4 year old boy was taken to the emergency room because of concerns by his parent

Question

4 year old boy was taken to the emergency room because of concerns by his parents hat the child had symptoms and signs that could be due to a recent accidental exposure to a household insecticide. The child's mother had found an open bottle of Pet AgreeM rand of flea and tick dog dip in the child's toys. On examination, the child was noted to be tremulous and glassy-eyed with pinpoint upils. The child was drooling and appeared mildly lethargic. A regular rhythm and achycardia with a rate of 156/minute were the only additional findings. Laboratory studies, including a urine toxicology screen, serum cholinesterase, and red lood cell cholinesterase were obtained. The child was treated with 0.5 mg intravenous atropine to reduce upper airway secretions and pralidoxamine 500 mg IV every 6 hours. Within 6 hours of beginning therapy, the child began to have increased strength, and by he next morning was able to sit up without difficulty Lab result: rapid urine drug screen for drugs of abuse was negative. Serum cholinesterase activity, libucaine inhibition of the enzyme activity, and red cell acetylcholinesterase activity were also measured at intervals after the ingestion. Cholinesterase (14 hrs after ingestion): 1000 U/L 3,100-6,500 U/L (34 hrs after ingestion): 1800 U/L Based on the cholinesterase values, what type of insecticide did the child most likely ingest? (I pt) I. What is the purpose of determining the dibucaine inhibition? Is it necessary in this case? (I pt) 2.

Explanation / Answer

A. The level of cholinesterase is higher than normal and its getting higher which is symptom of exposure of child with the insecticide. since the household insecticide is spreaded and has less effect . But the child is affected severely and very fast that can be happened due to direct ingestion of this insecticide or pesticide due to which the cholinesterase level increased to such extent.

So the child has ingested the dog tick dip.

2. THe dibucaine inhibition is necessary in this case. Because the cholinesterase value of the child is keep on increasing as a result of pesticide/insecticide ingestion, and the dibucaine is a competitive inhibitor of the cholinesterase and hence it will help in reducing the toxicity by preferentially competitive binding with the toxic insecticide

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