Podcast 732: Organophosphate Toxicity

<p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Organophosphates affect the cholinergic system by inhibiting acetylcholinesterase affecting muscarinic and nicotinic receptors</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Symptoms include lacrimation, salivation, bronchoconstriction, blurred vision, bradycardia, bronchorrhea, emesis, and diarrhea</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Initially, the patient should be decontaminated to prevent further organophosphate exposure</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Treatment consists of atropine every 5 minutes, 1-3 mg to start and doubling the dose each time it is given until reversal of symptoms is seen</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Atropine only works on muscarinic receptors, so nicotinic receptor activation continues despite atropine administration resulting in muscle contractions and eventually respiratory arrest</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Pralidoxime (2-PAM) should also be given to prevent the nicotinic effects and maturation of the organophosphate-acetylcholinesterase complex</span></li> </ul> <p><strong>References</strong></p> <p><span style="font-weight: 400;">Robb EL, Baker MB. Organophosphate Toxicity. [Updated 2021 Jul 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470430/</span></p> <p><em><span style="font-weight: 400;">Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD</span></em></p> <p><em><span style= "font-weight: 400;">*********************</span></em></p> <p><span style="font-weight: 400;">The Emergency Medical Minute is excited to announce that we are now offering</span> <em><span style="font-weig