Organophosphate Poisoning

Basics

Description

  • Organophosphates (pesticides and nerve agents) irreversibly bind and inactivate cholinesterases, including acetylcholinesterase (AChE)
  • Acetylcholine accumulates at neural synapses, causing central and peripheral cholinergic neurotransmission:
    • Symptoms vary but predominantly include muscarinic and nicotinic effects
  • Mortality is secondary to respiratory failure:
    • Primarily bronchorrhea à pulmonary edema
    • Central depression of respiratory drive and weakness of respiratory muscles
    • Bronchoconstriction

Pediatric Considerations

  • Symptoms may be difficult to differentiate in young children
  • 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, and mucosa

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