poisoning and are not well understood, are due to the suppressive cholinergic effects on the CNS, sympathetic ganglionic synapses, or adrenal medulla.[ 6 ]

The pathogenesis is based on direct penetration of the poison into the body by one of three routes (through the skin, through the respiratory tract and the digestive tract). Damage depends on how exactly the poison entered the body. When penetrating through the respiratory tract, damage to the mucous membranes of the respiratory tract occurs with the subsequent development of inflammatory processes, the addition of infection. Common complications are chemical burns, tracheitis, bronchitis, pleurisy. Penetration through the skin is accompanied by damage to the skin, chemical burns, dermatitis. When the poison penetrates through the digestive tract, damage to the digestive organs occurs, dyspeptic disorders, gastritis, ulcers develop.

Then the poison is absorbed through the mucous membranes and walls of internal organs, penetrates into the blood, and spreads further throughout the body. This entails a disruption of metabolic processes in the body. The kidneys and liver suffer first, since they bear the main burden of processing and neutralizing the poison, and its removal occurs.

Many organophosphates are easily converted from thiones to oxons. This conversion occurs due to the replacement of oxygen by sulfur in the environment under the influence of oxygen and light, as well as in the body, mainly under the influence of liver microsomes. Oxons are usually more toxic than thiones, but oxons are more easily destroyed. [ 7 ] Inflammatory processes develop, and dehydration develops against the background of inflammation (a large amount of water is removed from the body). The water-salt balance is disrupted, and cells and tissues are destroyed.

Symptoms Dichlorvos poisoning in adults and children

Typical symptoms of organophosphorus poisoning include salivation, lacrimation, urinary and defecation disorders, stomach cramps, and vomiting (SLUDGE). Symptoms are also traditionally classified as acute (minutes to hours) and delayed or late (days to weeks). [ 8 ]

It is quite possible to get poisoned by a cockroach remedy. The symptoms of poisoning are similar to those of poisoning with dichlorvos, karbosos, and other fos. This is due to the fact that most cockroach remedies contain organophosphorus compounds. They have toxic properties. Poisoning may be indicated by headache, dizziness, constriction of the pupil, nausea, vomiting, chemical burns. Clouding of consciousness gradually develops, up to complete loss of consciousness. Hallucinations and delirium may occur. Often the heartbeat, pulse, breathing quickens, body temperature decreases or increases, blood pressure. People prone to allergic reactions may develop progressive edema, suffocation, anaphylactic shock.

The first signs are a general deterioration in health, nausea, headache. A slight metallic taste may appear in the mouth, which indicates poisoning, blood disorders, and hemoglobin destruction. It is also worth noting that the first signs are dizziness, increased heart rate, shortness of breath, and lack of air.

• Acute abdomen syndrome

In case of poisoning, signs of acute abdomen appear. This is a syndrome that is related to surgical pathologies and requires immediate surgical intervention. Otherwise, peritonitis develops, in which the entire abdominal cavity is affected, and infectious and toxic damage to internal organs develops. If emergency surgical care is not provided in the first 2-3 hours, a fatal outcome occurs.

• Rhinitis

Poisoning with dichdophos may be accompanied by the development of rhinitis if the poison enters the body through the respiratory tract. First of all, the mucous membrane is damaged, in particular, a chemical burn develops. This may lead to an inflammatory process or an allergic reaction. Rhinoscopy reveals signs of rhinitis - swelling of the mucous membrane, irritation, hyperemia.

Also, symptoms such as nasal congestion, difficulty breathing at night, snoring, and runny nose appear. The inflammatory process and swelling tend to spread and can cause the development of the inflammatory process in other organs. Inflammation and infection can spread in two directions - ascending and descending. In the first case, the inflammation spreads to the lower respiratory tract, developing tracheitis, tracheobronchitis, bronchitis, pneumonia, pleurisy, pulmonary obstruction, alveolitis, and other diseases of the lower respiratory tract. When inflammation spreads ascendingly, diseases of the upper respiratory tract develop, in particular, rhinitis, rhinosinusitis, sinusitis, frontal sinusitis develop, and inflammation and swelling can be transmitted through the Eustachian tube to the ear. In this case, middle ear pathology develops (otitis, tubootitis, etc.).

• Neurological manifestations

Three types of paralysis have been described. Type I paralysis, characterized by weakness, fasciculations, spasms, and twitching, occurs acutely with cholinergic symptoms. Type II paralysis, observed in 80-49%, [ 9 ], [ 10 ] occurs 24-96 h after poisoning [ 11 ] and is characterized by paralysis of the proximal, cervical, and respiratory muscles with recovery within 1-2 weeks. Type III paralysis, characterized by distal weakness, occurs 2-3 weeks after poisoning with recovery within weeks to months. [ 12 ] Weakness of specific muscle groups at sites of skin exposure, [ 13 ] cranial nerve palsy, [ 14 ] supranuclear gaze palsy, [ 15 ] isolated laryngeal paralysis [ 16 ] and diaphragmatic paralysis have been reported. [ 17 ]

Restlessness, delirium, agitation, seizures, or coma may occur with acute exposure, while neuropsychiatric symptoms and signs called chronic organophosphate disorders may occur with chronic exposure.[ 18 ] Extrapyramidal manifestations, ocular signs, ototoxicity, and manifestation as Guillain-Barré syndrome have also been described.[ 19 ]

• Cardiovascular manifestations

Cardiac manifestations are observed in approximately two-thirds of patients with dichlorvos poisoning.[ 20 ] Common electrocardiographic findings include QTc prolongation, ST-T segment changes, and T wave abnormalities.[ 21 ] Other cardiac manifestations include sinus bradycardia or tachycardia, hypotension or hypertension, supraventricular and ventricular arrhythmias and ventricular premature complexes, and noncardiogenic pulmonary edema.[ 22 ][ 23 ]

Death from cardiac causes in dichlorvos poisoning occurs either due to arrhythmias or severe and refractory hypotension.[ 24 ] Although shock is primarily vasodilatory,[ 25 ] endocardial ischemia of the peripheral vessels with cardiogenic shock results in death.[ 26 ]

• Respiratory symptoms

Respiratory symptoms are common in dichlorvos poisoning. Muscarinic effects of salivation, rhinorrhea, bronchorrhea, and bronchospasm contribute to hypoxemia and dyspnea. Nicotinic effects lead to muscle weakness and paralysis and predispose to hypercapnic respiratory failure. Central effects of agitation, restlessness, and convulsions further impair respiratory function.

In large cohorts, respiratory failure occurs in 24–66% of patients.[ 27 ] Other factors contributing to respiratory failure include pneumonia, cardiovascular collapse, acute pulmonary edema, and acute respiratory distress syndrome.[ 28 ],[ 29 ]

Gastrointestinal symptoms occur early in organophosphate poisoning and are rapidly resolved by treatment with atropine. There is concern that atropine slows intestinal transit time and prolongs organophosphate toxicity.

Pancreatitis is not uncommon in OP poisoning and occurs in 12.8%. [ 30 ] Metabolic complications such as hyperglycemia and glycosuria [ 31 ] and organophosphorus intoxication manifesting as diabetic ketoacidosis have also been described. [ 32 ]

• Dichlorvos vapor poisoning

Poisoning with dichlorvos vapors primarily causes damage to the mucous membranes. The respiratory system is mainly damaged. Also, some of the pathology occurs in the skin. Poisoning with dichlorvos, including vapors, can have serious consequences.

Dichlorvos poisoning in children

Dichlorvos poisoning manifests itself in the same way in both children and adults. Characteristic features of poisoning are vomiting, diarrhea, abdominal pain, headache, dizziness, general weakness, decreased activity, and appetite. Sweating increases, the heartbeat quickens, the body is covered in cold sweat, the pupils dilate, and coordination of movements is impaired. Choking may develop, especially if the child has a tendency to allergic reactions or a history of bronchial asthma. Gradually, the symptoms increase and intensify.

It is important to consider that poisoning in a child is much more severe, develops faster and more intensely. It is worth noting that the most dangerous condition is diarrhea and vomiting, since dehydration of the body occurs very quickly. If vomiting and diarrhea do not stop within 24 hours, death may occur. Self-medication should not be done, it is necessary to call a doctor and provide the child with qualified medical care. Correct diagnosis is very important. Since knowing the cause of the pathology, you can quickly find an effective remedy, administer an antidote (atropine). This will prevent serious health problems and severe complications. [ 33 ]

During diagnostics, three groups of methods are mainly used: methods for diagnosing skin lesions, methods for diagnosing respiratory tract pathology, and methods for diagnosing damage to the digestive system (depending on how the poison entered the body). If damage to the digestive system or the development of any gastrointestinal disease is suspected, gastroscopy, radiography, ultrasound, and colonoscopy may be required.

When the poison enters through the respiratory tract, injuries and diseases of the respiratory system develop. The following research methods are used: spirogram, radiograph. Sometimes they also resort to such methods as functional tests, fluorographic examination.

In case of skin pathologies, the main method of examination is examination of the skin and mucous membranes. Additionally, toxicological examination, scraping, biochemical examination, bacteriological culture of the skin or mucous membrane contents can be used.

Regardless of how the poison entered the body, other methods may be required (various methods of examining the cardiovascular, nervous, and musculoskeletal systems). These systems are most susceptible to the effects of the poison and experience various complications. The following are used: electrocardiogram, angiography, ultrasound of the heart, magnetic resonance imaging, and computed tomography.

Dichlorvos poisoning during pregnancy

Pregnancy is one of the most important life cycles of a woman. It is not a disease, as many believe, however, the body functions under increased stress. Due to the fact that the condition and needs of the body change, and toxicosis, hormonal and autoimmune pathologies develop, poisoning can occur much faster, including with minimal concentrations of dichlorvos.

You should call an ambulance as soon as possible, it is better not to self-medicate. But if the condition is serious, before the ambulance arrives, it is necessary to provide emergency assistance. The main thing is to stop further penetration of the poison into the body, it is necessary to remove and neutralize those toxins that have entered the body. The essence of first aid is that it is necessary to wash the stomach. Press your fingers on the root of the tongue, induce vomiting. Then you should give a warm drink, ensure rest. Further treatment for dichlorvos poisoning during pregnancy is provided by a doctor, namely: it is necessary to eliminate those pathological phenomena that occur in the human body. [ 34 ]

Symptomatic treatment aimed at eliminating pathology of the kidneys, liver, gastrointestinal tract may be required. In a medical institution, the stomach is washed with potassium permanganate, tannin. Laxatives are given. It is not recommended to eat anything during the day, you can only drink. The woman requires mandatory hospitalization and further inpatient treatment. A physiological solution is necessarily administered, and if necessary - in combination with glucose and vitamins, to ensure nutrition of the body, and sorbents are also given. Any medications are used exclusively as prescribed by a doctor, since they can have serious side effects.

One retrospective study analyzed 21 cases of organophosphorus poisoning during pregnancy. Two women (9.52%) died of organophosphorus poisoning during the acute stage of poisoning. One woman had a spontaneous abortion. The remaining 15 women had no significant complications during pregnancy or delivery. No infants had congenital anomalies or neurological deficits. However, long-term follow-up of the neonates was not performed in this study. [ 35 ]

Complications and consequences

The consequences can affect any organs. Complications occur quite often. First of all, these are chemical burns, rhinitis, diseases of the upper and lower respiratory tract, digestive disorders, respiratory processes, blood circulation, heart activity. The risk of complications of the liver and kidneys increases, especially in pregnant women. Transplacental penetration of the poison into the body is possible, due to which the risk of developing fetal pathology increases. An allergic reaction, anaphylaxis, peritonitis are also possible. Otherwise, if first aid is provided to the patient in a timely manner, the toxin is neutralized, emergency care is provided, the prognosis will be favorable. If emergency care is not provided, dichlorvos poisoning can lead to the development of severe pathology of the kidneys, liver, up to renal and hepatic failure, which subsequently ends in death, multiple organ failure.

Coma occurs in 17-29% of patients and may last from a few hours to several days.[ 36 ],[ 37 ] Dichlorvos poisoning may also manifest as a brainstem stroke.[ 38 ] However, some patients experience altered consciousness or coma several days after poisoning, especially after a period of "normal" consciousness. This clinical phenomenon, termed delayed organophosphate encephalopathy (DOPE) or "intermediate CNS", is probably akin to type II paralysis. Coma with absent brainstem reflexes or encephalopathy has been reported after 4 days of normal consciousness and spontaneously resolved after 4 days.[ 39 ],[ 40 ]

Diagnostics Dichlorvos poisoning in adults and children

Dichlorvos is an organophosphorus compound. Like other substances in this group, diagnostics are primarily based on identifying the substances that caused the poisoning and determining their quantitative indicators. Toxicological testing is used for this purpose. Biochemical testing is also used to identify changes that occurred in the body under the influence of the poison.

Other clinical, instrumental, and laboratory research methods are also used. Differential diagnostics are essential, which allows us to distinguish the signs of dichlorvos poisoning from poisoning by other substances with similar effects. [ 41 ]

Usually, the primary diagnosis is made by the ambulance doctor who provides emergency care. Then, a more precise diagnosis can be made by the doctor of the department where the victim was hospitalized, based on additional studies. To make a diagnosis, anamnesis is needed. The patient should describe all the symptoms to the doctor in as much detail as possible, and say what substances they had to deal with. This can significantly facilitate the diagnosis. It is also important to describe your condition, your subjective sensations, and accurately report what kind of assistance was provided on the spot (although usually, when hospitalized, such information is passed on to the attending physician along with the primary diagnosis).

Then a standard examination is carried out, the patient is questioned, and the results of laboratory and instrumental studies are analyzed.

Usually, classical examination methods are used during the examination, such as palpation, percussion, and auscultation. During palpation, possible lesions are probed to detect an inflammatory reaction, hyperemia, and tissue edema. At the same time, the local temperature is assessed. During auscultation, the doctor listens to breathing and heartbeat (based on which a conclusion can be made about the severity of the pathological process). Percussion can also detect various lesions, such as inflammation, edema, compaction, and areas of exudate accumulation.

Tests

As mentioned above, the main research methods are toxicological analysis and biochemical research. During toxicological analysis, the name, qualitative and quantitative characteristics of the toxin that caused the poisoning are identified. [ 42 ] During biochemical research, the changes that occurred in the body under the influence of the poison are identified. If it is necessary to obtain more detailed information, other research methods are also used:

• blood test (clinical, biochemical, sugar); [ 43 ]
• urine analysis (clinical, according to Necheporenko, daily monitoring of diuresis);
• stool analysis;
• analysis of wash water;
• biopsy;
• histological and microscopic examination (biopsy, scraping, biological fluids);
• immunogram;
• serological, immunological, allergological research methods;
• bacteriological cultures;
• virological diagnostics;
• rheumatic tests and tumor marker tests.

These tests may be required during further diagnostics and in eliminating the consequences that arose under the influence of poison in the body. Often, rehabilitation treatment lasts quite a long time, much longer than the basic treatment for poisoning. Poisoning provokes an exacerbation of chronic pathologies, entails the development of new serious diseases, internal injuries, and trauma.

Instrumental diagnostics

Sometimes the data from the survey and examination are not enough to establish a diagnosis and select adequate treatment. Therefore, to clarify the data, instrumental research methods are prescribed, which depend on the organ or organ system in which the possible pathology is located and what functional changes have occurred. The need for further instrumental research may be indicated by the results of laboratory tests.

Differential diagnosis

This is an important stage of general diagnostics and making a more precise diagnosis, the essence of which is to differentiate the signs of one disease from the signs of another disease with similar manifestations. The following research methods may be required during differential diagnostics:

• gastroscopy,
• X-ray of the gastrointestinal tract,
• Ultrasound of the abdominal cavity,
• colonoscopy.
• spirogram,
• radiograph,
• functional tests,
• fluorographic examination.
• electrocardiogram,
• angiography,
• ultrasound of the heart,
• magnetic resonance imaging and computed tomography.
• rheography.

Treatment Dichlorvos poisoning in adults and children

The treatment takes place in several stages:

• stopping the flow of poison into the body;
• removing toxins from the body;
• neutralization of poison;
• detoxification therapy;
• pathogenetic, symptomatic treatment;
• restorative treatment.

Treatment largely depends on how the poison entered the body. When poison enters through the digestive system, the digestive system, urinary organs, and liver are primarily affected. Complex treatment is required.

When penetrating through the respiratory tract, the lungs, bronchi, and mucous membranes of the respiratory tract suffer first. Treatment aimed at eliminating the pathology of the respiratory tract is required.

When penetrating the skin, a chemical burn occurs, which requires appropriate therapy.

What to do in case of dichlorvos poisoning?

The first thing to do is to neutralize the poison, stop its effect on the body. To do this, it is necessary to provide the victim with first aid: induce vomiting, wash the stomach until the water is "clean". Then further detoxification therapy is carried out (sorbents and other substances with a similar effect are introduced into the body). After the threat to life has passed, maintenance therapy is carried out (aimed at stabilizing vital functions, normalizing the body's condition).

Then follows restorative therapy. Usually, treatment continues even after there are no longer any visible symptoms of poisoning. Primarily, etiological therapy is used, which is aimed at eliminating the cause, since almost all pathologies developing in the body after poisoning are a consequence of the pathological process that occurs in the body as a result of the poison. [ 44 ]

What to do if a child has inhaled dichlorvos?

In case of any type of poisoning, you need to act immediately, the life of the victim depends on it. If a child has inhaled diclofos, and you do not know what to do, you need to call an ambulance. Before it arrives, you need to provide access to fresh air, stop the toxin from affecting the body. Then you should induce vomiting, provide plenty of fluids. You can drink a sorbent, for example, activated carbon, which binds and removes toxins from the body.

Until the doctor arrives, the victim should be kept at rest. You can give him warm tea to drink. You can offer warm milk, since it is the means that ensures the removal and absorption of toxins. Egg white has similar properties.

First aid for poisoning after spraying dichlorvos

You should immediately call an ambulance, and in the meantime try to alleviate the condition yourself. The essence is to neutralize the poison and remove it from the body. To do this, induce vomiting, then give the victim a sorbent (activated carbon, sorbex, enterosgel). Gastric lavage and activated carbon are commonly used decontamination procedures, but their value has not been definitively proven in cases of organophosphorus poisoning. [ 45 ] Of the folk remedies, egg white, milk, jelly, and mucous drinks have similar properties. The patient is provided with plenty of fluids, rest, and warmth.

If it gets on the skin, a burn develops, since dichlorvos is a fairly strong substance that can cause a burn and irritation of the skin and mucous membranes. If the substance gets on the skin, it should be washed with plenty of water, and then smeared with a thick layer of greasy cream or Vaseline. The damaged area is covered with a sterile bandage and the patient is taken to the emergency room.

Poisoning by raid

Raid is a commercial name for a product that is manufactured by the industry. It can be found in almost any store. It is available in the form of powder, special plates, and an aerosol for spraying. It is used to kill cockroaches, ants, fleas, and other insects. Diclofos is used as a base. The composition also includes various additives and flavors. For example, you can buy a product with lavender, lemon, and other aromas.

Since the composition includes dichlorvos, the product remains toxic and potent. Actions in case of poisoning with raid are the same as in case of poisoning with pure dichlorvos. It is necessary to stop the effect of the poison on the body: if necessary, take the person out of the room, ventilate the place of poisoning. Then neutralize the poison (induce vomiting, give the person a sorbent, plenty of fluids). It is imperative to call an ambulance.

Antidotes

Atropine acts as an antidote. It is administered subcutaneously at the first signs of poisoning in an amount of 2-3 ml. 0.1% atropine sulfate is used. In case of severe poisoning, 2-3 ml of 0.1% atropine are administered intravenously (repeatedly) and alox intramuscularly in an amount of 1 mg / kg. The drug is administered every 13 hours until signs of atropinization appear.

The choice of anticholinergic agent depends on which receptors are most affected, central, peripheral, or both. Although atropine is a logical choice since it acts on central and peripheral cholinergic receptors, side effects or allergic reactions may preclude its use.[ 46 ] In such situations, glycopyrrolate or scopolamine are recommended. Atropine and glycopyrrolate appear to be equally effective.[ 47 ] However, since glycopyrrolate does not cross the blood–brain barrier, a benzodiazepine or a specific antimuscarinic drug with good CNS penetration, such as scopolamine, may be required to counteract the central effects. Severe extrapyramidal signs are sometimes observed with intravenous scopolamine in dichlorvos poisoning.[ 48 ] However, given its selective action, scopolamine is considered inferior to atropine and caramiphen. [ 49 ], [ 50 ]

Given the irreversible binding of dichlorvos to acetylcholinesterase, the choice of muscle relaxant in organophosphorus poisoning is also important. Several studies [ 51 ], [ 52 ], [ 53 ] have reported prolonged neuromuscular blockade and apnea in acute or chronic dichlorvos exposure due to decreased succinylcholine metabolism as a result of cholinesterase inhibition by the insecticide.

Oximes are nucleophilic agents that cleave a covalently bound organophosphorus compound from the OP-acetylcholinesterase conjugate, thereby releasing acetylcholinesterase. [Oxymotherapy for dichlorvos poisoning has been the subject of numerous trials and meta-analyses. Although there is a pharmacological basis for the use of oximes in organophosphorus poisoning, recent systematic reviews indicate that the available data are insufficient to indicate whether oximes are useful. [ 54 ], [ 55 ]

Medicines

When the first signs of poisoning appear, a number of medications may be required. But their use requires mandatory compliance with precautions, in particular, giving the victim only the most necessary means to maintain life and prevent a serious condition. Then all the necessary means are prescribed by a doctor.

Poisoning may be accompanied by an allergic reaction, edema. In this case, antiallergic drugs are prescribed. First of all, this is a well-known drug - suprastin. It is taken 1 tablet 2-3 times a day, in case of an attack - 2 tablets once. Suprastin has one significant drawback - it can cause drowsiness and a slow reaction.

To relieve pain, painkillers such as novocaine are prescribed. A 1% solution of novocaine is administered intramuscularly. A single dose of 0.5 to 1 ml is administered intramuscularly.

For spasms and convulsions, baralgin is prescribed at 0.5-1 ml intramuscularly.

As a sorbent, to eliminate toxins, autoantibodies and metabolic products from the body, it is recommended to take regular activated carbon, or white carbon (sorbex). As a result of taking it, the body is cleansed, the symptoms of intoxication gradually disappear. Activated carbon requires 5-6 tablets, and sorbex is enough 1-2 tablets per day.

Vitamins

Vitamins promote faster recovery. Therefore, they are absolutely necessary at the stage of recovery treatment. They are prescribed after the poison has been neutralized, the main vital signs have normalized and stabilized, and the body has begun to recover. It is recommended to take vitamins in the following daily concentrations:

• Vitamin PP – 60 mg
• Vitamin A – 240 mg
• Vitamin E – 45 mg
• Vitamin C – 1000 mg.

Vitamins A and E are especially important after poisoning, as they have an antioxidant effect, eliminate and neutralize toxins, free radicals, metabolites. Accordingly, they are able to eliminate the effects of intoxication. Vitamin C is a powerful source of energy, has antioxidant properties, and promotes tissue restoration.

Physiotherapy treatment

It can be part of a comprehensive treatment. It is almost never prescribed on its own. Physiotherapy is used mainly during rehabilitation treatment, since it helps to cope with the consequences of poisoning quite effectively and in a short time, and also allows you to speed up the recovery processes in the body.

The choice of method depends on the nature of the damage, as well as on the way the poison entered the body. The main methods of physiotherapy treatment are ultrasound, microcurrents, waves of different lengths, electrophoresis.

If the poison has penetrated the body through the skin, caused a chemical burn and is accompanied by damage to the skin, special medical cosmetic procedures, cryoprocedures, thermal procedures, peelings, laser procedures, phototherapy are indicated.

Folk remedies

Folk remedies have proven themselves well and are often included in complex treatment. They are especially effective at the recovery stage. Various mixtures, balms, and decoctions intended for internal use are used. They quickly relieve inflammation and infection, prevent the development of infection, and promote the elimination of toxins, metabolites, and autoimmune complexes.

Herbal treatment

Horsetail has found wide application in medicine. It is especially often used in cases where poison has entered the gastrointestinal tract through the stomach or oral cavity. It is used to treat digestive disorders, inflammation, [ 56 ] to relieve the effects of intoxication, and to overcome convulsions and spasms. It should be taken into account that horsetail has hemostatic properties, so it is not recommended for people with a tendency to thrombosis. The main forms of application are powder, decoction, and tincture. Powder is ground roots that are often added to tea, coffee, and decoctions. Infusions and decoctions are drunk in the morning on an empty stomach.

Lavender is also often used to overcome the effects of intoxication. It is necessary to strictly observe the dosage, adhere to the recommended treatment regimen. It relieves spasms and reduces pain well, [ 57 ] and also helps to normalize the condition. [ 58 ]

Hops are used to treat intoxication, eliminate digestive disorders, and normalize the composition and function of blood. [ 59 ] Use 200 ml in the morning and evening. Do not exceed the dosage.

Homeopathy

Homeopathic remedies are widely used to treat the effects of poisoning. When taking homeopathy, you need to take into account that numerous side effects can develop, so you need to strictly follow precautions (consult a doctor).

Prevention

Prevention - compliance with the rules for working with dichlorvos, raid and other products that contain dichlorvos. Especially if there are children in the house, since they often drink or inhale excessive amounts of poison, which leads to poisoning. If the poison gets into the body, first aid must be provided as quickly as possible. In no case is it recommended to leave it with food, since the product can be accidentally added to food.

• How long should the room be ventilated after dichlorvos?

After dichlorvos, the room must be thoroughly ventilated. If you do not know exactly how long to ventilate, you need to use average indicators. So, usually, for the smell to completely disappear, at least 12 hours are needed. It is also recommended to additionally treat the room with a damp cloth, carry out wet cleaning.

Forecast

If first aid is provided to the patient in a timely manner, the toxin is neutralized, and then the necessary detoxification, supportive and restorative treatment is carried out, the prognosis will be favorable. Dichlorvos poisoning ends in death only if first aid is not provided in a timely manner.