Organophosphorus
insecticide self-
poisoning is a major global health problem, killing over 100,000 people annually. It is a complex multi-organ condition, involving the inhibition of
cholinesterases, and perhaps other
enzymes, and the effects of large doses of ingested
solvents. Variability between organophosphorus
insecticides-in lipophilicity, speed of activation, speed and potency of
acetylcholinesterase inhibition, and in the chemical groups attached to the
phosphorus-results in variable speed of
poisoning onset, severity, clinical toxidrome, and case fatality. Current treatment is modestly effective, aiming only to reactivate
acetylcholinesterase and counter the effects of excess
acetylcholine at
muscarinic receptors. Rapid titration of
atropine during
resuscitation is lifesaving and can be performed in the absence of
oxygen. The role of
oximes in
therapy remains unclear. Novel antidotes have been tested in small trials, but the great variability in
poisoning makes interpretation of such trials difficult. More effort is required to test treatments in adequately powered studies.