Pancreatitis as a Complication of Anticholinesterase Insecticide Intoxication

Abstract

Severe pancreatitis and a pseudocytst occurred in a patient following accidental ingestion of an anticholinesterase insecticide, a substance not previously known to produce pancreatitis. Experiments were done to elucidate the mechanism. In 1 group of dogs the pancreatic duct was perfused and intraductal pressures were measured. The cholinesterase inhibitor O,O-diethyl-O-(2-isopropyl-6-methyl-4-pyrimidinyl)phosphorothioate (25 mg/kg), caused a significant increase in the mean intraductal pressure from 12 .+-. 2.4 to 27.8 .+-. 5.9 cm saline. In a 2nd group of dogs pancreatic secretory rates were measured. Anticholinesterase (75 mg/kg) in combination with secretin infusion (1 u[units]/kg per h) caused a significant increase in the secretin stimulated flow rate from 0.13-0.56 ml/min. Atropine (75 .mu.g/kg) abolished the anticholinesterase induced pressure and secretory rate increases. In a 3rd group of dogs administration of cholinesterase inhibitor 75 mg/kg and secretin infusion 2 U/kg per h resulted in acute pancreatic interstitial edema, acinar cell vacuolization, hyperamylasemia and hyperlipasemia. Occurrence of pancreatitis as a complication of anticholinesterase insecticide intoxication is the result of hypersecretion and pharmacologic ductal obstruction.