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Organophosphate Poisoning

Organophosphate Poisoning is a topic covered in the 5-Minute Emergency Consult.

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  • 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

Pediatric Considerations
  • 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


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

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Rosen, Peter, et al., editors. "Organophosphate Poisoning." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307572/all/Organophosphate_Poisoning.
Organophosphate Poisoning. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307572/all/Organophosphate_Poisoning. Accessed April 23, 2019.
Organophosphate Poisoning. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307572/all/Organophosphate_Poisoning
Organophosphate Poisoning [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 23]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307572/all/Organophosphate_Poisoning.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Organophosphate Poisoning ID - 307572 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307572/all/Organophosphate_Poisoning PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -