Organophosphate Intoxication: A Case Report of Acute Cholinergic Syndrome

Background: Organophosphate (OP) pesticides are widely used in agriculture and can cause acute cholinergic toxicity by inhibiting the enzyme acetylcholinesterase, leading to an accumulation of acetylcholine.Case presentation: A 45-year-old male plumber was admitted to the emergency department four hours after ingesting an unknown quantity of a 50% emulsifiable concentration of diazinon. He presented with sialorrhea, excessive tearing, emesis, and constricted pupils. Laboratory tests revealed a significant reduction in serum cholinesterase activity. A chest X-ray showed no signs of pulmonary edema or lung abnormalities.Treatment Strategy: The patient was found to be moderately dehydrated and was managed with intravenous normal saline (20 mL/kg) during the first four hours of treatment. He received 1,770 mg of pralidoxime over the first 12 hours, along with 9.44 mg of atropine in the first eight hours, followed by 84.96 mg of atropine over the next three days.Clinical Outcome: The patient's condition significantly improved after 48 hours of intensive treatment, with symptom resolution and normalization of cholinesterase levels. His neurological function progressively returned to normal, and he was discharged on day seven without any lasting complications, having made a full recovery.Conclusion: This case highlights the critical importance of prompt diagnosis and immediate treatment of organophosphate poisoning to prevent life-threatening outcomes. Continuous monitoring and appropriate supportive care are essential for ensuring a successful recovery.