Organophosphate Poisoning

Description

• Organophosphates (pesticides and nerve agents) irreversibly bind and deactivate cholinesterases, including acetylcholinesterase
• Acetylcholine accumulates at neural synapses, causing central and peripheral cholinergic overdrive
• Predominant effects (muscarinic, nicotinic, CNS) may vary and can overlap
• Mortality is secondary to respiratory failure:
  • Weakness of respiratory muscles
  • Bronchorrhea and bronchoconstriction
  • Central depression of respiratory drive

• Symptoms are difficult to differentiate in toddlers
• Common symptoms: Miosis, salivation, and muscle weakness
• Seizure activity in 25% of pediatric cases:
  • Only 3% in adults

Etiology

• Exposure to insecticides (organophosphorus compounds)
• Exposure to chemical nerve agents (sarin, soman, tabun, VX)
• Extremely well absorbed from lung, GI tract, skin, mucosa, eyes