Pediatric Organophosphates Toxicity Clinical Presentation

Updated: Apr 15, 2018
  • Author: William Freudenthal, MD; Chief Editor: Stephen L Thornton, MD  more...
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Considerations when taking the history include the following:

  • Most symptoms appear within 12-24 hours of exposure.

  • Exposure can occur by means of ingestion, dermal exposure, or inhalation.

  • Children often ingest home pesticides they find in unmarked or poorly stored containers.

  • Children can also be exposed when playing in areas recently treated with organophosphate compounds.

  • A history of possible exposure combined with physical signs and symptoms consistent with exposure often lead to diagnosis.

  • Many organophosphates can irritate the skin and mucous membranes. Some have a characteristic odor, such as a garliclike smell.



Physical findings vary according to the route of exposure, the age of patient, and the specific chemical. In general, the signs and symptoms of organophosphate poisoning fall into the following three broad categories:

  • Muscarinic
  • Nicotinic
  • Central nervous system (CNS)

Muscarinic findings may include the following [8] :

  • Diaphoresis and diarrhea, urination, miosis, bradycardia, bronchorrhea, bronchospasm, emesis, lacrimation and salivation (DUMBELS)
  • Wheezing and/or bronchoconstriction
  • Pulmonary edema
  • Increased pulmonary and oropharyngeal secretions
  • Sweating
  • Bradycardia
  • Abdominal cramping and intestinal hypermotility
  • Miosis

Nicotinic findings may include the following:

  • Muscle fasciculations (twitching)
  • Fatigue
  • Paralysis
  • Respiratory muscle weakness
  • Diminished respiratory effort
  • Tachycardia
  • Hypertensio

CNS findings may include the following:

  • Anxiety
  • Restlessness
  • Confusion
  • Headache
  • Slurred speech
  • Ataxia
  • Seizures
  • Coma
  • Central respiratory paralysis
  • Altered level of consciousness and/or hypotonia

Children, particularly young children, are more likely to present with altered levels of consciousness than with the classic DUMBELS signs that are most commonly observed in adults. Studies of pediatric organophosphate poisoning have yielded the following results:

  • Lifshitz et al (1999) retrospectively examined 36 children aged 2-8 years who were exposed to organophosphates or carbamates in Israel. [9] The authors observed a decreased level of consciousness, including coma, stupor, and hypotonicity in all children.

  • Zwiener and Ginsburg (1988) retrospectively examined 37 patients aged 1 month to 11 years who had been exposed to insecticides. [10] The most common signs were miosis, excessive salivation, muscle weakness, and lethargy. Approximately 49% of these children presented with tachycardia.

  • Lima and Reis (1995) reported carbamate poisoning in Rio de Janeiro. [11] Symptoms included salivation, lacrimation, urination, defecation, GI distress, and emesis (SLUDGE) and were more commonly observed in adults than in children.

  • Sofer et al (1989) retrospectively examined 25 patients aged 3 months to 7 years with carbamate or organophosphate poisoning in Israel. [12] The most common presenting symptoms were CNS depression, stupor, coma, and flaccidity. The classic SLUDGE symptoms were more likely to be absent in these children.