Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- increased secretions
- fasciculations
- pinpoint pupils
- distinctive odour
- chest crackles and rhonchi
- semi-conscious/coma
Other diagnostic factors
- visual disturbances
- vomiting
- influenza-like syndrome
- urinary or faecal incontinence
- proximal muscle weakness
- abnormal deep tendon reflexes
- abnormal heart rate
- abnormal BP
- decreased respiration
- hypothermia
- seizures
- delayed-onset central nervous system 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
- red blood cell cholinesterase
Treatment algorithm
Contributors
Authors
Professor of Clinical Pharmacology
Pharmacology Department
Sydney Medical School
University of Sydney
Sydney
New South Wales
Australia
Disclosures
NB is an author of a number of references cited in this topic.
Peer reviewers
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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