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organophosphate poisonings is DUMBELS:
D = Defecation/diaphoresis
U = Urination
M = Miosis
B = Bronchospasm/bronchorrhea
E = Emesis
L = Lacrimation
S = Salivation
Eye: Miosis, blurred vision, pin point pupil, red
tears.
Cardiovascular: Bradycardia, hypotension.
Glands: Extreme salivation, lacrimation, sweating.
Symptoms Gastrointestinal: Anorexia, nausea, vomiting,
associated with diarrhea.
Autonomic Respiratory: Bronchoconstriction, bronchial
Nervous System secretion.
Skeletal Muscle: Fasciculations, weakness,
paralysis.
CNS: Ataxia, confusion, convulsions, coma,
paralysis & tremor.
Death
Respiratory depression due to,
Bronchoconstriction.
Increased secretions.
Paralysis of diaphragm & Intercostal
muscles.
Symptoms Central respiratory depression.
associated with Those who survive may also develop the
Autonomic following neuropsychiatric deficits:
Nervous System Confusion
Impairment in memory
Lethargy
Psychosis
Irritability
Parkinson like symptoms
If the patient survives the acute poisoning,
there are other long-term complications.
Intermediate neurologic symptoms typically
occur 24 to 96 hours after exposure.
Symptoms include neck flexions, weakness,
Complications decreased deep tendon reflexes, cranial
nerve abnormalities, proximal muscle
weakness, and respiratory insufficiency.
With supportive care, these patients can have
a complete return to normal neurologic
function within 2 to 3 weeks.
Polyneuropathy is linked to very
specific organophosphate compounds
that contain chlorpyrifos.
Most commonly this starts as stocking-
Complications glove paresthesia and progresses to
symmetric polyneuropathy with flaccid
weakness that starts in the lower
extremities and progresses to include
the upper extremities.
Grading Severity of AchE Poisoning
Normal AChE
levels:
8-18 units/L
Diagnosis of acute or chronic organophosphate
poisoning is strictly clinical.
You must have a high clinical suspicion for OP when
no history of exposure or ingestion is known.
If OP is on the differential but not confirmed, a trial
of atropine may be employed.