Do You Know the Dangers of Organophosphates and Carbamates?

Organophosphates and Carbamates: Insecticides and Causes of Poisoning

• Organophosphates and carbamates are insecticides that inhibit cholinesterase activity, causing acute muscarinic manifestations.
• Muscarinic symptoms include salivation, lacrimation, urination, diarrhea, emesis, bronchorrhea, bronchospasm, bradycardia, miosis, and sometimes nicotinic symptoms such as muscle fasciculation and weakness.
• Neuropathy can develop days to weeks after exposure, and diagnosis is made through clinical observation and sometimes a trial of atropine or measurement of red blood cell acetylcholinesterase level.
• Bronchorrhea and bronchospasm are treated with titrated high-dose atropine, while neuromuscular toxicity is treated with IV pralidoxime.
• Organophosphates and carbamates both inhibit cholinesterase activity, and some are used medically for various conditions including neuromuscular blockade reversal, glaucoma, myasthenia gravis, and Alzheimer's disease.
• Some organophosphates were developed as nerve agents for use in warfare, including sarin.
• Commonly used organophosphates and carbamates as insecticides include Aldicarb, methomyl, Chlorpyrifos, diazinon, dursban, fenthion, malathion, and parathion.
• These chemicals are a common cause of poisoning and poison-related deaths worldwide.
• Organophosphates and carbamates are absorbed through the gastrointestinal tract, lungs, and skin, and can irreversibly bind to cholinesterase.
• Symptoms of acute poisoning include both muscarinic and nicotinic cholinergic symptoms, with muscle fasciculations and weakness being typical and respiratory findings including rhonchi, wheezing, and hypoxia.
• Central nervous system toxicity is common, sometimes with seizures and excitability and often with lethargy and coma.
• Long-term effects of organophosphate poisoning may include cognitive deficits or parkinsonism, and supportive therapy is key in treatment, with close monitoring for respiratory failure.