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Organophosphate Poisoning and Carbamate Poisoning
Symptoms and Signs
Organophosphates and carbamates cause cholinergic symptoms due to activation of both major cholinergic receptors, which are characterized as muscarinic and nicotinic: Muscarinic cholinergic symptoms: Salivation, lacrimation, urination, defecation, vomiting, pinpoint pupils (miosis), bronchorrhea and wheezing, bradycardia Nicotinic cholinergic symptoms: Mydriasis, tachycardia, weakness and fasciculations, sweating, abdominal pain Of these manifestations, muscle fasciculations and weakness are typical. Respiratory findings include rhonchi, wheezing, and hypoxia, which may be severe. Most patients have bradycardia and, if poisoning is severe, hypotension. Central nervous system toxicity is common, sometimes with seizures and excitability and often with lethargy and coma. Overview of Pancreatitis is possible, and organophosphates may cause Weakness, particularly of proximal, cranial, and respiratory muscles, may develop 1 to 3 days after exposure to organophosphates or rarely carbamates despite treatment (the intermediate syndrome); these symptoms resolve in 2 to 3 weeks. A few organophosphates (eg, chlorpyrifos, triorthocresyl phosphate) may cause an axonal neuropathy that begins 1 to 3 weeks after exposure. The mechanism may be independent of RBC cholinesterase levels, and the risk is independent of the severity of poisoning. Long-term, persistent sequelae of organophosphate poisoning may include cognitive deficits or Secondary and Atypical Parkinsonism . 