Now that you have concluded the target system, it is important for you to know t
ID: 179069 • Letter: N
Question
Now that you have concluded the target system, it is important for you to know that the neurologic examinations revealed that the most severely ill worker had ocular muscle weakness and was unable to maintain an upward gaze. In addition, this person had decreased sensation to light touch below the left knee. Otherwise, all other neurologic findings were unremarkable. Results of plasma and red blood cell Cholinesterase activity tests were within the normal range for all workers tested. What agent or agents do you feel may be the culprits in this case? If you are still unsure about the agent causing the problem, here is your final clue. Your investigation and questioning has found that there are 22 different preparations of insecticide dips, shampoos, pills, powders, and sprays used in the clinic or dispensed by the clinic These products include 12 types of pesticides Employees use no precautions to protect the skin How might you secure information regarding the operation at the clinic with sick workers and other pesticide usage by other veterinary clinics?Explanation / Answer
4.
Myasthenia Gravis – Main symptoms include fluctuating weakness of voluntary muscles especially influencing the cranial nerves. Some of the symptoms include double vision, ptosis and dysphagia. As the proximal muscles are problematic, there is high difficulty in combing the hair, rising from the chair, and so on. The onset of this disease is normally sub-acute, while acute onset also does occur. Here, the striated muscle is affected and this condition does not have pupils or sphincters.
The major signs of muscle weakness include ptosis, ocular palsies, gaze palsies, jaw weakness and facial weakness and bulbar palsy. Due to the poisoning, there will be sensory and behavioral changes, no coordination and depressed motor function.
The accumulation of acetylcholine results from irreversible phosphorylation of acetyl cholinesterase enzyme or reversible carboxylation of the enzyme due to continuous exposure to pesticides. The cholinergic junctions generate muscarinic effect on the gland cells and smooth muscles resulting in the muscle contractions and secretions. There are some nicotinic junctions that can generate excitatory influence on the skeletal muscles and autonomic ganglia and weaken the end plate cells.
The laboratory tests that are available for lowering of cholinesterase levels in the plasma and red blood cells are Michael, Nabb-Whitfield, and Ellman-Boehringer. Depressed levels or 25percent reduced levels of cholinesterase is considered to be due to poisoning or exposure to pesticides. It is necessary to estimate the levels before the exposure or take baseline values. There are many people who show normal cholinesterase levels but, record as low levels. These cases are categorized under poisoned ones. If two samples are taken with the difference of 4 weeks in between, the marked changes indicate the excessive poisoning.
If urine analysis is strong enough to prove clinically that the patient is exposed to poisoning with the presence of N-methyl carbamate metabolites, it is not necessary to wait for laboratory blood test confirmation. Treatment can be taken immediately.
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