Organophosphates Treatment & Management

Updated: Nov 29, 2016
  • Author: Frances M Dyro, MD; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Treatment

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

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.
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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.
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