Organophosphate poisoning: Of mice and men

Exposures to organophosphate and carbamate compounds acting as acetylcholinesterase inhibitors can present to the emergency department as accidental or intentional poisonings. These can result from exposures to pesticides, prescribed medications, and even chemical nerve agents, also known as war gases. The inhibition of acetylcholinesterase leads to large amounts of acetylcholine that affect both muscarinic and nicotinic receptors resulting in a characteristic toxidrome of salivation, lacrimation, urinary frequency, gastrointestinal (GI) hypermotility, miosis, fasciculations, and muscular paralysis. The muscarinic side effects are typically treated with atropine while the nicotinic side effects are treated with supportive care and often the use of pralidoxime which serves to lyse the bond between the acetylcholinesterase and the acetylcholinesterase inhibitor.