53. A 44-year-old woman who had spent much of the day working in her garden is a
ID: 256570 • Letter: 5
Question
53. A 44-year-old woman who had spent much of the day working in her garden is a patient of yours. A gust of wind caused her to unintentionally inhale the insecticide that she was spraying throughout the garden. When she began wheezing severely, she was taken to the emergency room. The attending physician observed other symptoms including constricted pupils and a slowed heart rate. The patient was treated with the IV administration of atropine sulfate. What division of the ANS has been affected? What types of receptors are involved in her symptoms? a. b. How did the insecticide result in her presenting symptoms? What effects do you expect to occur in the gastrointestinal system? Explain your answer. c. What effect may the insecticide have on generalized sweating in this patient? Localized sweating? Explain. d. e. In high doses, what skeletal muscle effect(s) would you expect to see? Explain. f. Would the administration of a B-adrenergic receptor antagonist be useful in the treatment of this patient? Why or why not? If so, what drug would you recommend? Would the administration of a B-adrenergic receptor agonist be useful in the treatment of this patient? Why or why not? If so, what drug would you recommend? g. h. Why is atropine an appropriate treatment?Explanation / Answer
Answer:
a. By the symptoms it appears the lady was using organophosphorous insecticide. The symptoms also refers to that the affect is mostly on Parasympathetic division of nervous system. Parasympathetic Nervous syetem regulates pupil constriction, myocardium, respiration, salivation and sexual arousal. the insecticide must have stimulated the parasymathetic nervous system. Muscarinic acetylcholine (ACh) receptors in the parasympathetic system are involved in this type of poisoning. This insecticide inhibit esterase enzymes, especially acetylcholinesterase in synapses and on red-cell membranes, and butyrylcholinesterase in plasma. Acetylcholinesterase inhibition results in accumulation of acetylcholine and overstimulation of acetylcholine receptors in synapses of the autonomic nervous system.
b. Insecticide cause blockage of enzyme Acetylcholinesterase, which is necessary for the degradation of Acetylcholine a neurotransmitter. due to absence of enzyme acetylecholine start accumulating on muscarinic acetylecholine receptors. this accumulation causes bronchoconstriction, pin point pupils, bradycardia and eventually coma and death.
c. Vomiting and Diarrhea are the effects on GIT by the insecticide. this effect is because of involvement of muscarinin ACh receptors. accumulation of ACh on the receptors causes vomition and diarrhea.
d. Excess body fluid secretion is one of the symptoms and that includes excessive salivation and sweating. there will be a generalized sweating as the insecticide was inhaled. A profuse local sweating is expected when the insecticde comes in contact with skin directly. in this case also excessive sweating on the chest area can be seen as the respiratory muscles are most affected.
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