Increased saliva, diarrhea, small pupils, muscle tremors, confusion
Usual onset
Within 12 hours[1]
Causes
Organophosphates[2]
Diagnostic method
Based on symptoms and confirmed by butyrylcholinesterase[2]
Differential diagnosis
Carbamate poisoning[2]
Prevention
decreasing access[2]
Medication
Atropine, oximes, diazepam[2]
Frequency
Nearly 3 million per year[3]
Deaths
>200,000 per year[2]
Organophosphate poisoning is poisoning due to organophosphates (OPs).[4] Organophosphates are used as insecticides, medications, and nerve agents.[4] Symptoms include increased saliva and tear production, diarrhea, vomiting, small pupils, sweating, muscle tremors, and confusion.[2] While onset of symptoms is often within minutes to hours, some symptoms can take weeks to appear.[5][1] Symptoms can last for days to weeks.[2]
Organophosphate poisoning occurs most commonly as a suicide attempt in farming areas of the developing world and less commonly by accident.[2] Exposure can be from drinking, breathing in the vapors, or skin exposure.[4] The underlying mechanism involves the inhibition of acetylcholinesterase (AChE), leading to the buildup of acetylcholine (ACh) in the body.[2] Diagnosis is typically based on the symptoms and can be confirmed by measuring butyrylcholinesterase activity in the blood.[2] Carbamate poisoning can present similarly.[2]
Prevention efforts include banning very toxic types of organophosphates.[2] Among those who work with pesticides the use of protective clothing and showering before going home is also useful.[6] In those who have organophosphate poisoning the primary treatments are atropine, oximes such as pralidoxime, and diazepam.[2][4] General measures such as oxygen and intravenous fluids are also recommended.[2] Attempts to decontaminate the stomach, with activated charcoal or other means, have not been shown to be useful.[2] While there is a theoretical risk of health care workers taking care of a poisoned person becoming poisoned themselves, the degree of risk appears to be very small.[2]
OPs are one of the most common causes of poisoning worldwide.[2] There are nearly 3 million poisonings per year resulting in two hundred thousand deaths.[2][3] Around 15% of people who are poisoned die as a result.[2] Organophosphate poisoning has been reported at least since 1962.[7]
^ abStoller JK, Michota FA, Mandell BF (2009). The Cleveland Clinic Foundation Intensive Review of Internal Medicine. Lippincott Williams & Wilkins. p. 108. ISBN 9780781790796. Archived from the original on 2017-09-10.
^ abBerg S, Bittner EA (2013). The MGH Review of Critical Care Medicine. Lippincott Williams & Wilkins. p. 298. ISBN 9781451173680. Archived from the original on 2017-09-10.
^ abcdKing AM, Aaron CK (February 2015). "Organophosphate and carbamate poisoning". Emergency Medicine Clinics of North America. 33 (1): 133–51. doi:10.1016/j.emc.2014.09.010. PMID 25455666.
^Peter JV, Sudarsan TI, Moran JL (November 2014). "Clinical features of organophosphate poisoning: A review of different classification systems and approaches". Indian Journal of Critical Care Medicine. 18 (11): 735–45. doi:10.4103/0972-5229.144017. PMC 4238091. PMID 25425841.
^Quandt SA, Hernández-Valero MA, Grzywacz JG, Hovey JD, Gonzales M, Arcury TA (June 2006). "Workplace, household, and personal predictors of pesticide exposure for farmworkers". Environmental Health Perspectives. 114 (6): 943–52. doi:10.1289/ehp.8529. PMC 1480506. PMID 16759999.
^Neurological Practice: An Indian Perspective. Elsevier India. 2005. p. 479. ISBN 9788181475497. Archived from the original on 2017-09-10.
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