Pancreatitis as a complication of anticholinesterase insecticide intoxication.
Dressel-TD; Goodale-RL Jr.; Arneson-MA; Borner-JW
Ann Surg 1979 Feb; 189(2):199-204
In view of the occurrence of pancreatitis in a previously healthy 19 year old woman following the accidental ingestion of an anticholinesterase insecticide, experiments were conducted to determine if there were a causal relation between anticholinesterase intoxication and pancreatitis. In six mongrel dogs the pancreatic duct was perfused and intraductal pressures recorded. Intravenous (iv) dosing with 25mg/kg O,O-diethyl-O-(2-isopropyl-6-methyl-4- pyrimidinyl)phosphorothioate (333415) caused a significant increase in the mean pressure from 12 to 27 centimeters saline. Atropine was injected 45 minutes later at 75 micrograms/kilogram intravenously (iv) and caused the mean pressure to return to control levels. In a second group of dogs, the major pancreatic duct was cannulated through a duodenotomy and pancreatic juice collected by gravity into a small reservoir connected to a pressure transducer. Secretin was infused at a low dose level iv for 1 hour. As this infusion continued, a total of 75mg/kg of the anticholinesterase agent was given iv in three doses, 5 minutes apart. Secretin was discontinued 45 minutes later and atropine was administered 45 minutes later. Addition of the anticholinesterase agent caused a significant increase in the mean flow rate from 0.13 to 0.56 cubic centimeters/minute (cc/min). Atropine inhibited this stimulation. Exposure to the insecticide without Secretin stimulation resulted in flow rates not significantly different from the Secretin stimulated rate of 0.14cc/min. Two dogs in group 1 died. The other eight dogs receiving iv bolus doses of anticholinesterase in addition to Secretin developed acute hyperamylasemia and hyperlipasemia. The authors indicate this is the first report of this organophosphate anticholinesterase causing a functional ductal obstruction at the same time as stimulation of pancreatic exocrine secretion and is the first report of clinical pancreatitis complicating anticholinesterase insecticide intoxication.
NIOSH-Publication; NIOSH-Grant; Grants-other; Pesticides; Organo-phosphorus-compounds; Organo-phosphorus-pesticides; Toxic-effects; Humans; Laboratory-animals; Digestive-system
Environmental Health University of Minnesota 1158 Mayo Memorial Minneapolis, Minn 55455
Annals of Surgery
University of Minnesota of Mnpls-St Paul, Minneapolis, Minnesota