Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • increased secretions
  • fasciculations
  • pinpoint pupils
  • distinctive odor
  • chest crackles and rhonchi
  • semiconscious/coma

Other diagnostic factors

  • visual disturbances
  • vomiting
  • influenza-like syndrome
  • urinary or fecal incontinence
  • proximal muscle weakness
  • abnormal deep tendon reflexes
  • abnormal heart rate
  • abnormal BP
  • decreased respiration
  • hypothermia
  • seizures
  • delayed-onset CNS and peripheral (predominantly motor) neuropathy

Risk factors

  • pesticide availability
  • history of self-harm or recent interpersonal conflict
  • mental illness
  • alcohol or drug abuse

Diagnostic investigations

1st investigations to order

  • atropine therapeutic trial
  • plasma cholinesterase
  • RBC cholinesterase
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Professor of Clinical Pharmacology

Pharmacology Department

Sydney Medical School

University of Sydney

Sydney

New South Wales

Australia

Disclosures

NB declares that he has no competing interests.

Peer reviewers VIEW ALL

Assistant Professor of Emergency Medicine

Division of Medical Toxicology

University of Massachusetts Medical School

North Worcester

MA

Disclosures

SBB declares that he has no competing interests.

Program Director

Medical Toxicology

Regional Poison Center

Children's Hospital of Michigan

Detroit

MI

Disclosures

CKA holds stock in Merck Pharmaceuticals and is a paid consultant for ToxEd. She was briefly a paid consultant for Lexi-Comp.

Professor Medical Director

San Francisco Division

California Poison Control System

San Francisco

CA

Disclosures

KRO declares that he has no competing interests.

Consultant Physician and Clinical Toxicologist

National Poisons Information Service (Newcastle)

Newcastle-upon-Tyne

UK

Disclosures

RT declares that he has no competing interests.

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