Organophosphate Poisoning — RACP Adult Medicine MCQ

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ModerateEmergency MedicineOrganophosphate PoisoningRACP Adult Medicine

A 30-year-old man presents with miosis, excessive salivation, lacrimation, diarrhoea, and muscle fasciculations after occupational exposure to organophosphate insecticides. His respiratory rate is 8/min with copious bronchial secretions. What is the most important initial treatment?

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Correct answer: A — IV atropine titrated to dry secretions

Organophosphate poisoning causes a cholinergic crisis (SLUDGE: Salivation, Lacrimation, Urination, Diarrhoea, GI cramps, Emesis; plus miosis, bradycardia, bronchorrhoea, bronchospasm, and fasciculations). Atropine is the first-line treatment – given IV in escalating doses (starting 1.2–3 mg, doubling every 5 minutes) titrated to drying of bronchial secretions (NOT to pupil size or heart rate). Pralidoxime (oxime – reactivates acetylcholinesterase) should also be commenced but does NOT replace atropine. Decontamination (remove clothing, wash skin) is critical.

Reference: eTG – 2025 – Toxicology