emDOCS / ToxCard - June 7, 2023 - By Daniel Escobar; Ann-Jeannette Geib
Reviewed by: James Dazhe Cao; Alex Koyfman; Brit Long
Clinical Pearls:
- Exposure can occur via ingestion, dermal absorption, or inhalation from spraying.
- There are two clinical syndromes with acute toxicity, Acute Poisoning and Intermediate Syndrome, that lead to cholinergic crisis, muscle weakness, respiratory failure, and neurologic complications.
- Diagnosis is made clinically. Do not delay therapy in lieu of pending lab results.
- Treatment mainstay is antidote therapy with Atropine (for control of pulmonary secretions and cardiopulmonary stability) and Pralidoxime (to prevent Aging process) and should be administered immediately. Otherwise, provide supportive care.
- Titrate atropine therapy to pulmonary secretions/bronchospasm, not to the other cholinergic findings.