Organophosphate Poisoning

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

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Basics

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

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

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

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