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Pediatric Organophosphates Toxicity Follow-up

  • Author: William Freudenthal, MD; Chief Editor: Timothy E Corden, MD  more...
Updated: Sep 07, 2015

Further Outpatient Care

Patients with minor or no symptoms of toxicity after organophosphate exposure may be discharged from the emergency department after 6 hours of observation. Discharged patients usually do not require outpatient medications.


Further Inpatient Care

See the list below:

  • Admit patients to the hospital if they require therapy with anticholinergenic agents or 2-PAM. Monitoring, respiratory support, and ventilation may be needed.
  • Consult poison control center personnel for information regarding the specific agent, the length of inpatient treatment, and the duration of likely toxicity.


See the list below:

  • Transfer pediatric patients with severe life-threatening exposures to a facility with a pediatric intensivist and intensive care unit.
  • Patients should be clinically stable before their transfer.


Parents sould be educate regarding the following:

  • Use of safety lids on accessible containers of pesticides
  • Proper storage of chemicals in the home

On a societal level, legislation regarding the sale and storage of dangerous chemicals can be effective in reducing organophosphate poisoning.



Intermediate syndrome can develop 24-96 hours after exposure.[16] A combination of presynaptic and postsynaptic impairment of neuromuscular transmission probably causes the syndrome. Features of intermediate syndrome as as follows:

  • The syndrome tends to occur in patients with prolonged exposure before treatment.
  • The syndrome is characterized by weakness in the motor cranial nerves, proximal limb muscles, neck flexors, and respiratory muscles.
  • A delayed peripheral neuropathy may develop days to weeks after the exposure.
  • Patients may also have persistent CNS effects, weakness, lethargy, fatigue, and memory impairment.[17]

Shahar et al reported extrapyramidal parkinsonism as a complication of acute organophosphate poisoning.[18, 19] Symptoms developed 5 days after exposure and completely resolved after treatment with amantadine



See the list below:

  • The prognosis for patients treated early is excellent; most patients fully recover in 7-10 days.
  • Patients with toxicity untreated for more than 24 hours may have a prolonged and severe course with lasting neurologic complications.[20]
Contributor Information and Disclosures

William Freudenthal, MD Staff Physician, Department of Emergency Medicine, St. Vincent Hospital Indianapolis, IN

William Freudenthal, MD is a member of the following medical societies: American College of Emergency Physicians, Association of Military Surgeons of the US

Disclosure: Nothing to disclose.


Mark E Ralston, MD, MPH Staff Pediatrician, Naval Hospital Oak Harbor; Assistant Professor of Pediatrics, F Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences

Mark E Ralston, MD, MPH is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Jeffrey R Tucker, MD Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut School of Medicine, Connecticut Children's Medical Center

Disclosure: Received salary from Merck for employment.

Chief Editor

Timothy E Corden, MD Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin

Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, Wisconsin Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

Michael E Mullins, MD Assistant Professor, Division of Emergency Medicine, Washington University in St Louis School of Medicine; Attending Physician, Emergency Department, Barnes-Jewish Hospital

Michael E Mullins, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians

Disclosure: Received stock ownership from Johnson & Johnson for none; Received stock ownership from Savient Pharmaceuticals for none.

  1. Bryant S, Singer J. Management of toxic exposure in children. Emerg Med Clin North Am. 2003 Feb. 21(1):101-19. [Medline].

  2. Sadaka Y, Broides A, Tzion RL, Lifshitz M. Organophosphate acetylcholine esterase inhibitor poisoning from a home-made shampoo. J Emerg Trauma Shock. 2011 Jul. 4(3):433-4. [Medline]. [Full Text].

  3. van Heel W, Hachimi-Idrissi S. Accidental organophosphate insecticide intoxication in children: a reminder. Int J Emerg Med. 2011 Jun 15. 4(1):32. [Medline]. [Full Text].

  4. Sexton K, Ryan AD, Adgate JL, Barr DB, Needham LL. Biomarker measurements of concurrent exposure to multiple environmental chemicals and chemical classes in children. J Toxicol Environ Health A. 2011 Jan. 74(14):927-42. [Medline].

  5. Lawrence DT, Kirk MA. Chemical terrorism attacks: update on antidotes. Emerg Med Clin North Am. 2007 May. 25(2):567-95; abstract xi. [Medline].

  6. Mowry JB, Spyker DA, Cantilena LR Jr, McMillan N, Ford M. 2013 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 31st Annual Report. Clin Toxicol (Phila). 2014 Dec. 52 (10):1032-283. [Medline]. [Full Text].

  7. Barthold CL, Schier JG. Organic phosphorus compounds--nerve agents. Crit Care Clin. 2005 Oct. 21(4):673-89, v-vi. [Medline].

  8. Zwiener RJ, Ginsburg CM. Organophosphate and carbamate poisoning in infants and children [published erratum appears in Pediatrics 1988 May;81(5):683]. Pediatrics. 1988 Jan. 81(1):121-6. [Medline].

  9. Lifshitz M, Shahak E, Sofer S. Carbamate and organophosphate poisoning in young children. Pediatr Emerg Care. 1999 Apr. 15(2):102-3. [Medline].

  10. Lima JS, Reis CA. Poisoning due to illegal use of carbamates as a rodenticide in Rio de Janeiro. J Toxicol Clin Toxicol. 1995. 33(6):687-90. [Medline].

  11. Sofer S, Tal A, Shahak E. Carbamate and organophosphate poisoning in early childhood. Pediatr Emerg Care. 1989 Dec. 5(4):222-5. [Medline].

  12. Mortensen ML. Management of acute childhood poisonings caused by selected insecticides and herbicides. Pediatr Clin North Am. 1986 Apr. 33(2):421-45. [Medline].

  13. Burillo-Putze G, Hoffman RS, Howland MA, Duenas-Laita A. Late administration of pralidoxime in organophosphate (fenitrothion) poisoning. Am J Emerg Med. 2004 Jul. 22(4):327-8. [Medline].

  14. Reddy SD, Reddy DS. Midazolam as an anticonvulsant antidote for organophosphate intoxication--A pharmacotherapeutic appraisal. Epilepsia. 2015 Jun. 56 (6):813-21. [Medline].

  15. Yesilbas O, Kihtir HS, Altiti M, Petmezci MT, Balkaya S, Bursal Duramaz B, et al. Acute severe organophosphate poisoning in a child who was successfully treated with therapeutic plasma exchange, high-volume hemodiafiltration, and lipid infusion. J Clin Apher. 2015 Aug 14. [Medline].

  16. De Bleecker JL. The intermediate syndrome in organophosphate poisoning: an overview of experimental and clinical observations. J Toxicol Clin Toxicol. 1995. 33(6):683-6. [Medline].

  17. Horton MK, Kahn LG, Perera F, Barr DB, Rauh V. Does the home environment and the sex of the child modify the adverse effects of prenatal exposure to chlorpyrifos on child working memory?. Neurotoxicol Teratol. 2012 Sep-Oct. 34(5):534-41. [Medline].

  18. Shahar E, Bentur Y, Bar-Joseph G, et al. Extrapyramidal parkinsonism complicating acute organophosphate insecticide poisoning. Pediatr Neurol. 2005 Nov. 33(5):378-82.

  19. Shahar E, Bentur Y, Bar-Joseph G, Cahana A, Hershman E. Extrapyramidal parkinsonism complicating acute organophosphate insecticide poisoning. Pediatr Neurol. 2005 Nov. 33(5):378-82. [Medline].

  20. Saunders M, Magnanti BL, Correia Carreira S, Yang A, Alamo-Hernández U, Riojas-Rodriguez H, et al. Chlorpyrifos and neurodevelopmental effects: a literature review and expert elicitation on research and policy. Environ Health. 2012 Jun 28. 11 Suppl 1:S5. [Medline]. [Full Text].

  21. Brahmi N, Mokline A, Kouraichi N, Ghorbel H, Blel Y, Thabet H. Prognostic value of human erythrocyte acetyl cholinesterase in acute organophosphate poisoning. Am J Emerg Med. 2006 Nov. 24(7):822-7. [Medline].

  22. Ellenhorn MJ. Organophosphates. Ellenhorn's Medical Toxicology: Diagnosis and Treatment of Human Poisoning. 2nd ed. Baltimore, MD: Lippincott, Williams and Wilkins; 1997. 1614-21.

  23. Karr CJ, Solomon GM, Brock-Utne AC. Health effects of common home, lawn, and garden pesticides. Pediatr Clin North Am. 2007 Feb. 54(1):63-80, viii. [Medline].

  24. Kovacic P. Mechanism of organophosphates (nerve gases and pesticides) and antidotes: electron transfer and oxidative stress. Curr Med Chem. 2003 Dec. 10(24):2705-9. [Medline].

  25. Kozer E, Mordel A, Haim SB, Bulkowstein M, Berkovitch M, Bentur Y. Pediatric poisoning from trimedoxime (TMB4) and atropine automatic injectors. J Pediatr. 2005 Jan. 146(1):41-4. [Medline].

  26. Litovitz TL, Klein-Schwartz W, Caravati EM, et al. 1998 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. 1999 Sep. 17(5):435-87. [Medline].

  27. O'Malley M. Clinical evaluation of pesticide exposure and poisonings. Lancet. 1997 Apr 19. 349(9059):1161-6. [Medline].

  28. Peter JV, Moran JL, Graham P. Oxime therapy and outcomes in human organophosphate poisoning: an evaluation using meta-analytic techniques. Crit Care Med. 2006 Feb. 34(2):502-10. [Medline].

  29. Schexnayder S, James LP, Kearns GL, Farrar HC. The pharmacokinetics of continuous infusion pralidoxime in children with organophosphate poisoning. J Toxicol Clin Toxicol. 1998. 36(6):549-55. [Medline].

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