The timing and onset of symptoms in individuals with organophosphate poisoning depend on the dose, duration, and route of exposure of the specific toxic substance [1]. Children typically present with seizure and coma while adults are more likely to manifest with muscarinic or nicotinic effects [2]. The acute clinical picture traditionally features salivation, lacrimation, urination, defecation, gastric cramps, and emesis (SLUDGE).

Among the wide spectrum of CNS symptoms, patients may experience seizures, various types of paralysis, cranial nerve palsies, and muscle weakness [3] as well as muscle twitching and cramping. Neuropsychiatric symptoms include fatigue, anxiety, irritability, confusion, lethargy, cognitive impairment, loss of consciousness, and possibly coma [3].

Patients are very likely to develop respiratory manifestations such as wheezing, increased bronchial secretions, bronchospasm, bronchial narrowing, and respiratory depression [4]. They are also at risk for cardiovascular effects such as bradycardia, tachycardia, hypertension, hypotension, and arrhythmia [5].

Possible long-term outcomes include confusion, memory loss, and post-traumatic stress disorder [6] [7].

The leading causes of death are respiratory paralysis and cardiac arrest [8] [9].

Physical exam

The vital signs will be notable for abnormal heart rate and/or rhythm as well as blood pressure extremes. Additionally, mental status changes will be apparent. Patients may exhibit pinpoint pupils, slurred speech, gait ataxia, and a broad range of neurologic, respiratory, and behavioral symptoms.

• Fatigue

  Neuropsychiatric symptoms include fatigue, anxiety, irritability, confusion, lethargy, cognitive impairment, loss of consciousness, and possibly coma. [symptoma.com]

  Children may experience different symptoms including, fatigue, seizures, constricted pupils, excessive salivation, muscle weakness, and coma. Malathion can be dangerous to your health in large enough doses. Image by Benjah-bmm27 Malathion vs. [decodedscience.org]

  Victims may also have symptoms of anemia, including fatigue. If poisoning is severe, the victim may progress to shock and death. Zinc phosphide Poisonings by ingested zinc phosphide are extremely difficult to manage. [extension.missouri.edu]

  CNS effects such as confusion, fatigue, irritability, nervousness, and impairment of memory can occasionally last for several weeks. There is no evidence that malathion induces delayed neurotoxicity. [wwwn.cdc.gov]

• Unconsciousness

  Report of a Case An unconscious 17-year-old boy was brought to the hospital at midnight from a nearby settlement with an accompanying note from a physician stating that the boy had drunk an insecticide (a 2% solution of chlordane in kerosene [Flit]). [jamanetwork.com]

  Do not induce vomiting if the victim is unconscious, because the victim could choke. First aid for some swallowed pesticides includes giving activated charcoal after vomiting. [extension.missouri.edu]

• Intravenous Administration

  The traditional treatment has included oxygen, ventilatory support, and intravenous administration of atropine. [ncbi.nlm.nih.gov]

• Fever

  […] doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect: Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever [drugs.com]

• Asymptomatic

  Symptomatic and asymptomatic patients suspected of significant exposure should have determinations of plasma and red blood cell (RBC) cholinesterase activity. [wwwn.cdc.gov]

• Cough

  Early symptoms of exposure include nose, eye and throat irritation, weakness, nausea, vomiting, difficult breathing, cough, restlessness, muscle twitching and seizures. [extension.missouri.edu]

  Tell your doctor about the allergy and what signs you had, like rash; hives ; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs. [drugs.com]

  Print this handout only.pdf icon[PDF - 23.5 KB] [ ] Call your doctor or the Emergency Department if you develop any unusual signs or symptoms within the next 24 hours, especially: irritability, confusion, or fatigue coughing, wheezing, or shortness of [wwwn.cdc.gov]

• Diarrhea

  Consumers complained about having food poisoning symptoms, like diarrhea, vomiting and stomach aches after eating packaged frozen croquettes, frozen chicken teriyaki with mayonnaise, or pizza. [rt.com]

  Symptoms of the poisoning include vomiting and diarrhea, and customers complained of a strong odor from the foods. According to Maruha Nichiro, none of the contaminated products has been shipped to other countries. [foodsafetynews.com]

  Indications: Organophosphate Poisoning (i.e. parathion, malathion, rid-a-bug) and carbamate (Baygon, sevin, and many common roach and ant sprays) Poisoning Signs “SLUDGE” Salivation Lacrimation Urination Defecation GI hypermotility (Emesis, diarrhea) [orangecountyfl.net]

  Malathion can cause nausea, vomiting, stomach cramps, and diarrhea, as well as confusion, blurred vision, sweating, muscle twitching, irregular heartbeat, convulsions, and death. [wwwn.cdc.gov]

  Slow heart rate In some cases, heart rate may be rapid Weakness NERVOUS SYSTEM Agitation Anxiety Coma Confusion Convulsions Dizziness Headache Muscle twitching SKIN Blue lips and fingernails Sweating STOMACH AND GASTROINTESTINAL TRACT Abdominal cramps Diarrhea [medlineplus.gov]

• Vomiting

  Do not induce vomiting if the victim is unconscious, because the victim could choke. First aid for some swallowed pesticides includes giving activated charcoal after vomiting. [extension.missouri.edu]

  Consumers complained about having food poisoning symptoms, like diarrhea, vomiting and stomach aches after eating packaged frozen croquettes, frozen chicken teriyaki with mayonnaise, or pizza. [rt.com]

  Symptoms of the poisoning include vomiting and diarrhea, and customers complained of a strong odor from the foods. According to Maruha Nichiro, none of the contaminated products has been shipped to other countries. [foodsafetynews.com]

  Malathion can cause nausea, vomiting, stomach cramps, and diarrhea, as well as confusion, blurred vision, sweating, muscle twitching, irregular heartbeat, convulsions, and death. [wwwn.cdc.gov]

  […] rate may be rapid Weakness NERVOUS SYSTEM Agitation Anxiety Coma Confusion Convulsions Dizziness Headache Muscle twitching SKIN Blue lips and fingernails Sweating STOMACH AND GASTROINTESTINAL TRACT Abdominal cramps Diarrhea Loss of appetite Nausea and vomiting [medlineplus.gov]

• Nausea

  Malathion can cause nausea, vomiting, stomach cramps, and diarrhea, as well as confusion, blurred vision, sweating, muscle twitching, irregular heartbeat, convulsions, and death. [wwwn.cdc.gov]

  If ingested, boric acid can cause nausea, persistent vomiting, abdominal pain and diarrhea. [extension.missouri.edu]

  […] cases, heart rate may be rapid Weakness NERVOUS SYSTEM Agitation Anxiety Coma Confusion Convulsions Dizziness Headache Muscle twitching SKIN Blue lips and fingernails Sweating STOMACH AND GASTROINTESTINAL TRACT Abdominal cramps Diarrhea Loss of appetite Nausea [medlineplus.gov]

  Malathion Poisoning According to Oregon State University’s National Pesticide Information Center, people who are exposed to a high enough level of malathion can experience nausea, vomiting, muscle tremors, cramps, weakness, abdominal pain, and diarrhea [decodedscience.org]

  The signs and symptoms of Malathion Poisoning may include: Breathing difficulties; chest pain or tightness Headache, increased tearing from the eyes Sweating Increased salivation in the mouth Nausea, vomiting; diarrhea Stomach or abdominal pain (cramping [dovemed.com]

• Abdominal Pain

  Haug Browse recently published Learning/CME Learning/CME View all learning/CME CME Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis Case 4-2019: An 18-Year-Old Man with Abdominal Pain and Hematochezia Bridging the Gap Challenge Yourself [nejm.org]

  Malathion Poisoning According to Oregon State University’s National Pesticide Information Center, people who are exposed to a high enough level of malathion can experience nausea, vomiting, muscle tremors, cramps, weakness, abdominal pain, and diarrhea [decodedscience.org]

  The signs and symptoms of Malathion Poisoning may include: Breathing difficulties; chest pain or tightness Headache, increased tearing from the eyes Sweating Increased salivation in the mouth Nausea, vomiting; diarrhea Stomach or abdominal pain (cramping [dovemed.com]

  All sixty developed nausea, vomiting and abdominal pain over the next three hours. They were taken to a local primary healthcare center where they received treatment for their symptoms (intravenous fluids, antiemetics and antibiotics). [panna.org]

  She was found fallen in her room and complain of severe abdominal pain, salivation, lacrimation and diarrhea a few hours after the ingestion of the insecticide. [omicsonline.org]

• Hypersalivation

  In addition, the heart rate increased and hypersalivation was improved after the initiation of HDF. For aspiration-related pneumonia, sulbactam/ampicillin was used. [jintensivecare.biomedcentral.com]

• Muscle Weakness

  Among the wide spectrum of CNS symptoms, patients may experience seizures, various types of paralysis, cranial nerve palsies, and muscle weakness as well as muscle twitching and cramping. [symptoma.com]

  Four days later she developed numbness from her groin to her bust, muscle weakness, tingling down her arms, and aching in her chest. [getipm.com]

  Peripheral Neurologic Peripheral neurologic effects include muscle twitching and weakness due to inhibition of acetylcholinesterase at neuromuscular junctions. [wwwn.cdc.gov]

  Children may experience different symptoms including, fatigue, seizures, constricted pupils, excessive salivation, muscle weakness, and coma. Malathion can be dangerous to your health in large enough doses. Image by Benjah-bmm27 Malathion vs. [decodedscience.org]

  Nicotinic effects Skeletal muscle initially exhibits fasciculation (involuntary irregular, violent muscle contractions) followed by the inability to repolarize cell membranes resulting in weakness and paralysis. [openanesthesia.org]

• Muscle Twitch

  Among the wide spectrum of CNS symptoms, patients may experience seizures, various types of paralysis, cranial nerve palsies, and muscle weakness as well as muscle twitching and cramping. [symptoma.com]

  twitching SKIN Blue lips and fingernails Sweating STOMACH AND GASTROINTESTINAL TRACT Abdominal cramps Diarrhea Loss of appetite Nausea and vomiting Call the poison control center for treatment information. [medlineplus.gov]

  There can be many symptoms, though they may not be as clear-cut in children as they are in adults: blurred vision; tearing and sweating; loss of bowel and bladder control; difficulty breathing, as the airway may fill with fluid; tremors, muscle twitching [poison.org]

  Peripheral Neurologic Peripheral neurologic effects include muscle twitching and weakness due to inhibition of acetylcholinesterase at neuromuscular junctions. [wwwn.cdc.gov]

  Early symptoms of exposure include nose, eye and throat irritation, weakness, nausea, vomiting, difficult breathing, cough, restlessness, muscle twitching and seizures. [extension.missouri.edu]

• Lacrimation

  Some foamy secretion was present at the mouth, but there was no sweating or lacrimation, and no fasciculations were observed. Respiration was labored, and wheezing was heard over the chest. His gaze wandered, and the pupils were pinpoint. [jamanetwork.com]

  The acute clinical picture traditionally features salivation, lacrimation, urination, defecation, gastric cramps, and emesis (SLUDGE). [symptoma.com]

  Indications: Organophosphate Poisoning (i.e. parathion, malathion, rid-a-bug) and carbamate (Baygon, sevin, and many common roach and ant sprays) Poisoning Signs “SLUDGE” Salivation Lacrimation Urination Defecation GI hypermotility (Emesis, diarrhea) [orangecountyfl.net]

  Signs and Symptoms Muscarinic signs (SLUDGE) salivation, lacrimation, urination, diaphoresis, gastrointestinal upset, emesis and progressing to bronchospasm, bronchorrhea, blurred vision, bradycardia or tachycardia, hypotension, confusion, and shock. [openanesthesia.org]

  She was found fallen in her room and complain of severe abdominal pain, salivation, lacrimation and diarrhea a few hours after the ingestion of the insecticide. [omicsonline.org]

• Blurred Vision

  Signs and Symptoms Muscarinic signs (SLUDGE) salivation, lacrimation, urination, diaphoresis, gastrointestinal upset, emesis and progressing to bronchospasm, bronchorrhea, blurred vision, bradycardia or tachycardia, hypotension, confusion, and shock. [openanesthesia.org]

  Malathion can cause nausea, vomiting, stomach cramps, and diarrhea, as well as confusion, blurred vision, sweating, muscle twitching, irregular heartbeat, convulsions, and death. [wwwn.cdc.gov]

  There can be many symptoms, though they may not be as clear-cut in children as they are in adults: blurred vision; tearing and sweating; loss of bowel and bladder control; difficulty breathing, as the airway may fill with fluid; tremors, muscle twitching [poison.org]

• Headache

  Small pupils In some cases, pupils may be dilated and do not react to light HEART AND BLOOD Low or high blood pressure Slow heart rate In some cases, heart rate may be rapid Weakness NERVOUS SYSTEM Agitation Anxiety Coma Confusion Convulsions Dizziness Headache [medlineplus.gov]

  The signs and symptoms of Malathion Poisoning may include: Breathing difficulties; chest pain or tightness Headache, increased tearing from the eyes Sweating Increased salivation in the mouth Nausea, vomiting; diarrhea Stomach or abdominal pain (cramping [dovemed.com]

  The most commonly reported early symptoms include headache, nausea, dizziness, and increased secretions, such as sweating, salivation, tearing and respiratory secretions. [extension.missouri.edu]

  At low-dose exposures the symptoms include dizziness, headaches, loss of coordination, lack of balance, all of which have to do with inability of the brain or the cells in the brain to have a defined message because of the inhibition or cholinesterase [members.tripod.com]

• Hyperactivity

  Also, Lambert allocated disturbances of the rhythm of pancreatic origin in two phenomena: the association of an increase in the blood rates of enzymes proteolysis, and a hyperactivity of vagus nerve [ 16 ]. [jintensivecare.biomedcentral.com]

When evaluating a patient with clinical features suspicious for organophosphate poisoning, the medical team should assess and manage the patient urgently. The clinicians must inquire about the exposure route and the amount of malathion while also obtaining the history and conducting the physical exam. The diagnosis is mainly clinical but malathion poisoning is confirmed through the appropriate studies.

Laboratory tests

The definitive diagnostic tool is the measurement of cholinesterase activity. There are two types of assays, butyrylcholinesterase (also referred to as plasma cholinesterase and pseudocholinesterase) and red blood cell (RBC) acetylcholinesterase [10]. The activity of the former does not correlate to the clinical severity [10]. However, RBC acetylcholinesterase is likely a good indicator of the severity [11].

A comprehensive workup will also include a complete blood count (CBC) and complete metabolic panel (CMP), which would reveal leukocytosis, hypokalemia, hypomagnesemia, hyperglycemia [12], increased liver function tests (LFTs), and elevated amylase [1]. Furthermore, an arterial blood gas (ABG) is crucial; this will demonstrate respiratory and/or metabolic acidosis. Additionally, myocardial enzymes will show elevated troponin [13].

Imaging

The clinical manifestations will reflect which imaging modalities should be performed. For example, respiratory symptoms are investigated with a chest x-ray, which displays pulmonary edema in affected patients.

Other

Since cardiac involvement is common, an electrocardiogram (EKG) is an essential study. Abnormalities may include ST segment changes [13], inverted T waves, torsade de points and ventricular fibrillation [14]. Sinus tachycardia is a frequent finding initially, but this transforms to sinus bradycardia as the toxicity progresses.

The prognosis of Malathion Poisoning is dependent on the amount of substance consumed, time between consumption and treatment, severity of the symptoms, as well as general health status of the patient If the individual can recover from the symptoms within [dovemed.com]

Methomyl-induced severe acute pancreatitis: possible etiological association. JOP. 2005;6(2):166–71. PubMed Google Scholar Lambert H. Electrocardiographic changes in acute pancreatitis. Cardiologia. 1966;48(4):387–90. [jintensivecare.biomedcentral.com]

Describes everything you need to know about Organophosphates and Carbamates Extensively covers pesticides, nerve agents, therapeutic drugs, and flame retardants Describes epidemiology of the world's major disasters involving Organophosphates and Carbamates [books.google.ro]

Although most patients rapidly become symptomatic, the onset and severity of symptoms depend on the specific compound, amount, route of exposure, and rate of metabolic degradation. [5] Epidemiology Frequency United States In 2016, the American Association [emedicine.medscape.com]

These have included difficulties in executive functions, psychomotor speed, verbal, memory, attention, processing speed, visual-spatial functioning, and coordination. [4] Pathophysiology The primary mechanism of action of organophosphate pesticides is [emedicine.medscape.com]

The technology to prevent bee kills exists, but cooperation between the farmer and beekeeper is necessary to prevent damage from pesticides. [www1.agric.gov.ab.ca]

You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week. Take the container with you to the hospital, if possible. [medlineplus.gov]

Benzyl Alcohol: Sold under the name Ulesfia, this product will smother the adult lice by preventing them from shutting down their spiracles. Direct contact with each bug for a minimum of 10 minutes is required. [theliceplace.com]

Antidotes should be administered as prevention even if the diagnosis is in doubt. [wwwn.cdc.gov]

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14. Ludomirsky A, Klein HO, Sarelli P, et al. Q-T prolongation and polymorphous ("torsade de pointes") ventricular arrhythmias associated with organophosphorus insecticide poisoning. Am J Cardiol. 1982;49(7):1654-8.