Organophosphate PoisoningICU / resuscitation

Farmer drank an organophosphate insecticide 1 h ago; vomiting, drooling, pinpoint pupils, fasciculations, wheeze with bronchorrhoea; HR 48, SpO₂ 86%

• Bronchorrhoea / SpO₂ falling
• Bradycardia with hypotension
• Coma or seizures
• Neck-flexion weakness

• Carbamate poisoning
• Opioid toxicity (miosis)
• Nicotine/mushroom (muscarinic)
• Pontine haemorrhage
• Aluminium phosphide

• Admit: All symptomatic or suspected ingestions
• ICU: Respiratory failure, large atropine needs, GCS ≤8, intermediate syndrome
• Intubate: Bronchorrhoea, respiratory failure, coma — early
• Ventilate: Respiratory failure; lung-protective settings

• India has among the world's highest pesticide poisoning deaths; many ingestions are intentional.
• Aluminium phosphide (celphos) is another common, deadly agrochemical — no antidote; supportive ICU care.
• Carbamates look the same but resolve faster; treat identically with atropine.

• Use the pupils as the atropine endpoint
• Give succinylcholine for intubation
• Delay atropine for the cholinesterase result
• Discharge within 24–48 h of stopping atropine (intermediate syndrome)

• Under-dosed atropine
• Succinylcholine
• Staff contamination
• Early discharge

ICU for most; observe 24–96 h after atropine for intermediate syndrome.