Management of Suspected Organophosphate Poisoning with Concomitant Antidotal and Hemoperfusion Therapy (HA 230): A Case Report

Introduction: Organophosphates, pose a Public health hazard through various exposure routes. They act by inhibiting acetylcholinesterase, leading to excess acetylcholine and systemic toxicity. Despite regulations, pesticide misuse remains prevalent in the Philippines. Hemoperfusion, shows promise in severe OP poisoning. This is the first reported case in the Philippines of OP poisoning successfully treated with hemoperfusion. Case Description: case of 41-year-old female brought to ER with tremors and altered mentation hours after termite pesticide exposure presented with cholinergic symptoms: pinpoint pupils, muscle fasciculations, hypersalivation, and metabolic acidosis. She received high-dose atropine, diazepam, and sodium bicarbonate. After 10 days of minimal improvement, hemoperfusion was initiated. Three sessions using HA230 cartridge resulted in clinical recovery. Discussion: Chlorpyrifos causes toxicity by blocking acetylcholinesterase, leading to muscarinic and nicotinic overstimulation. Standard treatment includes atropine and oximes. Hemoperfusion enhances toxin clearance, particularly lipid-soluble OPs. This case demonstrated clinical improvement after delayed hemoperfusion. Hemoperfusion therapy using HA230 following antidotal therapy improved the clinical outcomes of our index patient. It is mostly indicated in acute intoxications especially in cases of a drug overdose, pesticides, and industrial toxin poisoning. Hemoperfusion is a blood purification technique where blood passes through extracorporeal circuit containing adsorptive resins, allowing effective removal of toxins. In organophosphate poisoning, combining hemoperfusion with atropine shown superior outcomes by reducing adverse effects, shortening cholinesterase reactivation time, and decreasing complication rates. It reduce toxin levels in the blood by 30–50%. Due to their high lipid solubility, organophosphates can accumulate at concentrations 20–50 times higher than in blood, leading to prolonged toxic effects. However, hemoperfusion alone cannot restore acetylcholinesterase activity or reverse all pathophysiological changes. Therefore, a combination of hemoperfusion with atropine and cholinesterase reactivators provides a more effective therapeutic strategy in managing severe or refractory cases of OP poisoning.