Case 1: Oral Burns as a Presentation of Accidental Organophosphorus Poisoning in a Neonate

A 5-day-old girl is brought to the hospital emergency department for excessive crying. There is a history of accidental oral administration of a liquid insect repellent by her 3.5-year-old sibling ∼2 hours earlier. The bottle brought by the parents reads “mosquito repellent.” Examination reveals an irritable, excessively crying baby, possibly due to pain. Her vital signs are essentially normal, with a temperature of 99.7°F (37.6°C), a heart rate of 146 beats/min, a respiratory rate of 52 breaths/min, a prompt capillary refill time, blood pressure of 90/56 mm Hg, and saturation of 100% in room air. Her pupils are of normal size and responding normally. Her oral cavity shows extensive burns involving the palate and posterior pharyngeal wall with bleaching of the mucosa (Fig). There are no dermal burns. Systemic examination findings are normal. Investigations show normal blood sugar levels and serum biochemistry results. Findings on chest radiography are normal. The active ingredient is confirmed by a forensic laboratory at All India Medical Institute of Medical Sciences, New Delhi, as dichlorvos (organophosphorus [OP] compound) with a pH of 3 to 5. Figure. Extensive burns in the oral cavity of the patient caused by mosquito repellent. After admission, the baby’s eyes are cleaned with distilled water and her body is sponged dry to eliminate further risk of absorption. The baby receives supportive treatment, is kept nil orally, and is administered intravenous fluids. …