Emergency Medical Minute23 Nov 2021

Podcast 732: Organophosphate Toxicity

Educational Pearls:

Organophosphates affect the cholinergic system by inhibiting acetylcholinesterase affecting muscarinic and nicotinic receptors
Symptoms include lacrimation, salivation, bronchoconstriction, blurred vision, bradycardia, bronchorrhea, emesis, and diarrhea
Initially, the patient should be decontaminated to prevent further organophosphate exposure
Treatment consists of atropine every 5 minutes, 1-3 mg to start and doubling the dose each time it is given until reversal of symptoms is seen
Atropine only works on muscarinic receptors, so nicotinic receptor activation continues despite atropine administration resulting in muscle contractions and eventually respiratory arrest
Pralidoxime (2-PAM) should also be given to prevent the nicotinic effects and maturation of the organophosphate-acetylcholinesterase complex

References

Robb EL, Baker MB. Organophosphate Toxicity. [Updated 2021 Jul 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470430/

Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD

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