Acute respiratory failure from organophosphate poisoning: Early intervention and holistic care in a resource-limited...

Acute respiratory failure due to organophosphate (OP) poisoning is a life-threatening emergency caused by acetylcholinesterase inhibition and subsequent cholinergic overstimulation. The author reports a 36-year-old male who intentionally ingested 50% malathion and presented with blurred vision, excessive salivation, muscle fasciculations, altered consciousness, and acute respiratory distress. His laboratory tests showed reduced cholinesterase levels, and chest imaging showed mild bilateral infiltrates without evidence of aspiration pneumonia. Immediate management included securing the airway with mechanical ventilation and administering atropine according to the patient's clinical response. Pralidoxime was administered, and appropriate intravenous fluid resuscitation was provided for hypotension. Close monitoring allowed early differentiation between his primary respiratory failure due to OP toxicity and potential secondary complications. He was discharged on day nine after making a full recovery. This case highlights the critical importance of rapid recognition, early airway stabilization, and timely antidote administration in managing acute respiratory failure resulting from OP poisoning.