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.

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.

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.

Diet

See the list below:

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.

Activity

See the list below:

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.

Medication

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Author

Frances M Dyro, MD Associate Professor of Neurology, New York Medical College; (Retired) Physician, 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

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Neil A Busis, MD Chief of Neurology and Director of Neurodiagnostic Laboratory, UPMC Shadyside; Clinical Professor of Neurology and Director of Community Neurology, Department of Neurology, University of Pittsburgh Physicians

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

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: American Academy of Neurology<br/>Serve(d) as a speaker or a member of a speakers bureau for: American Academy of Neurology<br/>Received income in an amount equal to or greater than $250 from: American Academy of Neurology.

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, Phi Beta Kappa

Disclosure: Nothing to disclose.

Additional Contributors

Jonathan S Rutchik, MD, MPH, FACOEM Associate Clinical Professor, Division of Occupational Medicine, Department of Medicine, University of California, San Francisco, School of Medicine; Neurology, Environmental and Occupational Medicine Associates (www.neoma.com)

Jonathan S Rutchik, MD, MPH, FACOEM 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, International Parkinson and Movement Disorder Society, Society of Toxicology, Western Occupational and Environmental Medical Association

Disclosure: Nothing to disclose.