Organophosphate Poisoning

Key points

• Organophosphates: irreversibly inhibit acetylcholinesterase → cholinergic excess (muscarinic + nicotinic + CNS).
• Muscarinic features (SLUDGE/DUMBELS): salivation, lacrimation, urination, diarrhoea, GI cramps, emesis, miosis, bronchorrhoea, bradycardia.
• Nicotinic: fasciculations, muscle weakness; CNS: confusion, seizures.
• Management: atropine (repeated boluses until chest clear/BP adequate — large doses may be needed) + pralidoxime (reactivates AChE if given early).
• Remove clothing and decontaminate to protect staff.