: Organophosphate (OP) poisoning continues to be a significant global health problem, especially in developing and low-middle-income countries where these substances are used in agriculture to a great extent and are easily accessible without strict regulations. It is estimated that annually almost three million cases of pesticide intoxication occur worldwide which brings about 200,000 fatalities, with organophosphates being responsible for a large portion of the deaths 1, 2. In India, poisonings caused by organophosphates account for a large part of acute poisoning-related hospital admissions and deaths, particularly in rural areas where agricultural pesticides are often used for suicide 3, 4. The main, and really characteristic, toxic effect of organophosphates is the irreversible blockage of the acetylcholinesterase (AChE) enzyme, leading to the accumulation of acetylcholine at synapses and the over-excitation of the mentioned receptors 5,6. The poisoning’s clinical manifestation is the cholinergic crisis which is composed of a number of symptoms like extreme secretions, spasm of the airways, involuntary muscle contraction, convulsions, and finally death by asphyxia. Although acute toxicity is the primary concern, other complications are also there like the intermediate syndrome and organophosphate-induced delayed polyneuropathy which not only add to the patients’ suffering but also increase the hospital stay 7,8. Organophosphate poisoning management entails the early detection, aggressive supportive care, rapid introduction of atropine and oxime therapy, and heavy care support in critical cases 1,9. New therapeutic interventions like magnesium sulphate therapy, discovery of new oximes, bioscavenger therapies, and protocoled ICU management have been seen to enhance patient outcomes 10,12. This review presents a thorough and recent account of the toxicological mechanisms, clinical symptoms, diagnosis, management practices, and new treatment approaches in organophosphate poisoning, particularly pointed out the importance to the developing countries.
Waghmare et al. (Thu,) studied this question.