- organophosphate irreversibly inhibit acetylcholinesterase and nicotinic synapses
- poisoning characterised by muscarinic and nicotinic effects
- muscarinic effect : nausea, vomiting, miosis, abdominal cramp, urinary and fecal incontinence, bronchorrhea, diaphoresis, salivation, lacrimation, bradycardia, conduction block, pulmonary edema
- nicotinic effect: twitching, fasciculation, weakness, cramp, hypoventilation with respiratory failure
- cholinesterase activity in plasma and red blood cells is reduced to less than 50% normal
- remove contaminated clothing and wash skin and mucous membrane with copious amount of water
- Atropine (muscarinic receptor antagonist) 0.5-2mg given IV every 5-10minutes until atropinization is adequate (drying of tracheobronchial secretion, dry mouth, flushing, dilated pupils, HR>120)
- Pralidoxime (oxime that reactivates phosphorylated cholinesterase) counteracts weakness (nicotinic effects)
- pralidoxime is contraindicated in carbamate poisoning.
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