July 11, 1994

Organophosphate and Carbamate Poisoning

Author Affiliations

From the Critical Care Unit A5, Pulmonary Inflammation and Infection Group, Department of Internal Medicine, University of Stellenbosch, Tygerberg Hospital, Cape Town, South Africa. Dr van Eeden is now with the University of British Columbia, Pulmonary Research Laboratory, St Pauls' Hospital, Vancouver, British Columbia. Dr Bardin is now with the Southampton (England) General Hospital.

Arch Intern Med. 1994;154(13):1433-1441. doi:10.1001/archinte.1994.00420130020005

Organophosphate insecticides may cause serious poisoning either accidentally or by deliberate ingestion. Toxic symptoms are produced by acetylcholine accumulation at cholinergic receptors. Diagnosis is based on history of exposure or ingestion, symptoms and signs of cholinergic overactivity and a decrease in serum pseudocholinesterase levels. Following diagnosis, grading of disease severity may identify patients with serious poisoning who should receive treatment in intensive care using adequate doses of anticholinergic drugs. Complications, particularly ventricular arrhythmias, central nervous system depression or seizures, and respiratory failure, should be anticipated and treated. Relapse may occur after seemingly successful treatment. Public education with regard to symptoms of toxicity must be encouraged, and physicians must provide skilled treatment for a potentially lethal condition.

(Arch Intern Med. 1994;154:1433-1441)