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Organophosphate poisoning — RACP Paediatrics MCQ

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HardEmergencyOrganophosphate poisoningRACP Paediatrics

A 3-year-old exposed to organophosphate insecticide has bronchorrhoea, wheeze, bradycardia, miosis and fasciculations. After decontamination and airway support, how should atropine be titrated?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Escalate IV atropine until the chest clears, then commence an infusion

Explanation lettering: D = shown as A · A = shown as B · B = shown as C · E = shown as D · C = shown as E

D is correct because atropine is titrated rapidly to muscarinic endpoints—clearing bronchial secretions and wheeze with haemodynamic improvement—then maintained by infusion. E uses an unreliable peripheral endpoint. A may leave fatal bronchorrhoea untreated; tachycardia alone is not the endpoint. B delays lifesaving therapy for laboratory confirmation. C atropine does not reverse nicotinic weakness or fasciculations, and persistent airway secretions mean under-treatment.

Reference: Queensland Poisons Information Centre, Atropine: https://www.poisonsinfo.health.qld.gov.au/for-health-professionals/antidote-stocking-recommendations/atropine