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Organophosphate Toxicity 





  • Life threatening emergency situation 

  • Multisystem failure: 

    • Respiratory: weakness & respiratory failure, bronchospasm, hypoxemia

    • Cardiovascular: hemodynamic instability

    • CNS: seizures, ↓ LOC

  • Decontamination/exposure to medical personnel





  • Intubation & ventilation as appropriate

  • Consult toxicology, ICU

  • Atropine 2-5 mg IV (often need 15-20 mg) until ↓ secretions & adequate tidal volumes

  • Pralidoxime 1000-2000 mg IV, then 1000mg q12h, DO NOT give pralidoxime without atropine 

  • Benzodiazepines for seizures, phenytoin ineffective

  • Paralysis for airway management:

    • Note: succinylcholine may result in prolonged paralysis due to inhibition of acetylcholinesterase by these compounds 

    • ↑ doses of rocuronium may be needed due to competitive inhibition at the neuromuscular junction 

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