Cholinesterase Aging Phenomenon Following Acute Ethoprophos Poisoning: A Case Report

Acute poisoning by Ethoprphos, an organophosphorus pesticide, leads to a veritable cholinergic syndrome whose diagnosis is based on the determination of cholinesterase activity. The treatment relies on the administration of atropine and pralidoxime to regenerate cholinesterases before their ageing. We report a case of a two-year-old child, hospitalized for ethoprophos poisoning, with seizures associated with tight myosis, bronchial congestion, fever, and sialorrhea. The determination of butyrylcholinesterase and acetylcholinesterase showed low rates throughout the hospitalization. Knowing that pralidoxime was introduced from the 5th day of the poisoning, these rates could be explained by aging of cholinesterases. This phenomenon is well established for organophosphate pesticides (OPs) with methylated or ethyl alkyl groups in contrast to others that are much less documented such as dipropyled OPs such as ethoprophos. The recovery of the enzyme rates was very slow with good clinical improvement. Ethoprophos poisoning may cause a life-threatening prognosis with a possible phenomenon of cholinesterase aging in the absence of rapid management with administration of pralidoxime.