An Irish hospital treated a case of deliberate sheep dip® ingestion, which caused organophosphate poisoning. Atrial fibrillation complicated the condition. Organophosphates irreversibly inhibit acetylcholinesterase, causing acetylcholine buildup and a cholinergic crisis.

Description

A 76-year-old farmer was admitted following suicidal ingestion of sheep dip® and alcohol. He developed high anion gap metabolic acidosis, acute kidney injury, new onset atrial fibrillation, and aspiration pneumonia. His Glasgow Coma Scale (GCS) score was 14/15, with excessive oral secretions, miosis, laboured breathing, and respiratory failure, necessitating orotracheal intubation and resuscitation. Diagnostic imaging identified right lower lobe opacification, severe esophagitis, and inflammation of small bowel loops. Management included atropine for cholinergic symptoms, pralidoxime to restore acetylcholinesterase function, and amiodarone for atrial fibrillation. He experienced clinical improvement, resolution of arrhythmia, and was discharged from the ICU on day ten without residual cardiac dysfunction.

Discussion

Studies confirm that organophosphorus poisoning can cause arrhythmias, from bradycardia to tachyarrhythmias such as atrial fibrillation and ventricular tachycardia. Mechanisms include autonomic imbalance, hypoxia, acidosis, and direct myocardial injury. This case shows the need for continuous cardiac monitoring in severe organophosphate poisoning and the effectiveness of amiodarone infusion for atrial fibrillation.

Acknowledgements

I sincerely thank Dr Eby Koonthalloor for his expert guidance and insightful discussions throughout the management of this case. I also appreciate the dedicated support of the nursing team at Portiuncula University Hospital, whose care was invaluable. Finally, I am grateful to the patient and his family for their cooperation and consent to share this case for educational purposes.