{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T10:03:12Z","timestamp":1766138592368,"version":"3.44.0"},"reference-count":22,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,2,9]]},"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:p>Organophosphate poisoning is a common, under-reported cause of attempted and completed suicide worldwide. Following the resolution of the acute cholinergic syndrome, patients may develop respiratory muscle and proximal limb weakness, known as intermediate syndrome. A young man was brought to our rural hospital unconscious, in extremis, due to organophosphate pesticide poisoning. He developed atypical intermediate syndrome with global paralysis, persistent fasciculations and prolonged cholinergic symptoms, differing from the recognised presentation. He was intubated for fifteen days in our newly developed intensive care unit. Limited treatment options and the absence of blood gases, electrolyte testing, ECGs, invasive monitoring and imaging, in conjunction with regular disruptions to electricity and oxygen, and complications including seizures and pneumonia, all made this prolonged intubation an ambitious and challenging endeavour. We offer learning points for the acute physician and rural intensivist, and a summary of our reflections and hints for best care when adapting to a resource-limited setting.<\/jats:p>","DOI":"10.1136\/bcr-2022-253435","type":"journal-article","created":{"date-parts":[[2024,2,21]],"date-time":"2024-02-21T12:50:18Z","timestamp":1708519818000},"page":"e253435","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Atypical organophosphate poisoning and a successful case of prolonged intubation in a low-resource newly developed intensive care unit in rural Zambia"],"prefix":"10.1136","volume":"17","author":[{"given":"Lara","family":"Bowell","sequence":"first","affiliation":[{"name":"Intensive Care Unit, Katete, Zambia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4607-9338","authenticated-orcid":false,"given":"Mark Timothy","family":"Williams","sequence":"additional","affiliation":[{"name":"General Practice - Global Health Fellow, NELFT NHS Foundation Trust, Rainham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,2,21]]},"reference":[{"key":"2025082703322364000_17.2.e253435.1","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-020-09939-0","article-title":"The global distribution of acute unintentional pesticide poisoning: estimations based on a systematic review","volume":"20","author":"Boedeker","year":"2020","journal-title":"BMC Public Health"},{"key":"2025082703322364000_17.2.e253435.2","doi-asserted-by":"publisher","DOI":"10.2165\/00139709-200625010-00001"},{"key":"2025082703322364000_17.2.e253435.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2017.05.002"},{"key":"2025082703322364000_17.2.e253435.4","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2458-14-606","article-title":"Suicidal behaviour across the African continent: a review of the literature","volume":"14","author":"Mars","year":"2014","journal-title":"BMC Public Health"},{"key":"2025082703322364000_17.2.e253435.5","doi-asserted-by":"crossref","DOI":"10.1186\/s12873-016-0068-3","article-title":"Pattern of acute poisoning at two urban referral hospitals in Lusaka, Zambia","volume":"16","author":"Z\u2019gambo","year":"2016","journal-title":"BMC Emerg Med"},{"key":"2025082703322364000_17.2.e253435.6","doi-asserted-by":"crossref","unstructured":"Braitberg G . Chapter 98 - drugs and Antidotes in acute intoxication. In: Ronco C , Bellomo R , Kellum J , et al , eds. Critical Care Nephrology. 3rd edn. Elsevier, 2019: 574\u201388. 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