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Introduction

Organophosphate poisoning is caused by exposure to organophosphates, a group of chemicals commonly used as pesticides.  These compounds inhibit acetylcholinesterase in the muscarinic and nicotinic cholinergic synapses, leading to overstimulation of the corresponding receptors.  Symptoms resulting from muscarinic hyperactivity include bronchospasm, bronchorrhea, miosis, bradycardia, and hypersalivation.  Nicotinic overactivation leads to muscle weakness, paralysis, and respiratory failure.

Risk factors

Organophosphate poisoning can occur via oral, cutaneous, or inhalational routes.  Potential sources include the following:

  • Occupational exposure:  farmers, pesticide applicators, and agricultural workers
  • Accidental ingestion:  particularly children who gain inadvertent access to pesticides
  • Intentional ingestion:  suicide attempts, especially in agricultural communities
  • Chemical warfare (eg, sarin, soman):  used for military and terrorist attacks; colorless, tasteless, and often with a slight fruity odor

Common organophosphate-based insecticides include parathion, malathion, and diazinon.

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