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Toxicity, Organic Phosphorous Compounds and Carbamates: Differential Diagnoses & Workup

Author: Daniel K Nishijima, MD, Staff Physician, Department of Emergency Medicine, University of California Davis Medical Center
Coauthor(s): Sage W Wiener, MD, Assistant Professor, Department of Emergency Medicine, State University of New York Downstate, Director of Medical Toxicology, Department of Emergency Medicine, Kings County Hospital Center
Contributor Information and Disclosures

Updated: Sep 14, 2009

Differential Diagnoses

Acute Respiratory Distress Syndrome
Pediatrics, Gastrointestinal Bleeding
Adrenal Insufficiency and Adrenal Crisis
Pediatrics, Intussusception
Asthma
Pediatrics, Reactive Airway Disease
CBRNE - Biological Warfare Agents
Pediatrics, Respiratory Distress Syndrome
CBRNE - Chemical Warfare Agents
Respiratory Distress Syndrome, Adult
Congestive Heart Failure and Pulmonary Edema
Shock, Cardiogenic
Gastroenteritis
Shock, Septic
Inflammatory Bowel Disease
Toxicity, Mushroom - Gyromitra Toxin
Pediatrics, Bacteremia and Sepsis
Toxicity, Mushrooms
Pediatrics, Dehydration
Toxicity, Phosgene
Pediatrics, Gastroenteritis

Workup

Laboratory Studies

  • The most common tests to determine OPC and carbamate poisoning are measurements of serum cholinesterase and RBC AChE activity, which are used to estimate neuronal AChE activity.
  • Although the RBC AChE test may not be as readily available as the other, it provides a better indicator of neuronal AChE activity than serum AChE.10
  • In many health care centers, neither of these tests are immediately available and therefore are of no assistance in the acute setting or in guiding therapy.
  • Moreover, normal levels of enzyme activity vary widely in populations and in individuals.11 Butyryl-cholinesterase activity may vary after exposure to cocaine, succinylcholine, morphine, and codeine.
  • These tests are most useful for confirming the diagnosis.
  • In the ideal case, the diagnosis is confirmed with a decrease in enzyme activity from baseline (50% for RBC cholinesterase activity), though a baseline, preexposure enzyme level is not available for most patients.

Other Tests

  • ECG may be considered.
  • Many retrospective studies have shown that a prolonged QTc interval is the most common ECG abnormality.12,13
  • Elevation of the ST segment, sinus tachycardia, sinus bradycardia, and complete heart block (rare) may also occur. Sinus tachycardia occurs just as commonly as sinus bradycardia.

More on Toxicity, Organic Phosphorous Compounds and Carbamates

Overview: Toxicity, Organic Phosphorous Compounds and Carbamates
Differential Diagnoses & Workup: Toxicity, Organic Phosphorous Compounds and Carbamates
Treatment & Medication: Toxicity, Organic Phosphorous Compounds and Carbamates
Follow-up: Toxicity, Organic Phosphorous Compounds and Carbamates
References
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References

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Further Reading

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Keywords

pesticide exposure, organic phosphorous compound poisoning, OPC poisoning, carbamate poisoning, pesticide poisoning, pesticides, physostigmine, neostigmine, nerve agent, self-poisoning, toxic ingestion, toxidrome, suicidal ingestion, accidental ingestion, Tokyo subway sarin attack, VX, soman, agricultural exposure, organophosphate toxicity, carbamate toxicity, organophosphate exposure, carbamate exposure, pesticide toxicity

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Contributor Information and Disclosures

Author

Daniel K Nishijima, MD, Staff Physician, Department of Emergency Medicine, University of California Davis Medical Center
Daniel K Nishijima, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Sage W Wiener, MD, Assistant Professor, Department of Emergency Medicine, State University of New York Downstate, Director of Medical Toxicology, Department of Emergency Medicine, Kings County Hospital Center
Sage W Wiener, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American College of Medical Toxicology, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Dana A Stearns, MD, Assistant Director of Undergraduate Education, Department of Emergency Medicine, Massachusetts General Hospital
Dana A Stearns, MD is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians
Disclosure: Nothing to disclose.

Pharmacy Editor

John T VanDeVoort, PharmD, Regional Director of Pharmacy, Sacred Heart & St. Joseph's Hospitals
John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists
Disclosure: Nothing to disclose.

Managing Editor

Fred Harchelroad, MD, FACMT, FAAEM, FACEP, Chair, Department of Emergency Medicine, Director of Medical Toxicology - Allegheny General Hospital, Associate Professor, Department of Emergency Medicine, Drexel University College of Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD, Assistant Professor, Department of Surgery, Section of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital
Disclosure: Nothing to disclose.

 
 
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