Journal
EMERGENCY MEDICINE CLINICS OF NORTH AMERICA
Volume 33, Issue 1, Pages 133-+Publisher
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1016/j.emc.2014.09.010
Keywords
Organophosphate; Carbamate; Pesticides; Insecticides; Nerve agents; Chemical warfare; Atropine; Oxime
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Organophosphates (OPs) and carbamates have a wide variety of applications, most commonly as pesticides used to eradicate agricultural pests or control populations of disease-carrying vectors. Some OP and carbamates have therapeutic indications such as physostigmine. Certain organophosphorus compounds, known as nerve agents, have been employed in chemical warfare and terrorism incidents. Both classes inhibit acetylcholinesterase (AChE) enzymes, leading to excess acetylcholine accumulation at nerve terminals. In the setting of toxicity from either agent class, clinical syndromes result from excessive nicotinic and muscarinic neurostimulation. The toxic effects from OPs and carbamates differ with respect to reversibility, subacute, and chronic effects. Decontamination, meticulous supportive care, aggressive antimuscarinic therapy, seizure control, and administration of oximes are cornerstones of management.
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