History and exam
Key diagnostic factors
common
increased secretions
Severe bronchorrhea may be seen and is diagnostic.
Excessive lacrimation and salivation also occur.
fasciculations
These are much more noticeable early on and are diagnostic. They usually occur in periorbital, chest, or leg muscles, and are not responsive to atropine.
pinpoint pupils
These are almost universally present in severe cases prior to atropine treatment and do not respond to naloxone (an opioid receptor antagonist used in the treatment of opioid overdose).
distinctive odor
Distinctive odor of solvent can often be detected on a patient.
chest crackles and rhonchi
Widespread wheezes and crackles indicate bronchospasm and pulmonary edema.
semiconscious/coma
Patient may be semiconscious at presentation; coma indicates a worse prognosis.
Other diagnostic factors
common
visual disturbances
Patient may report blurred vision.
vomiting
Nausea and vomiting are common muscarinic symptoms of organophosphate poisoning.
influenza-like syndrome
Exposure, even dermal, may result in an influenza-like syndrome (e.g., fatigue, runny nose, headache, dizziness, anorexia, sweating, diarrhea, and muscle weakness).
urinary or fecal incontinence
Patient may report incontinence, or it may be a sign on presentation if a patient is semiconscious or confused.
proximal muscle weakness
This may occur early on, or after other signs are resolving. It is not responsive to atropine.
abnormal deep tendon reflexes
Frequently increased early on, and decreased or absent later. It is not responsive to atropine.
abnormal heart rate
Extreme bradycardia or tachycardia may be seen.
abnormal blood pressure
Hypertension may be seen. Refractory hypotension is a far more concerning sign, indicating a grave prognosis.
decreased respiration
Oxygen saturation is usually low. Respiratory failure is more common with severe poisoning.
hypothermia
Mild to moderate hypothermia is often present on admission if atropine treatment has not been given.
uncommon
seizures
Seizures are more common with severe poisoning.
delayed-onset central nervous system and peripheral (predominantly motor) neuropathy
Onset is 1 to 5 weeks. The neuropathy may be severe and can lead to permanent disability. It may also have upper motor neuron disease features.
Risk factors
strong
pesticide availability
A major factor determining the frequency with which fatal and nonfatal acute pesticide poisoning occurs in various countries.[4]
history of self-harm or recent interpersonal conflict
mental illness
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