One Container Holds Shampoo, The Other Insecticide (fwd)

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One Container Holds Shampoo, The Other Insecticide

By LARRY ZAROFF, M.D. and JONATHAN ZAROFF, M.D., The New York Times

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(Dec. 19) - Attention is paid to hair.

In our culture the hair industry is huge — shampoos, conditioners, coloring,

cutting, shaping, styling. For “hair-loss treatment†alone, Google conjures

up 749,000 references. Some people undergo surgical procedures, sometimes

uncomfortable and expensive, to implant hair.

Total hair loss is often an unfortunate and undesirable complication of the

agents used to treat and cure cancer. Yet baldness — the hairless look —

can

for some represent spirituality and religion, or for others may suggest that

they are athletic, smart, cool, reeking of testosterone.

Depending on where you are in your life, what you are doing, your age and

sex, baldness is loved or hated — or just accepted. Baldness can be bought

and

bought off. But it is not a medical treatment, at least not since shaving the

head for lice was stopped.

In one patient, however, shaving the head was life saving.

A 50-year-old woman was admitted to the hospital with complaints of severe

weakness and difficulty breathing. She had been quite healthy until the

afternoon of the admission, with no history of serious illnesses.

The doctors at the university hospital where she became a patient are known

for using their brains. They also use their stethoscopes wisely, and observe

closely how a patient looks.

On examination this one was sweaty and had pinpoint pupils, and her lungs

were wheezy. But unlike physicians of centuries ago, doctors today do not

regularly use their noses. (In the 18th century, doctors could make diagnoses

of

kidney failure, diabetes and liver disease by smelling a patient.) For this

woman, the diagnosis remained obscure for the next hour as her breathing got

more labored and she became comatose.

A tube was placed in her windpipe and she was attached to a breathing

machine. Then an experienced nurse, with good sense and a good sense of smell,

came

to the rescue. The nurse noted that the patient had a peculiar odor,

resembling garlic, most prominently from her hair. The unusual odor raised the

suspicion of insecticide poisoning with organophosphates.

The patient was immediately treated with atropine and 2-PAM to reverse the

effects of the poison, while blood was sent to the lab to verify the

diagnosis. Each time she received the medications she woke and improved, but

then

lapsed back into a coma with increasing lung problems. Her skin was washed and

her hair was shampooed several times with no lasting improvement.

Since the primary contamination seemed to be in her hair, her head was

shaved. After that she improved rapidly, her medicines were tapered and she

regained consciousness. Soon she was able to breathe on her own.

The lab reports verified that the nurse had been correct. The patient had

been poisoned with an organophosphate insecticide. Now her doctors wondered,

How did her hair become impregnated with insecticide in quantities to bring her

to the brink of death? This was no casual exposure. She denied a suicide

attempt — swallowing would have been more direct. Nor could it have been

attempted murder — there are easier ways to administer poisons more covertly.

The answer came from the patient when she fully awakened. She remembered

exactly what she had done before becoming ill: her usual activities, except

that

she had gotten her hair shampooed by a neighbor.

The neighbor, when contacted, was willing to bring in the shampoo.

Chagrined, she showed up shortly, bringing two containers. One held shampoo.

The

other, a similar jug, contained an organophosphate insecticide. Both

receptacles

were the same size, the labels old and blurred.

I must have used the wrong one, she said, when told that her friend was just

recovering from insecticide poisoning.

Organophosphates have a bad reputation, and quite correctly. They are

extremely dangerous, even in small amounts, and are easily absorbed through the

skin as well as the lungs. They poison an important enzyme, acetylcholine

esterase, without which acetylcholine accumulates in the body, disabling

muscles

and nerves and important centers in the brain.

Organophosphates are frequently used in agriculture as an insecticide.

Studies suggest that each year, there are 18 cases of pesticide-caused illness

for

every 100,000 American workers. In gaseous forms, like tabun and sarin, they

can also be deadly biological weapons. Sarin was used by members of the

Japanese cult Aum Shinrikyo in the Tokyo subway attack of 1995.

In this case, the patient recovered well, after the correct diagnosis by a

nurse with a sensitive nose, proper treatment with drugs and the elimination

of the insecticide by balding.

12-19-06 12:27 EST

Copyright © 2006 _The New York Times Company_

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