Organophosphates Treatment & Management

  • Author: Frances M Dyro, MD; Chief Editor: Stephen A Berman, MD, PhD, MBA   more...
 
Updated: Jan 23, 2012
 

Medical Care

The patient exposed to organophosphates often arrives at the hospital with cutaneous contamination. The clothing should be removed and discarded. All traces of residue must be removed by careful washing with alkaline soap or bleach solution.

  • Laboratory studies should be drawn and a baseline ECG done.
  • Patients who have had a high level of exposure and are obtunded should be intubated; those having seizures or severe spasms should be given diazepam.
  • Volume depletion may be a problem if the patient is having diarrhea. Intravenous infusion with 5% dextrose in water should be started.
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Surgical Care

Surgical care such as tracheotomy and ventilatory assistance generally is not needed unless toxic effects are severe. In late-onset neuropathy, phrenic nerve function may be compromised and the patient may need ventilatory assistance.

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Consultations

Consultation should be sought from pulmonary medicine, neurology, and if possible, psychiatry. An agitated patient requiring intubation in the acute phase of treatment can be difficult to control because sedatives may worsen the condition.

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Diet

  • Feeding the patient should be avoided until the patient's condition is stabilized.
  • During acute intoxication, vomiting, diarrhea, and involuntary urination may occur.
  • The patient should be hydrated intravenously.
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Activity

  • Patients in the acute phase of organophosphate toxicity may be agitated and should be kept in a quiet environment. As weakness and respiratory difficulties resolve, normal physical activity can resume.
  • The patient should be monitored closely during the first 24-48 hours.
  • The patient may respond initially to therapy and then become confused or agitated, requiring repeat doses of medication.
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Contributor Information and Disclosures
Author

Frances M Dyro, MD  Associate Professor of Neurology, New York Medical College; Neuromuscular Section, Department of Neurology, Westchester Medical Center

Frances M Dyro, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, and Muscular Dystrophy Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Jonathan S Rutchik, MD, MPH  Clinical Professor, Division of Occupational Medicine, Department of Neurology, Environmental and Occupational Medicine, University of California, San Francisco, School of Medicine

Jonathan S Rutchik, MD, MPH is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Occupational and Environmental Medicine, and Society of Toxicology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Neil A Busis, MD  Chief, Division of Neurology, Department of Medicine, Head, Clinical Neurophysiology Laboratory, University of Pittsburgh Medical Center-Shadyside

Neil A Busis, MD is a member of the following medical societies: American Academy of Neurology and American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Selim R Benbadis, MD  Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association

Disclosure: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Honoraria Speaking, consulting

Chief Editor

Stephen A Berman, MD, PhD, MBA  Professor of Neurology, University of Central Florida College of Medicine

Stephen A Berman, MD, PhD, MBA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, and Phi Beta Kappa

Disclosure: Nothing to disclose.

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