Diagnosis and Therapy for Anticholinesterase Poisoning

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Abstract
A recent communication1stressed that 75% of the systemic poisonings resulting from occupational exposures to agricultural chemicals are due to organophosphorus insecticides, and that 31% to 58% of the people working with pesticides show effects of absorption of these chemicals. Physicians can expect to see more and more victims of organophosphorus insecticide (eg, malathion, parathion, tetraethylpyrophosphate [TEPP], diisopropyl fluorophosphate [DFP]) poisonings as the dosages of these compounds are increased and more toxic materials are developed to overcome the resistance now appearing in many species of insects. A review of the literature on fatalities resulting from these anticholinesterase compounds reveals several important facts. The death of the majority of patients who were attended by medical personnel was the result of lack of proper diagnosis, improper or ineffective method of resuscitation, use of improper or, if correct, inadequate therapy—too littleandtoo late. The following is intended to give the physician

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