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Organophosphate (OP) compounds, developed during World War II, are a group of chemicals used as pesticides, insecticides and herbicides. As irreversible inhibitors of the enzyme acetylcholinesterase (AChE), they reduce anti-cholinesterase activity and therefore increase acetylcholine (ACh) levels at the neuromuscular junction (NMJ). Diazinon, the OP leading to the patient's symptoms in this report, is an amber-brown liquid that was once the most widely used insecticide in the United States of America. The patient inhaled diazinon and experienced a mixture of muscarinic and nicotinic receptor symptoms ranging from acute cholinergic syndrome to mild delayed intermediate syndrome. The patient was intubated, managed in the intensive care unit (ICU) with level 3 care, and made a full recovery. The report focuses on evolving toxicology advice and the adjustment of muscle relaxant dosing for intubation.
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Griffiths et al. (2024) studied this question.
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