Organophosphate poisoning

What it is

Organophosphate poisoning follows exposure to organophosphates, insecticides used as sprays and dusts. Among disorders of the NMJ it is the intra-synaptic example, alongside pre-synaptic Lambert Eaton and post-synaptic Myasthenia Gravis.

Causes and risk

The listed causes are:

• Inhalation of sprays or dusts of insecticides.
• Contamination of skin of agricultural workers.
• Contamination of crops or food.
• Accidental or intentional ingestion of insecticides.
• War gases in the chemical war.

How it presents

The muscarinic signs are listed under DUMBBELLS. With them come abdominal pain, vomiting and weakness, and on examination muscle fasciculations, lacrimation, salivation and widespread wheeze on auscultation. Other expected findings are increased bowel sounds, sweating, constricted pupils, and a slow or fast pulse.

Early or mild exposure may give the nicotine findings alone: muscle fasciculation, weakness and paralysis, with hypertension, mydriasis and tachycardia. Hypotension, hypertension, confusion and coma are also described.