{ "schemaVersion": 2, "eyebrow": "Medical Toxicology", "title": "Organophosphate Toxicity", "summary": "Treat suspected organophosphate toxicity as a clinical cholinergic emergency: protect staff, control airway and bronchorrhea, titrate atropine to a clear chest, add an oxime when indicated, and use cholinesterase testing as confirmation rather than a reason to delay resuscitation.", "seoDescription": "Point-of-care management of organophosphate toxicity: decontamination, airway support, atropine endpoints, pralidoxime, diagnosis, and monitoring.", "clinicalQuestion": "How should clinicians rapidly diagnose, stabilize, antidote-treat, and monitor suspected acute organophosphate toxicity?", "specialty": "Emergency Medicine and Medical Toxicology", "audience": "U.S. physicians and medical trainees", "tags": [ "organophosphate poisoning", "cholinergic toxidrome", "atropine", "pralidoxime", "nerve agent", "pesticide poisoning" ], "keyTakeaways": [ "Respiratory failure from bronchorrhea and bronchospasm is the principal immediate lethal threat; prioritize airway, oxygenation, ventilation, and secretion control over confirmatory testing. [19][4]", "Titrate atropine to resolution of bronchorrhea and a clear chest rather than to pupil size alone; nerve-agent guidance uses 2 mg IM/IV with dose doubling every 5-10 minutes until clinical endpoints are reached. [3][22]", "Remove contaminated clothing and wash exposed skin with soap and water; perform decontamination while preventing secondary exposure of staff. [22][20]", "Pralidoxime is used with atropine, not instead of atropine; evidence for outcome benefit in adult pesticide poisoning remains uncertain. [3][23]", "Measure serum cholinesterase when available to support the diagnosis and obtain ECG in acute poisoning, but begin antidotal and respiratory treatment on clinical grounds. [21][8]" ], "sections": [ { "id": "first-minutes", "eyebrow": "Resuscitation", "heading": "Stabilize respiratory cholinergic toxicity before diagnostic confirmation", "intro": "Treat a compatible exposure and cholinergic syndrome as an antidote-responsive emergency.", "paragraphs": [ "Move the patient from the contaminated atmosphere, protect personnel from secondary contamination, remove clothing, and wash exposed skin thoroughly with soap and water. If soap and water are unavailable after suspected nerve-agent skin exposure, dry removal with absorbent material is a fallback measure. [22][20]", "Perform immediate airway, breathing, circulation, and neurologic assessment. Give oxygen, establish monitoring and IV access, and provide ventilatory support when bronchorrhea, bronchospasm, coma, seizures, or respiratory muscle weakness compromises ventilation. Early resuscitation with atropine, oxygen, respiratory support, and fluids is recommended to improve oxygen delivery. [3][4][22]", "Do not delay atropine for cholinesterase results. In suspected organophosphate toxicity, use serial lung examination and secretion burden as the dominant treatment endpoint: resolution of bronchorrhea is the most important antimuscarinic effect. [3][19]" ], "bullets": [ "Intubate when secretions, hypoxemia, impaired consciousness, or neuromuscular respiratory failure prevents adequate oxygenation or airway protection; continue atropine during airway management. [22][19]", "Treat seizures with a benzodiazepine; diazepam 5 mg IV stat is included in one emergency protocol. [21][22]", "Avoid activated charcoal in patients with a compromised airway or CNS depression because aspiration risk outweighs benefit. [3]" ], "subsections": [], "table": { "caption": "Immediate priorities in suspected acute organophosphate toxicity. [3][4][22]", "columns": [ "Problem", "Bedside finding", "Immediate action", "Treatment endpoint" ], "rows": [ [ "Airway/ventilation", "Bronchorrhea, bronchospasm, hypoxemia, coma, or weakness [19][22]", "Oxygen and respiratory support; intubate when ventilation or airway protection is inadequate. [4][22]", "Adequate oxygenation and ventilation. [4][22]" ], [ "Muscarinic excess", "Wet lungs or persistent bronchial secretions [3]", "Start IV/IM atropine and rapidly escalate. [22]", "Clear chest with resolution of bronchorrhea. [3][22]" ], [ "Ongoing contamination", "Dermal or respiratory exposure [22]", "Remove clothing; wash skin with soap and water; protect staff. [22][20]", "No ongoing external contamination. [22]" ], [ "Seizure/coma", "Convulsions or depressed consciousness [22]", "Benzodiazepine and airway-directed supportive care. [21][22]", "Seizure control and protected ventilation. [22]" ] ] } }, { "id": "recognition-and-testing", "eyebrow": "Diagnosis", "heading": "Recognize the cholinergic pattern and use tests to support—not postpone—treatment", "intro": "Exposure history plus a compatible toxidrome drives the first treatment decision.", "paragraphs": [ "Suspect acetylcholinesterase-inhibiting organophosphate exposure after pesticide contact, deliberate ingestion, occupational exposure, or a potential nerve-agent event when miosis, diaphoresis, excessive secretions, bronchospasm, bradycardia, diarrhea, fasciculations, or central neurologic toxicity occur together. Organophosphate poisoning follows dermal, inhalational, or oral exposure and may progress to seizures or respiratory failure. [1][19]", "Obtain a 12-lead ECG and serum cholinesterase level when available after initial stabilization. Serum cholinesterase testing can support the clinical diagnosis, while ECG identifies associated rhythm or conduction abnormalities that may alter monitoring and resuscitation; neither test should delay atropine or respiratory intervention. [21][3]", "Interpret a cholinesterase value in clinical context. Acetylcholinesterase inhibition from organophosphates may recover more slowly than butyrylcholinesterase, creating a cumulative inhibitory effect; serial laboratory values therefore do not substitute for serial respiratory examinations and atropine requirement. [9][8]" ], "bullets": [ "Ask specifically for product name, formulation, route, timing, estimated amount, coingestants, and whether other exposed persons are symptomatic; agent toxicity and exposure route contribute to variable presentation. [2][1]", "Consider carbamate insecticide exposure in the differential because it can produce a similar cholinergic clinical picture. [17][18]", "Do not anchor on isolated miosis or depressed consciousness: bright light can cause small pupils, and opioid exposure can produce miosis with depressed consciousness. [22]" ], "subsections": [], "table": { "caption": "Clinical findings that change the immediate diagnostic and treatment pathway. [1][19][22]", "columns": [ "Pattern", "Interpretation", "Next action" ], "rows": [ [ "Bronchorrhea, wheeze, hypoxemia", "Life-threatening respiratory cholinergic toxicity; respiratory failure is the major fatal complication. [19]", "Immediate atropine titration plus oxygen and ventilatory support. [4][22]" ], [ "Fasciculations or weakness", "Nicotinic involvement with risk of respiratory pump failure. [19][11]", "Closely reassess ventilation and prepare for assisted ventilation. [11][22]" ], [ "Miosis, diarrhea, bradycardia with secretion excess", "Compatible muscarinic cholinergic syndrome. [1][19]", "Treat clinically while obtaining exposure history, ECG, and cholinesterase testing. [21][3]" ], [ "Miosis and coma without secretion excess", "May be opioid toxicity or another cause rather than isolated organophosphate toxicity. [22]", "Reassess toxidrome, exposure history, and response to treatment. [22]" ] ] } }, { "id": "atropine-and-oxime", "eyebrow": "Antidotal Therapy", "heading": "Titrate atropine to a clear chest and add pralidoxime as adjunctive therapy", "intro": "Antimuscarinic treatment is guided by pulmonary secretions, not a fixed cumulative dose.", "paragraphs": [ "For adult nerve-agent or highly toxic organophosphate exposure, administer atropine 2 mg IM or IV and double the dose every 5-10 minutes until the chest is clear on auscultation and heart rate and systolic blood pressure are adequate; the cited guidance specifies targets of heart rate 80 beats/minute and systolic blood pressure 80 mm Hg. After control, continue atropine 1-2 mg/hour by IV infusion, adjusting to recurrent secretions, for up to 24 hours. [22]", "For pesticide poisoning, atropine should be titrated to the same clinically meaningful endpoint—resolution of bronchorrhea—rather than using mydriasis as the principal target. One emergency protocol describes an atropine maintenance infusion at 20% of the atropinizing dose per hour, with tapering after stabilization. [3][21]", "Use pralidoxime as an acetylcholinesterase-sparing adjunct with atropine. For adult nerve-agent exposure, cited guidance lists an initial pralidoxime chloride dose of 600 mg, 1,200 mg, or 1,800 mg IM/IV according to exposure severity, followed by 10-20 mg/kg in 0.9% saline by IV infusion; continue until atropine has not been required for 12-24 hours. A separate emergency protocol uses 2 g IV in 100 mL normal saline over 30 minutes followed by 1 g IV four times daily. [22][21]", "The pralidoxime decision requires clinical judgment because adult trial data have not conclusively established efficacy in acute organophosphate poisoning. Do not withhold atropine or respiratory support while considering oxime therapy, and do not use pralidoxime alone as treatment for acute toxicity. [23][3]" ], "bullets": [ "Escalate atropine whenever bronchial secretions recur; a recurrent wet chest is a treatment failure signal even if pupils remain small. [3][22]", "Continue oxime therapy only in conjunction with ongoing clinical assessment and atropine adjustment; oximes and atropine are complementary components of antidote treatment. [3][16]", "For nerve-agent casualties, antidotal therapy is broadly similar to pesticide toxicity, but exposure-specific operational protocols may govern autoinjector use and decontamination. [22][6]" ], "subsections": [], "table": { "caption": "Antidotal treatment endpoints and source-described regimens. [3][21][22][23]", "columns": [ "Therapy", "Initial regimen", "Titration or continuation", "Decision endpoint" ], "rows": [ [ "Atropine", "2 mg IM/IV for adult nerve-agent/highly toxic organophosphate exposure. [22]", "Double every 5-10 minutes; after control, 1-2 mg/hour IV infusion adjusted as needed for up to 24 hours. [22]", "Clear chest; adequate heart rate and systolic blood pressure. [22]" ], [ "Atropine, alternative protocol", "3-5 ampules IV bolus in one emergency protocol. [21]", "Increase according to clinical progression; maintenance infusion described as 20% of atropinizing dose per hour. [21]", "No crepitations or wheezes and drying of secretions are listed signs of atropinization. [21]" ], [ "Pralidoxime", "600 mg, 1,200 mg, or 1,800 mg IM/IV by severity in adult nerve-agent guidance; another protocol uses 2 g IV over 30 minutes. [22][21]", "10-20 mg/kg IV infusion in 0.9% saline or 1 g IV four times daily in the alternative protocol. [22][21]", "Continue nerve-agent regimen until atropine has not been needed for 12-24 hours. [22]" ] ] } }, { "id": "decontamination-and-disposition", "eyebrow": "Monitoring", "heading": "Prevent secondary exposure and monitor for recurrent respiratory failure", "intro": "Disposition is determined by respiratory status, atropine requirement, and neurologic trajectory.", "paragraphs": [ "Maintain contamination control during emergency care. Remove clothing and decontaminate skin with soap and water after dermal exposure; this reduces ongoing absorption and limits nosocomial poisoning risk. [22][20]", "Consider gastric decontamination only after airway and hemodynamic stabilization. Nasogastric aspiration of liquid poison may be used for high-risk ingestions such as organophosphates, whereas orogastric lavage carries substantial risk with limited evidence of benefit. Activated charcoal may be considered within 1 hour of a potentially toxic ingestion but is contraindicated with an unprotected airway or CNS depression. [3]", "Admit patients with ongoing bronchorrhea, respiratory compromise, coma, seizures, or a continuing atropine infusion to an intensive-care setting for ventilatory support and frequent reassessment. Respiratory failure can arise from impaired respiratory pump function and/or direct lung injury in poisoning; monitor serial lung examination, oxygenation, ventilation, mental status, ECG, and recurrent secretion burden. [11][19][21]" ], "bullets": [ "Use emergency observation only after clinical stability, absence of ongoing respiratory compromise, and no need for intensive monitoring or escalating antidote therapy; one emergency protocol separates stable observation from ICU disposition. [21]", "For intentional ingestion, arrange psychiatric assessment after medical stabilization and removal from acute toxicity monitoring. [2]" ], "subsections": [], "table": { "caption": "Disposition decisions after acute organophosphate exposure. [11][19][21][22]", "columns": [ "Clinical state", "Location", "Monitoring or intervention" ], "rows": [ [ "Respiratory failure, coma, seizures, or ongoing ventilatory support [19][22]", "ICU", "Ventilatory support, continuous reassessment of secretions and neurologic status, and adjusted atropine therapy. [19][22]" ], [ "Persistent need for atropine infusion or recurrent bronchorrhea [21][22]", "ICU or equivalently monitored critical-care setting", "Serial chest examinations and infusion titration to pulmonary endpoint. [3][22]" ], [ "Clinically stable after evaluation [21]", "Emergency observation", "Continue observation for recurrence and reassess disposition if respiratory, neurologic, or secretory toxicity develops. [21]" ] ] } }, { "id": "nerve-agent-exposure", "eyebrow": "Special Situation", "heading": "Manage suspected nerve-agent exposure as a hazardous-materials emergency", "intro": "Nerve agents are highly toxic organophosphates requiring simultaneous patient care and scene safety.", "paragraphs": [ "Nerve agents are organophosphate compounds with substantially greater toxicity than pesticide organophosphates. Move patients to uncontaminated air, remove clothing, decontaminate skin, and coordinate antidote delivery with hazardous-materials procedures to prevent rescuer exposure. [10][22]", "Use atropine plus an oxime as first-line pharmacologic treatment for nerve-agent exposure, with supportive treatment for respiratory failure, coma, and seizures. Autoinjector products containing atropine and an oxime may be used under applicable emergency-response protocols. [22][6]" ], "bullets": [], "subsections": [], "table": { "caption": "", "columns": [], "rows": [] } } ], "faq": [], "references": [ { "number": 1, "title": "Organophosphate poisoning - Symptoms, diagnosis and treatment | BMJ Best Practice US", "detail": "bestpractice.bmj.com", "url": "https://bestpractice.bmj.com/topics/en-gb/852?locale=en_GB", "authors": "bestpractice.bmj.com", "host": "bestpractice.bmj.com" }, { "number": 2, "title": "Organophosphate poisoning - Symptoms, diagnosis and treatment | BMJ Best Practice", "detail": "bestpractice.bmj.com", "url": "https://bestpractice.bmj.com/topics/en-gb/852", "authors": "bestpractice.bmj.com", "host": "bestpractice.bmj.com" }, { "number": 3, "title": "Toxidromes and a general approach to poisoning", "detail": "adc.bmj.com", "url": "https://adc.bmj.com/content/110/9/681", "authors": "adc.bmj.com", "host": "adc.bmj.com" }, { "number": 4, "title": "Review Management of acute organophosphorus pesticide poisoning", "detail": "www.thelancet.com", "url": "https://www.thelancet.com/pdfs/journals/lancet/PIIS0140673607612021.pdf", "authors": "www.thelancet.com", "host": "www.thelancet.com" }, { "number": 5, "title": "Emergency adjunctive therapy for organophosphate poisoning: A meta-analysis - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S1755599X25000898", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 6, "title": "Organophosphorus nerve agent poisoning - ScienceDirect.com", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S0007091219304015", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 7, "title": "Acute organophosphate poisoning: 17 years of experience of the National Poison Control Center in Serbia - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0300483X1830163X", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 8, "title": "Acute organophosphorus poisoning - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0009898114000412", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 9, "title": "Acetylcholinesterase as a Biomarker in Environmental and ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/10.1155/2013/321213", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com" }, { "number": 10, "title": "Pathophysiological and clinical aspects of combat ...", "detail": "academic.oup.com", "url": "https://academic.oup.com/bmb/article/72/1/119/272834", "authors": "academic.oup.com", "host": "academic.oup.com" }, { "number": 11, "title": "Poisoning | Oxford Textbook of Respiratory Critical Care", "detail": "academic.oup.com", "url": "https://academic.oup.com/book/59690/chapter/506576921", "authors": "academic.oup.com", "host": "academic.oup.com" }, { "number": 12, "title": "Organophosphate Poisoning: Insights From a Case Report of Acute ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/full/10.1002/ccr3.71183", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com" }, { "number": 13, "title": "The need for translational research on antidotes for pesticide ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/10.1111/j.1440-1681.2005.04298.x", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com" }, { "number": 14, "title": "Pharmacological treatment of organophosphorus insecticide ...", "detail": "bpspubs.onlinelibrary.wiley.com", "url": "https://bpspubs.onlinelibrary.wiley.com/doi/pdf/10.1111/bcp.12784", "authors": "bpspubs.onlinelibrary.wiley.com", "host": "bpspubs.onlinelibrary.wiley.com" }, { "number": 15, "title": "Organophosphorus poisoning and anaesthesia - Karalliedde - 1999", "detail": "associationofanaesthetists-publications.onlinelibrary.wiley.com", "url": "https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1046/j.1365-2044.1999.01061.x", "authors": "associationofanaesthetists-publications.onlinelibrary.wiley.com", "host": "associationofanaesthetists-publications.onlinelibrary.wiley.com" }, { "number": 16, "title": "Oxidative stress in organophosphate poisoning: role of standard ...", "detail": "analyticalsciencejournals.onlinelibrary.wiley.com", "url": "https://analyticalsciencejournals.onlinelibrary.wiley.com/doi/10.1002/jat.3605", "authors": "analyticalsciencejournals.onlinelibrary.wiley.com", "host": "analyticalsciencejournals.onlinelibrary.wiley.com" }, { "number": 17, "title": "Treatment of acute organophosphate poisoning", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/pdf/10.5694/j.1326-5377.1991.tb112852.x", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com" }, { "number": 18, "title": "Analytical approaches for monitoring exposure to ...", "detail": "analyticalsciencejournals.onlinelibrary.wiley.com", "url": "https://analyticalsciencejournals.onlinelibrary.wiley.com/doi/10.1002/dta.1325", "authors": "analyticalsciencejournals.onlinelibrary.wiley.com", "host": "analyticalsciencejournals.onlinelibrary.wiley.com" }, { "number": 19, "title": "Organophosphate Toxicity - StatPearls - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/portal/utils/pageresolver.fcgi?recordid=69c62d3bf7dc4e68e7352376", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov" }, { "number": 20, "title": "Nosocomial Poisoning Associated with Emergency Department Treatment of Organophosphate Toxicity – Georgia 2000", "detail": "stacks.cdc.gov", "url": "https://stacks.cdc.gov/view/cdc/183196", "authors": "stacks.cdc.gov", "host": "stacks.cdc.gov" }, { "number": 21, "title": "[PDF] standard-treatment-protocol-of-emergency-health-service-package.pdf", "detail": "cdn.who.int", "url": "https://cdn.who.int/media/docs/default-source/nepal-documents/hss_nepal/standard-treatment-protocol-of-emergency-health-service-package.pdf?sfvrsn=6c838ca4_7", "authors": "cdn.who.int", "host": "cdn.who.int" }, { "number": 22, "title": "[PDF] ema-guidance-use-medicinal-products-treatment-case-exposure ...", "detail": "www.ema.europa.eu", "url": "https://www.ema.europa.eu/en/documents/regulatory-procedural-guideline/ema-guidance-use-medicinal-products-treatment-case-exposure-chemical-agents-used-weapons-terrorism-crime-or-warfare_en.pdf", "authors": "www.ema.europa.eu", "host": "www.ema.europa.eu" }, { "number": 23, "title": "[PDF] THE SELECTION AND USE OF ESSENTIAL MEDICINES - IRIS", "detail": "iris.who.int", "url": "https://iris.who.int/server/api/core/bitstreams/23e9d936-cbbf-44b0-aab4-e7f6054403e9/content", "authors": "iris.who.int", "host": "iris.who.int" }, { "number": 24, "title": "[PDF] POISONS CENTRE TRAINING MANUAL - IRIS", "detail": "iris.who.int", "url": "https://iris.who.int/server/api/core/bitstreams/b1702df9-e2ff-45a4-9457-4d61b6ff3ebd/content", "authors": "iris.who.int", "host": "iris.who.int" } ], "editorialNote": "Prepared from cited clinical literature using Astra's research workflow. Verify recommendations against current guidance and patient-specific factors.", "citations": [ { "number": 1, "title": "Organophosphate poisoning - Symptoms, diagnosis and treatment | BMJ Best Practice US", "detail": "bestpractice.bmj.com", "url": "https://bestpractice.bmj.com/topics/en-gb/852?locale=en_GB", "authors": "bestpractice.bmj.com", "host": "bestpractice.bmj.com", "snippet": "# Organophosphate poisoning. Log in or subscribe to access all of BMJ Best Practice. Last reviewed: 14 Nov 2025. Organophosphate poisoning can occur due to occupational or accidental exposure, deliberate ingestion, or chemical warfare with nerve gases. This topic covers organophosphate poisoning in ", "score": 0.74961954 }, { "number": 2, "title": "Organophosphate poisoning - Symptoms, diagnosis and treatment | BMJ Best Practice", "detail": "bestpractice.bmj.com", "url": "https://bestpractice.bmj.com/topics/en-gb/852", "authors": "bestpractice.bmj.com", "host": "bestpractice.bmj.com", "snippet": "open menu\n\nWhen viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.\n\n# Organophosphate poisoning\n\nEpidemiology\n\nAetiology\n\nCase history\n\nApproach\n\nHistory and exam\n\nInvestigations\n", "score": 0.5013922 }, { "number": 3, "title": "Toxidromes and a general approach to poisoning", "detail": "adc.bmj.com", "url": "https://adc.bmj.com/content/110/9/681", "authors": "adc.bmj.com", "host": "adc.bmj.com", "snippet": "Antidotes for cholinergic poisoning include an antimuscarinic component, typically atropine, and an acetylcholinesterase-sparing component, typically pralidoxime or obidoxime. Antidote kits containing both medications were originally created for military use after nerve gas exposure, but are availab", "score": 0.55391616 }, { "number": 4, "title": "Review Management of acute organophosphorus pesticide poisoning", "detail": "www.thelancet.com", "url": "https://www.thelancet.com/pdfs/journals/lancet/PIIS0140673607612021.pdf", "authors": "www.thelancet.com", "host": "www.thelancet.com", "snippet": "However, consensus suggests that early resuscitation with atropine, oxygen, respiratory support, and fluids is needed to improve oxygen delivery", "score": 0.33287454 }, { "number": 5, "title": "Emergency adjunctive therapy for organophosphate poisoning: A meta-analysis - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S1755599X25000898", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "### Hum Exp Toxicol\n\n### Increased morbidity and mortality in acute human organophosphate-poisoned patients treated by oximes: a meta-analysis of clinical trials\n\n### Hum Exp Toxicol\n\n### Efficacy of fresh frozen plasma transfusion in comparison with conventional regimen in organophosphate poisoning", "score": 0.4598771 }, { "number": 6, "title": "Organophosphorus nerve agent poisoning - ScienceDirect.com", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S0007091219304015", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "The mainstay of treatment for organophosphorus nerve agent poisoning remains decontamination, atropine, oximes, neuroprotection, and good quality critical care", "score": 0.349933 }, { "number": 7, "title": "Acute organophosphate poisoning: 17 years of experience of the National Poison Control Center in Serbia - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0300483X1830163X", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "### Q. J. Med.\n\n### Speed of initial atropinisation in significant organophosphorus pesticide poisoning—a systematic comparison of recommended regimens\n\n### J. Toxicol. Clin. Toxicol.\n\n### Early management after self-poisoning with an organophosphorus or carbamate pesticide—a treatment protocol for ", "score": 0.34647548 }, { "number": 8, "title": "Acute organophosphorus poisoning - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0009898114000412", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "Elsevier logo\nClinica Chimica Acta\n\n## Clinica Chimica Acta\n\n## Published by: Elsevier\n\n### Published by\n\nElsevier\n\n# Invited critical review Acute organophosphorus poisoning\n\n## Article preview\n\n## Highlights\n\n## Abstract\n\n## Keywords\n\n## Introduction\n\n## Organizational access\n\n### Other access opt", "score": 0.3416489 }, { "number": 9, "title": "Acetylcholinesterase as a Biomarker in Environmental and ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/10.1155/2013/321213", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "In fact, AChE inhibition by organophosphate shows a lower recovery rate compared to BChE and this produces cumulative inhibitory effect on the", "score": 0.45333505 }, { "number": 10, "title": "Pathophysiological and clinical aspects of combat ...", "detail": "academic.oup.com", "url": "https://academic.oup.com/bmb/article/72/1/119/272834", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "Abstract. Nerve agents are organophosphate compounds similar to those used as pesticides but with much higher toxicity.", "score": 0.108670644 }, { "number": 11, "title": "Poisoning | Oxford Textbook of Respiratory Critical Care", "detail": "academic.oup.com", "url": "https://academic.oup.com/book/59690/chapter/506576921", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "Poisoning and overdose may cause respiratory failure by compromising respiratory pump function and/or by causing direct injury to the lung", "score": 0.087634265 }, { "number": 12, "title": "Organophosphate Poisoning: Insights From a Case Report of Acute ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/full/10.1002/ccr3.71183", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "Treatment includes atropine, pralidoxime, and supportive care. Outcomes vary, with risks of respiratory failure or neurological sequelae.", "score": 0.63723457 }, { "number": 13, "title": "The need for translational research on antidotes for pesticide ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/10.1111/j.1440-1681.2005.04298.x", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "Oximes in acute organophosphorus pesticide poisoning: A systematic review of clinical trials. Q. J. Med. 2002; 95: 275–83. 10.1093/qjmed", "score": 0.5737984 }, { "number": 14, "title": "Pharmacological treatment of organophosphorus insecticide ...", "detail": "bpspubs.onlinelibrary.wiley.com", "url": "https://bpspubs.onlinelibrary.wiley.com/doi/pdf/10.1111/bcp.12784", "authors": "bpspubs.onlinelibrary.wiley.com", "host": "bpspubs.onlinelibrary.wiley.com", "snippet": "Organophosphate poisoning: grading the severity and comparing treatment between atropine and glycopyrrolate. Crit Care Med 1990; 18: 956–60", "score": 0.529045 }, { "number": 15, "title": "Organophosphorus poisoning and anaesthesia - Karalliedde - 1999", "detail": "associationofanaesthetists-publications.onlinelibrary.wiley.com", "url": "https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1046/j.1365-2044.1999.01061.x", "authors": "associationofanaesthetists-publications.onlinelibrary.wiley.com", "host": "associationofanaesthetists-publications.onlinelibrary.wiley.com", "snippet": "The traditional use of oximes and atropine in treatment has failed to reduce the morbidity and mortality associated with poisoning.", "score": 0.5117904 }, { "number": 16, "title": "Oxidative stress in organophosphate poisoning: role of standard ...", "detail": "analyticalsciencejournals.onlinelibrary.wiley.com", "url": "https://analyticalsciencejournals.onlinelibrary.wiley.com/doi/10.1002/jat.3605", "authors": "analyticalsciencejournals.onlinelibrary.wiley.com", "host": "analyticalsciencejournals.onlinelibrary.wiley.com", "snippet": "Current standardized therapy of OP intoxications comprises live-saving administration of the anticholinergic drug atropine accompanied by oxime", "score": 0.48996773 }, { "number": 17, "title": "Treatment of acute organophosphate poisoning", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/pdf/10.5694/j.1326-5377.1991.tb112852.x", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "... clinical pictures of organophosphorusester and carbamate poisoning are ... pralidoxime which restores the catalytic site of AChE. Oximes act only on", "score": 0.47139415 }, { "number": 18, "title": "Analytical approaches for monitoring exposure to ...", "detail": "analyticalsciencejournals.onlinelibrary.wiley.com", "url": "https://analyticalsciencejournals.onlinelibrary.wiley.com/doi/10.1002/dta.1325", "authors": "analyticalsciencejournals.onlinelibrary.wiley.com", "host": "analyticalsciencejournals.onlinelibrary.wiley.com", "snippet": "This review summarizes the methods for identifying poisoning by organophosphorus and carbamate poisons. cause convulsions, respiratory failure,", "score": 0.3312825 }, { "number": 19, "title": "Organophosphate Toxicity - StatPearls - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/portal/utils/pageresolver.fcgi?recordid=69c62d3bf7dc4e68e7352376", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "Title: Organophosphate Toxicity - StatPearls - NCBI Bookshelf\n# Organophosphate Toxicity. Organophosphates encompass a diverse group of chemical compounds with common applications in pesticides and herbicides, as well as nerve agents in chemical warfare. When introduced into the body, organophosphat", "score": 0.52173984 }, { "number": 20, "title": "Nosocomial Poisoning Associated with Emergency Department Treatment of Organophosphate Toxicity – Georgia 2000", "detail": "stacks.cdc.gov", "url": "https://stacks.cdc.gov/view/cdc/183196", "authors": "stacks.cdc.gov", "host": "stacks.cdc.gov", "snippet": "#### Exit Notification/Disclaimer Policy\n\nCDC STACKS serves as an archival repository of CDC-published products including\nscientific findings,\njournal articles, guidelines, recommendations, or other public health information authored or\nco-authored by CDC or funded partners.\n \n \nAs a repository, C", "score": 0.26502642 }, { "number": 21, "title": "[PDF] standard-treatment-protocol-of-emergency-health-service-package.pdf", "detail": "cdn.who.int", "url": "https://cdn.who.int/media/docs/default-source/nepal-documents/hss_nepal/standard-treatment-protocol-of-emergency-health-service-package.pdf?sfvrsn=6c838ca4_7", "authors": "cdn.who.int", "host": "cdn.who.int", "snippet": "PROTOCOL OF EMERGENCY HEALTH SER VICE PACK AGE 211 Resuscitation A: Airway B: Breathing C: Circulation Risk Assessment Supportive Care and Monitoring Investigations Decontamination Antidotes • IV Fluids • Supplemental oxygen • Benzodiazepines Inj. Diazepam 5mg IV stat • 12 Lead ECG • Serum Cholinest", "score": 0.66045773 }, { "number": 22, "title": "[PDF] ema-guidance-use-medicinal-products-treatment-case-exposure ...", "detail": "www.ema.europa.eu", "url": "https://www.ema.europa.eu/en/documents/regulatory-procedural-guideline/ema-guidance-use-medicinal-products-treatment-case-exposure-chemical-agents-used-weapons-terrorism-crime-or-warfare_en.pdf", "authors": "www.ema.europa.eu", "host": "www.ema.europa.eu", "snippet": "products EU MA status Treatment of exposure to nerve agents and other highly toxic organophosphates First line regimen1-6, 12, 13, 15-17, 20-23 Atropine and one oxime Atropine, pralidoxime, and obidoxime are authorised at national level in MSs. Adults (≥18 years, > 40kg) Atropine: 2 mg IM/IV, doubli", "score": 0.5677694 }, { "number": 23, "title": "[PDF] THE SELECTION AND USE OF ESSENTIAL MEDICINES - IRIS", "detail": "iris.who.int", "url": "https://iris.who.int/server/api/core/bitstreams/23e9d936-cbbf-44b0-aab4-e7f6054403e9/content", "authors": "iris.who.int", "host": "iris.who.int", "snippet": "of treatment related to the ingestion of or exposure to the organophosphate and concomitant use of other treatments for organophosphate poisoning (e.g., atropine sulfate, early mechanical ventilation). The Committee also noted that there are data from several small paediatric case-series, not cited ", "score": 0.5052006 }, { "number": 24, "title": "[PDF] POISONS CENTRE TRAINING MANUAL - IRIS", "detail": "iris.who.int", "url": "https://iris.who.int/server/api/core/bitstreams/b1702df9-e2ff-45a4-9457-4d61b6ff3ebd/content", "authors": "iris.who.int", "host": "iris.who.int", "snippet": "The emergency stabilization of a poisoned patient is included as an essential component of management. The chapter also emphasizes the contraindications and complications of the techniques used in the management of poisoning cases. Student Test CASE STUDY 1: A 30‐year old female was brought to the e", "score": 0.4059909 } ], "publishedAt": "2026-09-16T00:08:04.714361+00:00", "updatedAt": "2026-09-16T00:08:04.714361+00:00", "readingMinutes": 5, "slug": "organophosphate-toxicity" }