Dimethoate self-poisoning–Induced severe hypotension

Intentional ingestion of organophosphorus compound (OP) poisoning continues to be a frequent reason for critical care admission in India. For the past 6 decades, the OP compounds used in India for the poisoning had effects on cholinergic and neurogenic fibers producing the respiratory and neurologic presentation. Recently, a less frequent OP poison has appeared which acts on cardiac sympathetic fibers with bradycardia and hypotension as presenting features. The shock which was nonresponsive to dopamine/dobutamine was identified as a major cause of death in patients with dimethoate poisoning in a large prospective cohort study. Severe dimethoate poisoning in contrast to other OP compounds has a high case fatality rate. There have been case reports from outside India. We report the first two cases with successful treatment of this toxicity in India.