Insecticides

Organophosphate (OP) insecticide toxicity is the leading cause of major morbidity and death in the insecticides class. The clinical syndrome of OP toxicity varies widely, ranging from the classic cholinergic syndrome to flaccid paralysis and intractable seizures. The mainstays of therapy for OP-poisoned patients are atropine, pralidoxime, and benzodiazepines. Tachycardia is not a contraindication to treatment with atropine in OP toxicity. Atropine should be administered to alleviate respiratory distress, symptomatic bradycardia, and as an adjunct to benzodiazepines to alleviate seizure activity. Atropine should not be administered systemically to alleviate miosis. In acute OP toxicity, a continuous pralidoxime infusion should be considered. Intermediate syndrome and OP-induced delayed neuropathy may occur in select patients with OP poisoning.