Electrocardiographic repolarisation abnormalities after acute organophosphate poisoning

A 50-year-old man was admitted to our hospital 2.5 hours after suicidal ingestion of 100 ml of quinalphos (Ekalux), an environmental organophosphorus insecticide pollutant. Immediately, a therapy with atropine (a total of 15 mg within the first 28 hours) and the organophosphate antidote obidoxime (Toxogonin; a total of 1000 mg within the first 24 hours) was initiated. The first electrocardiogram (ECG) recorded 30 minutes after admission demonstrated sinus tachycardia and moderate prolongation of the QT interval (QTc 503 ms) but was otherwise inconspicuous (fig. 1). During the further course, the ECG demonstrated progressive repolarisation abnormalities, including the development of negative T waves and pronounced prolongation of the QTc interval peaking at day eleven after organophosphate ingestion (QTc 648 ms) (fig. 2). Cardiac troponin T levels remained within the normal range during the entire hospital course. An echocarTHE INTERESTING ECG