Acute Kidney Injury and Intermediate Syndrome Following Organophosphorus Poisoning: A Case Report

Organophosphate (OP) poisoning is an important cause of acute poisonings in several regions of India and leads to serious complications like cholinergic crisis, respiratory failure, and intermediate syndrome.Renal dysfunction is relatively uncommon and less described in such cases.We describe here a case of a 46-yearold gentleman admitted with severe OP poisoning associated with respiratory failure necessitating mechanical ventilation, intermediate syndrome, hemodynamic instability, rhabdomyolysis, and acute kidney injury (AKI) leading to hemodialysis.The initial presentation was with altered sensorium, hypoxemia, tachycardia, tachypnea, and metabolic acidosis with type 1 respiratory failure.The patient received atropine drip, pralidoxime, and mechanical ventilation.In addition, the patient during his hospital stay had episodes of hypotension necessitating pressor support, cardiopulmonary arrest necessitating resuscitation, and proximal muscle weakness, which is suggestive of intermediate syndrome.Creatinine progressively increased, urine output decreased, creatine phosphokinase (CPK) levels were found to be very high at 38,710 U/L, and there was refractory hyperkalemia requiring intermittent dialysis.AKI in this patient is thought to be multifactorial and could be related to hemodynamic instability, infection, rhabdomyolysis, and toxininduced nephrotoxicity.Renal function subsequently improved after dialysis.He was also treated for nosocomial infections.He was successfully treated and was closely followed up till full clinical recovery was achieved.This case highlights the importance of monitoring renal function, electrolytes, and markers of muscle injury in patients with severe OP poisoning.