Organophosphate poisoning - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Organophosphate poisoning can occur due to occupational or accidental exposure, deliberate ingestion, or chemical warfare with nerve gases.
Presentation is highly variable due to differences in dose, agent toxicity, and type of exposure.
Diagnosis is usually based on a history of exposure, with characteristic signs of cholinergic excess, but can be difficult when the patient is inadvertently exposed, unconscious, or confused.
Standard treatment is resuscitation, supportive care, decontamination, and use of atropine.
Accidental or occupational exposures nearly always have a favorable outcome.

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Definition

Epidemiology

Etiology

Pathophysiology

Citations

Key Articles

Eddleston M, Buckley NA, Eyer P, et al. Management of acute organophosphorus pesticide poisoning. Lancet. 2008 Feb 16;371(9612):597-607.[Abstract][Full Text]
Lavonas EJ, Akpunonu PD, Arens AM, et al. 2023 American Heart Association focused update on the management of patients with cardiac arrest or life-threatening toxicity due to poisoning: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2023 Oct 17;148(16):e149-84.[Abstract][Full Text]

Referenced Articles

1. Gunnell D, Eddleston M, Phillips MR, et al. The global distribution of fatal pesticide self-poisoning: systematic review. BMC Public Health. 2007 Dec 21;7:357.[Abstract][Full Text]
2. Gummin DD, Mowry JB, Beuhler MC, et al. 2019 Annual report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 37th annual report. Clin Toxicol (Phila). 2020 Dec;58(12):1360-541.[Abstract][Full Text]
3. Lotti M, Moretto A. Organophosphate-induced delayed polyneuropathy. Toxicol Rev. 2005;24(1):37-49.[Abstract]
4. Ajdacic-Gross V, Weiss MG, Ring M, et al. Methods of suicide: international suicide patterns derived from the WHO mortality database. Bull World Health Organ. 2008 Sep;86(9):726-32.[Abstract][Full Text]
5. Gajalakshmi V, Peto R. Suicide rates in rural Tamil Nadu, South India: verbal autopsy of 39 000 deaths in 1997-98. Int J Epidemiol. 2007 Feb;36(1):203-7.[Abstract][Full Text]
6. Abeyasinghe R, Gunnell D. Psychological autopsy study of suicide in three rural and semi-rural districts of Sri Lanka. Soc Psychiatry Psychiatr Epidemiol. 2008 Apr;43(4):280-5.[Abstract]
7. Phillips MR, Yang G, Zhang Y, et al. Risk factors for suicide in China: a national case-control psychological autopsy study. Lancet. 2002 Nov 30;360(9347):1728-36.[Abstract]
8. Fleischmann A, Bertolote JM, De Leo D, et al. Characteristics of attempted suicides seen in emergency-care settings of general hospitals in eight low- and middle-income countries. Psychol Med. 2005 Oct;35(10):1467-74.[Abstract]
9. Eddleston M, Buckley NA, Gunnell D, et al. Identification of strategies to prevent death after pesticide self-poisoning using a Haddon matrix. Inj Prev. 2006 Oct;12(5):333-7.[Abstract]
10. Davies JO, Eddleston M, Buckley NA, et al. Predicting outcome in acute organophosphorus poisoning with a poison severity score or the Glasgow coma scale. QJM. 2008 May;101(5):371-9.[Abstract][Full Text]
11. Eddleston M, Worek F, Eyer P, et al. Poisoning with the S-Alkyl organophosphorus insecticides profenofos and prothiofos. QJM. 2009 Nov;102(11):785-92.[Abstract][Full Text]
12. Eddleston M, Buckley NA, Eyer P, et al. Management of acute organophosphorus pesticide poisoning. Lancet. 2008 Feb 16;371(9612):597-607.[Abstract][Full Text]
13. Shihana F, Worek F, Dassanayake GA, et al. Evaluation of the accuracy of "ChE check mobile" in measurement of acetylcholinesterase in pesticide poisoning. Clin Toxicol (Phila). 2019 Jun;57(6):411-4.[Abstract]
14. Lavonas EJ, Akpunonu PD, Arens AM, et al. 2023 American Heart Association focused update on the management of patients with cardiac arrest or life-threatening toxicity due to poisoning: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2023 Oct 17;148(16):e149-84.[Abstract][Full Text]
15. Abedin MJ, Sayeed AA, Basher A, et al. Open-label randomized clinical trial of atropine bolus injection versus incremental boluses plus infusion for organophosphate poisoning in Bangladesh. J Med Toxicol. 2012 Jun;8(2):108-17.[Abstract]
16. Li Y, Tse ML, Gawarammana I, et al. Systematic review of controlled clinical trials of gastric lavage in acute organophosphorus pesticide poisoning. Clin Toxicol (Phila). 2009 Mar;47(3):179-92.[Abstract]
17. Eddleston M, Juszczak E, Buckley NA, et al; Ox-Col Poisoning Study collaborators. Multiple-dose activated charcoal in acute self-poisoning: a randomised controlled trial. Lancet. 2008 Feb 16;371(9612):579-87.[Abstract][Full Text]
18. Banerjee I, Tripathi SK, Roy AS. A study on comparative evaluation of add-on pralidoxime therapy over atropine in the management of organophosphorus poisoning in a tertiary care hospital. JK Science. 2011 Apr-Jun;13(2):65-9.[Full Text]
19. Banerjee I, Tripathi SK, Roy AS. Efficacy of pralidoxime in organophosphorus poisoning: revisiting the controversy in Indian setting. J Postgrad Med. 2014 Jan-Mar;60(1):27-30.[Abstract][Full Text]
20. Buckley NA, Eddleston M, Li Y, et al. Oximes for acute organophosphate pesticide poisoning. Cochrane Database Syst Rev. 2011 Feb 16;(2):CD005085.[Abstract][Full Text]
21. Blumenberg A, Benabbas R, deSouza IS, et al. Utility of 2-Pyridine Aldoxime Methyl Chloride (2-PAM) for Acute Organophosphate Poisoning: A Systematic Review and Meta-Analysis. J Med Toxicol. 2018 Mar;14(1):91-98.[Abstract][Full Text]
22. Eddleston M, Eyer P, Worek F, et al. Pralidoxime in acute organophosphorus insecticide poisoning - a randomised controlled trial. PLoS Med. 2009 Jun 30;6(6):e1000104.[Abstract][Full Text]
23. Thiermann H, Zilker T, Eyer F, et al. Monitoring of neuromuscular transmission in organophosphate pesticide-poisoned patients. Toxicol Lett. 2009 Dec 15;191(2-3):297-304.[Abstract]
24. Konickx LA, Worek F, Jayamanne S, et al. Reactivation of plasma butyrylcholinesterase by pralidoxime chloride in patients poisoned by WHO class II toxicity organophosphorus insecticides. Toxicol Sci. 2013 Dec;136(2):274-83.[Abstract][Full Text]
25. Roberts DM, Aaron CK. Management of acute organophosphorus pesticide poisoning. BMJ. 2007 Mar 24;334(7594):629-34.[Abstract]
26. Alahakoon C, Dassanayake TL, Gawarammana IB, et al. Prediction of organophosphorus insecticide-induced intermediate syndrome with stimulated concentric needle single fibre electromyography. PLoS One. 2018 Sep 27;13(9):e0203596.[Abstract][Full Text]
27. Perera PM, Jayamanna SF, Hettiarachchi R, et al. A phase II clinical trial to assess the safety of clonidine in acute organophosphorus pesticide poisoning. Trials. 2009 Aug 20;10:73.[Abstract]
28. Eddleston M. Novel clinical toxicology and pharmacology of organophosphorus insecticide self-poisoning. Annu Rev Pharmacol Toxicol. 2019 Jan 6;59:341-60.[Abstract]
29. Brvar M, Chan MY, Dawson AH, et al. Magnesium sulfate and calcium channel blocking drugs as antidotes for acute organophosphorus insecticide poisoning - a systematic review and meta-analysis. Clin Toxicol (Phila). 2018 Mar 20;56(8):725-36.[Abstract]
30. Roberts DM, Buckley NA. Alkalinisation for organophosphorus pesticide poisoning. Cochrane Database Syst Rev. 2005 Jan 25;(1):CD004897.[Abstract][Full Text]
31. Yu S, Yu S, Zhang L, et al. Efficacy and outcomes of lipid resuscitation on organophosphate poisoning patients: A systematic review and meta-analysis. Am J Emerg Med. 2018 Nov 17. [Epub ahead of print][Abstract]
32. World Health Organization. Management of Mental and Brain Disorders Team. Clinical management of acute pesticide intoxication: prevention of suicidal behaviours. World Health Organization; 2008.[Abstract][Full Text]
33. Dassanayake TL, Weerasinghe VS, Gawarammana I, et al. Subacute and chronic neuropsychological sequalae of acute organophosphate pesticide self-poisoning: a prospective cohort study from Sri Lanka. Clin Toxicol (Phila). 2021 Feb;59(2):118-30.[Abstract]
34. Pannu AK, Bhalla A, Vishnu RI, et al. Organophosphate induced delayed neuropathy after an acute cholinergic crisis in self-poisoning. Clin Toxicol (Phila). 2021 Jun;59(6):488-92.[Abstract]