Management of poisoning due to organophosphorus compounds

Acute poisonings due to organophosphorus (OP) compounds often present as medical emergencies, which require management in intensive care. There is urgent need for resuscitation, support or correction of function of vital organs (correction of arrhythmias, provision of ventilatory care), decontamination and antidotes. The muscarinic effects of excess acetylcholine consequent to the inactivation of the acetylcholinesterase are countered by atropine and/or glycopyrrolate therapy, whilst the antidote for the nicotinic effects are the oximes. Wide-ranging dysfunction may follow poisoning with disturbances in metabolism, temperature and the central nervous system (agitation, convulsions, extrapyramidal and psychological effects), along with pancreatitis and vocal cord paralysis, thus necessitating continuous monitoring and awareness. Despite the use of the traditional therapeutic regimes of atropine and oximes, the morbidity and mortality associated with OP poisoning has not decreased despite major advances in critical care. The need to develop more effective regimes has to be recognized and collaborative work between technologically advanced countries where the incidence of poisoning is low and developing countries where poisoning is very common, is probably the only way forward.